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Intimayta-Escalante C. Ethnic inequalities in coverage and use of women's cancer screening in Peru. BMC Womens Health 2024; 24:418. [PMID: 39048988 DOI: 10.1186/s12905-024-03225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE This study aimed to assess ethnic inequalities in the coverage and utilization of cancer screening services among women in Peru. METHODS Data from the 2017-2023 Demographic and Family Health Survey in Peru were analyzed to evaluate ethnic disparities in screening coverage for breast and cervical cancer, including clinical breast examination (CBE), Pap smear test (PST), and mammography. Measures such as the GINI coefficient and Slope Index of Inequality (SII) were used to quantify coverage and utilization disparities among ethnic groups. RESULTS The study included 70,454 women aged 30-69. Among women aged 40-69, 48.31% underwent CBE, 84.06% received PST, and 41.69% underwent mammography. It was found inequalities in coverage for any cancer screening (GINI: 0.10), mammography (GINI: 0.21), CBE (GINI: 0.19), and PST (GINI: 0.06), in 25 Peruvian regions. These inequalities were more pronounced in regions with larger populations of Quechua, Aymara, and Afro-Peruvian women. In rural areas, Quechua or Aymara women (SII: -0.83, -0.95, and - 0.69, respectively) and Afro-Peruvian women (SII: -0.80, -0.92, and - 0.58, respectively) experienced heightened inequalities in the uptake of CBE, mammography, and PST, respectively. Like Quechua or Aymara women (SII: -0.50, SII: -0.52, and SII: -0.50, respectively) and Afro-Peruvian women (SII: -0.50, SII: -0.58, and SII: -0.44, respectively) with only a primary education. CONCLUSION Ethnic inequalities affect breast and cervical cancer screening coverage across regions in Peru. In Quechua, Aymara, and Afro-Peruvian women the uptake of mammography, CBE, and PST was less frequently than their white or mestizo counterparts. These inequalities are attributed to sociodemographic conditions such as lower education levels and residence in rural or non-capital areas.
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Affiliation(s)
- Claudio Intimayta-Escalante
- Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru.
- Departamento de Promoción de la Salud, Prevención y Control Nacional del Cáncer, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru.
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Gebreegziabher ZA, Semagn BE, Kifelew Y, Abebaw WA, Tilahun WM. Cervical cancer screening and its associated factors among women of reproductive age in Kenya: further analysis of Kenyan demographic and health survey 2022. BMC Public Health 2024; 24:741. [PMID: 38459446 PMCID: PMC10921781 DOI: 10.1186/s12889-024-18148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/19/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Although cervical cancer screening is one of the most effective strategies to reduce the incidence and mortality of cervical cancer, the percentage of cervical cancer screening in low- and middle-income counties is low. In Kenya, the current nationwide prevalence and associated factors for the detection of cervical cancer is unknown. Therefore, this study aimed to assess the prevalence and associated factors for the detection of cervical cancer screening among women of reproductive age in Kenya using the Kenyan Demographic and Health Survey 2022. METHODS This study used the most recent Kenyan Demographic and Health Survey data (2022) with a total weighted sample of 16,901 women. A mixed effects logistic regression analysis was performed and in the multivariable analysis, variables with a p-value below 0.05 were considered statistically significant. The strength of the association was evaluated using adjusted odds ratios along with their corresponding 95% confidence intervals. RESULTS The prevalence of cervical cancer screening in Kenya was 16.81%(95% CI: 16.24, 17.38%). Having a history of abortion (AOR = 1.33, 95% CI: 1.171.50, 1.43), using modern contraceptive methods (AOR = 1.57, 95% CI: 1.25, 1.95), media exposure (AOR = 1.31, 95%CI: 1.03, 1.65), primary education (AOR = 1.56, 95%CI: 1.09, 2.22), secondary education (AOR = 21.99, 95% CI: 1.1.38, 2.87), higher education (AOR = 2..50, 95% CI: 1.71, 3.65), visiting health facility within the past 12 months (AOR = 1.61, 95%CI: 1.46, 1.79), positive HIV status (AOR: 3.50, 95% CI: 2.69, 4.57), being from a community with a higher proportion of educated individuals (AOR = 1.37, 95%CI: 1.13, 1.65) and being from a community with high proportion of poor individuals (AOR = 0.72, 9 5%CI: 0.60-0.87)) were significantly associated with cervical cancer screening. CONCLUSION In Kenya, the prevalence of cervical cancer screening was found to be low. A history of abortion, use of modern contraceptives, exposure to the media, visits to health facilities in the past 12 months, HIV status, level of education, community educational level, and community wealth were identified as significant associated factors for cervical cancer screening. Therefore, it is recommended to implement targeted public health interventions that focus on these identified factors to improve the adoption of cervical cancer screening in Kenya.
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Affiliation(s)
- Zenebe Abebe Gebreegziabher
- Department of Epidemiology and Biostatistics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Birhan Ewunu Semagn
- Department of Public Health, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yitagesu Kifelew
- Department of Statistics, College of Natural and Computational Science, Oda Bultum University, Chiro, Ethiopia
| | - Wondwosen Abey Abebaw
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Riano I, Contreras-Chavez P, Pabon CM, Meza K, Kiel L, Bejarano S, Florez N. An Overview of Cervical Cancer Prevention and Control in Latin America and the Caribbean Countries. Hematol Oncol Clin North Am 2024; 38:13-33. [PMID: 37330343 DOI: 10.1016/j.hoc.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Cervical cancer is a health crisis affecting women and their families across the world. It is known that developed countries have comprehensive protocols with recommendations regarding workforce, expertise, and medical resources to address this common cancer among women. In contrast, disparities in addressing cervical cancer remain present in Latin America and Caribbean countries. Here, we reviewed the current strategies of cervical cancer prevention and control in the region.
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Affiliation(s)
- Ivy Riano
- Division of Hematology and Oncology, Dartmouth Cancer Center, Geisel School of Medicine Dartmouth, One Medical Drive, Lebanon, NH 03766, USA.
| | - Pamela Contreras-Chavez
- Division of Hematology and Oncology, Dana Farber Cancer Institute, St. Elizabeth's Medical Center, 736 Cambridge Street, Brighton, MA 02135, USA. https://twitter.com/PamChMD
| | - Cindy Medina Pabon
- Division of Hematology and Oncology, The University of Texas MD Anderson Cancer Center, Unit 0463, 1515 Holcombe Boulevard, FC11.3055, Houston, TX 77030, USA. https://twitter.com/cmpabon
| | - Kelly Meza
- Division of Internal Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. https://twitter.com/KellyMezaMD
| | - Lauren Kiel
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA
| | - Suyapa Bejarano
- Department of Radiation Oncology, Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Narjust Florez
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA. https://twitter.com/NarjustFlorezMD
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Cetina-Pérez L, Luvián-Morales J, Delgadillo-González M, Castro-Eguiluz D, Galicia-Carmona T, Rely K, Vaca González R, Lugo-Martínez G, García-Barrientos N, Nateras A. Sociodemographic characteristics and their association with survival in women with cervical cancer. BMC Cancer 2024; 24:161. [PMID: 38302893 PMCID: PMC10832171 DOI: 10.1186/s12885-024-11909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND In 2020, the highest incidence and mortality from cervical cancer (CC) were detected in low and middle-income countries. CC remains a health problem for women living in them. In Mexico, CC ranks second in cancer incidence and mortality in women. The main characteristics of this population are low income, low educational level, and inadequate medical coverage. The present study characterized the Mexican population by CC, and the sociodemographic variables that impacted overall survival (OS) were identified. METHODS A retrospective study that included a cohort of patients with a confirmed diagnosis of CC at the Instituto Nacional de Cancerologia between 2003 and 2016. Information was collected on sociodemographic variables related to the disease and OS. RESULTS Four thousand six hundred thirty-one patients were included. The median age was 51 years, 78.5% were unemployed, 44.4% lived in a rural/suburban area, 50.8% had a partner when collecting this information, and 74.3% were classified as having low socioeconomic status. Age, living in a rural/suburban area, more advanced stages of the disease, and not receiving cancer treatment were associated with lower OS. CONCLUSION CC continues to affect mainly women with minimal resources, low educational levels, and living in marginalized areas. These characteristics influence the OS. Prevention and timely detection programs, education, and training focused on this population and with broader coverage are required to identify patients with CC at earlier stages.
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Affiliation(s)
- Lucely Cetina-Pérez
- Department of Clinical Research, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Sección XVI, 14080, Mexico City, Tlalpan, Mexico.
| | | | | | - Denisse Castro-Eguiluz
- Department of Clinical Research, Investigador por México, Consejo Nacional de Humanidades, Ciencia y Tecnología (CONAHCyT, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Kely Rely
- International Healthcare Consultant - CEAHealth Tech, Mexico City, Mexico
| | - Rita Vaca González
- Department of Social Work, Instituto Nacional de Cancerología, Mexico City, Mexico
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Vukomanovic IS, Kocic S, Vukomanovic V, Janicijevic K, Šorak M, Simic V, Djukic S, Djordjevic S, Radevic S. Assessment of Sexual Health and Use of Cervical Cancer Screening among the Female Working Population. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:198-207. [PMID: 38694863 PMCID: PMC11058389 DOI: 10.18502/ijph.v53i1.14696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/09/2023] [Indexed: 05/04/2024]
Abstract
Background Cervical cancer occupies a significant place in the overall structure of morbidity and mortality in developing countries. We focused on the sexual health and use of cervical cancer screening among the female working population of reproductive age in Central Serbia. Methods The research was conducted as a cross-sectional study, according to the methodology Stepwise approach to noncommunicable disease risk factor surveillance WHO. The study population consisted of 1182 female working population aged 18-49 years, living on the territory of Central Serbia. The method of simple random sampling was utilized in the research itself. An anonymous standardized questionnaire was used as a research tool. Results During the first sexual intercourse, 38.9% of the participants reported not having used any of the contraceptives, whereas 74.5% of the participants reported not having used them during their last sexual intercourse and 26.1% of the respondents reported not having had a single Pap smear in their lifetime. The multivariate logistic regression analysis singled out the following factors in women who reported not having done a Pap smear in their lifetime as the most significant ones: age - the youngest age group (OR = 3.30, CI = 1.80-6.04), unemployment (OR = 2.87, CI = 0.07-3.40), women who had never been married or had never been in a common-law marriage (OR = 2.55, CI = 1.40-4.66) and individuals with a medium education level (OR = 2.63, CI = 1.67-4.14). Conclusion In Serbia, all the activities should be directed towards increasing the levels of awareness and knowledge on sexual health and cervical cancer screening services.
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Affiliation(s)
- Ivana Simic Vukomanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Institute of Public Health Kragujevac, Kragujevac, Serbia
| | - Sanja Kocic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Institute of Public Health Kragujevac, Kragujevac, Serbia
| | - Vladimir Vukomanovic
- Department of Nuclear Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Katarina Janicijevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marija Šorak
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vera Simic
- Department of Nursing, Secondary Medical School “Beograd”, Belgrade, Serbia
| | - Svetlana Djukic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Slavica Djordjevic
- Department of the High School of Health, Academy of Vocational Studies, Belgrade, Serbia
| | - Svetlana Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Institute of Public Health Kragujevac, Kragujevac, Serbia
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Galindo JF, Formigari GM, Zeferino LC, Carvalho CF, Ursini EL, Vale DB. Social determinants influencing cervical cancer diagnosis: an ecological study. Int J Equity Health 2023; 22:102. [PMID: 37231421 DOI: 10.1186/s12939-023-01912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 05/07/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Barriers to accessing health care result in advanced cervical cancer. In Sao Paulo, Brazil, the Index of Social Responsibility (ISR) synthesizes the situation of each town concerning wealth, education, and longevity. This study aimed to evaluate in 645 municipalities the relation of the ISR with stage, age, and morphology in cervical cancer diagnosis. METHODS An ecological study that used data from Sao Paulo, Brazil, from 2010 to 2017. The ISR was identified through government platforms and data on cancer through the Hospital Cancer Registry. The subjects were the 9,095 women aged 30 years or older. The ISR summarizes municipalities into five levels: dynamic (ISR5), unequal (ISR4), equitable (ISR3), in transition (ISR2), and vulnerable (ISR1). It was used the chi2 tests and logistic regression. RESULTS The proportion of stage 1 increased significantly with ISR level, ranging from 24.9% in ISR1 to 30.0% in ISR5 (p = 0.040). To every increase in ISR level, the chance of a woman being diagnosed in stage I was at least 30% higher. Woman living where ISR2 had a 1.4 times higher chance of being diagnosed in stage 1 than those living in ISR1 (OR 1.40, 95% CI 1.07-1.84). Squamous tumors frequency decreased when ISR level increased (p = 0.117). A higher proportion of women under 50 years were observed when they lived in wealthier cities (ISR4 and ISR5) (42.2% vs. 44.6%, p = 0.016). CONCLUSION The ISR was a good health indicator for understanding and predicting the social determinants in cervical cancer diagnosis. The proportion of stage I increased significantly in more favorable social conditions.
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Affiliation(s)
- Juan Fernando Galindo
- School of Technology, University of Campinas, Rua Paschoal Marmo 1888, Limeira, 13484-332, Brazil
| | - Giovana Moura Formigari
- Gynecology and Obstetrics Department, University of Campinas, Rua Vital Brazil 80, Campinas, 13083-888, Brazil
| | - Luiz Carlos Zeferino
- Gynecology and Obstetrics Department, University of Campinas, Rua Vital Brazil 80, Campinas, 13083-888, Brazil
| | - Carla Fabrine Carvalho
- Gynecology and Obstetrics Department, University of Campinas, Rua Vital Brazil 80, Campinas, 13083-888, Brazil
| | - Edson Luiz Ursini
- School of Technology, University of Campinas, Rua Paschoal Marmo 1888, Limeira, 13484-332, Brazil
| | - Diama Bhadra Vale
- Gynecology and Obstetrics Department, University of Campinas, Rua Vital Brazil 80, Campinas, 13083-888, Brazil.
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Mohamed ZK, Amare YW, Getahun MS, Negussie YM, Gurara AM. Cervical Cancer Screening Service Utilization and Associated Factors Among Women Living With HIV Receiving Anti-Retroviral Therapy at Adama Hospital Medical College, Ethiopia. SAGE Open Nurs 2023; 9:23779608231152072. [PMID: 36726790 PMCID: PMC9885028 DOI: 10.1177/23779608231152072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Cervical cancer is the second highest cause of cancer-related mortality in the world, and it is one of the top 20 causes of mortality in Ethiopia. Even though cervical cancer is more common among women living with HIV, the utilization of cervical cancer screening services remains low in Ethiopia. Objectives This study aimed to assess cervical cancer screening service utilization and associated factors among women living with HIV receiving anti-retroviral therapy at Adama Hospital Medical College, Ethiopia. Methods An institution-based cross-sectional study was conducted among a sample of 304 women living with HIV from 1st-30th June 2022. Data were collected using an interviewer-administered questionnaire. The data were entered into Epi info version 7 and exported to SPSS version 25 for analysis. Bi-variable logistic regression analysis was used to identify candidate variables at p < .25. Finally, multivariable logistic regression analysis was used to identify the independent predictors of cervical cancer screening service utilization at p < .05 with 95% confidence intervals. Results The magnitude of cervical cancer screening service utilization was 26.9% (95% CI: 22.0, 32.6). Being a government employee (AOR: 8.09, 95% CI: 1.5, 41.19), having a family history of cervical cancer (AOR: 3.4, 95% CI: 1.02, 11.9), being aware of cervical cancer screening (AOR: 3.75, 95% CI: 2.11, 14.7), having a history of sexually transmitted infection (AOR: 3.14, 95% CI: 1.95, 10.2), and heard about cervical cancer (AOR: 2.6, 95% CI: 1.05, 6.41) were associated with cervical cancer screening service utilization. Conclusion The magnitude of cervical cancer screening service utilization was low. It was associated with occupation status, family history of cervical cancer, awareness about cervical cancer screening, history of STI, and ever heard about cervical cancer. Thus, to maximize utilization, health education programs and other multidisciplinary strategies had to be implemented.
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Affiliation(s)
| | | | - Mihiret Shawel Getahun
- Department of Nursing, Adama General Hospital and Medical
College, Adama, Ethiopia,Mihiret Shawel Getahun, Department of
Nursing, Adama General Hospital and Medical College, Adama, Ethiopia.
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Alie MS, Negesse Y, Ayenew M. Determinants of Cervical Cancer Screening Among Women Aged 30-49 Years Old in Four African Countries: A Cross-Sectional Secondary Data Analysis. Cancer Control 2023; 30:10732748231195681. [PMID: 37656980 PMCID: PMC10475266 DOI: 10.1177/10732748231195681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Early-stage cervical cancer screening is essential for providing women with a better chance of receiving effective treatment for precancerous and cancer stages. Delay in cervical cancer screening results in late presentation and cancer metastasis. National-level cervical cancer screening in resource-limited countries was scarce and not well studied in Africa based on national data specifically in Kenya, Cameroon, Nambia, and Zimbabwe. OBJECTIVE To determine the prevalence and determinants of cervical cancer screening among eligible women in Kenya, Cameroon, Nambia, and Zimbabwe. METHODS This study analyzed demographic and health survey data from Kenya, Cameroon, Nambia, and Zimbabwe. The data were extracted and analyzed by STATA version 15 and further analysis was done. Intraclass correlation coefficient, median odds ratio, and proportional change in variance were calculated to check the appropriateness of multilevel analysis. Variables with P-value < .25 were selected for multivariable multilevel logistic regression analysis. Finally, statistical significance between dependent and independent variables was assessed by odds ratios and 95% confidence intervals. RESULTS The prevalence of cervical cancer screening in 4 African countries (Nambia, Kenya, Cameroon, and Zimbabwe) was 23.4 [95%CI: 22.8-24.1]. The determinants identified in this study were women of age 41-50 years [AOR = 1.47; 95% CI 1.24, 1.73], rural residence [AOR = .67; 95% CI .55, .81], women who have their own work [AOR = 1.1; 95% CI 1.0, 1.37], smoking status [AOR = 1.89; 95% CI 1.17, 3.0], age at first birth >=35 [AOR = 5.27; 95% CI 1.29-21.52], condom use [AOR = 1.79; 95% CI 1.46,2.19], husbands having worked [AOR = 1.5; 95% CI 1.08,2.11], rich household wealth [AOR = 1.43; 95% CI 1.13,1.8], and having health insurance [AOR = 2.2; 95% CI 1.8,2.7]. CONCLUSION The prevalence of cervical cancer screening in Kenya, Cameroon, Nambia, and Zimbabwe was low as compared to World Health Organization (WHO) recommendations. Age, residence, work status, smoking status, women's age at first birth, condom use, husbands having work, wealth status, and health insurance were the identified determinants of cervical cancer screening. Programme and policy interventions could address younger, rural residence women, poor wealth status women, women without work, and those who never use health insurance for the uptake of cervical cancer screening.
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Affiliation(s)
- Melsew Setegn Alie
- Department of Public health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Yilkal Negesse
- Department Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Gojjam, Ethiopia
| | - Mengistu Ayenew
- Department of Public health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Vega Crespo B, Neira VA, Ortíz Segarra J, Andrade A, Guerra G, Ortiz S, Flores A, Mora L, Verhoeven V, Gama A, Dias S, Verberckmoes B, Vermandere H, Michelsen K, Degomme O. Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals. BMC Public Health 2022; 22:2144. [DOI: 10.1186/s12889-022-14601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer.
Methodology
A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data.
Results
Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient–physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women’s empowerment.
Conclusions
The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.
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Tawiah A, Konney TO, Dassah ET, Visser LE, Amo-Antwi K, Appiah-Kubi A, Bell SG, Johnston C, Lawrence ER. Determinants of cervical cancer screening uptake among women with access to free screening: A community-based study in peri-urban Ghana. Int J Gynaecol Obstet 2022; 159:513-521. [PMID: 35212393 DOI: 10.1002/ijgo.14158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/20/2022] [Accepted: 02/21/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Cervical cancer can be prevented by regular screening; however, screening rates are low in developing countries. We evaluated the proportion of women screened, modalities of screening utilized, and factors influencing uptake among Ghanaian women with access to free screening services. METHODS Participants were women aged 25-65 in Asokore-Mampong, Ghana. A structured questionnaire collected socio-demographic characteristics, risk factors, knowledge of, and utilization of cervical cancer screening. Adjusted logistic regression evaluated predictors of screening. RESULTS Of 710 participants, the majority had heard of cervical cancer (64.6%) and screening (57.7%). Screening utilization was 24.6%. Visual inspection with acetic acid was the most common screening method (97.1%). For those who had never been screened, common reasons were believing they were healthy (21.7%), fearing pain (12.9%), lacking awareness of screening (11.8%), and being too busy (11.6%). Participants who were aged 35-44 (aOR 1.82; 95% CI 1.09-3.03; p = 0.023), married (aOR 3.98; 95% CI 1.68-9.40; p = 0.002), formally employed (aOR 9.31; 95% CI 2.86-30.35; p <0.001), and had higher cervical cancer knowledge (aOR 3.98; 95% CI 2.64-6.02; p <0.001) were more likely to have been screened. CONCLUSION Despite geographic proximity to a health center that provides free cervical cancer screening, screening uptake among Ghanaian women remains low.
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Affiliation(s)
- Augustine Tawiah
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Obstetrics and Gynecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas O Konney
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Obstetrics and Gynecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward T Dassah
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kwabena Amo-Antwi
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Obstetrics and Gynecology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adu Appiah-Kubi
- Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sarah G Bell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn Johnston
- Division of Gynecologic Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emma R Lawrence
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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11
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Liebermann E, Van Devanter N, Frías Gúzman N, Hammer MJ, Ompad D. Dominican Provider Attitudes Towards HPV Testing for Cervical Cancer Screening and, Current Challenges to Cervical Cancer Prevention in the Dominican Republic: a Mixed Methods Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1170-1185. [PMID: 32307667 PMCID: PMC7572473 DOI: 10.1007/s13187-020-01746-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Creating effective programs for cervical cancer prevention is essential to avoid premature deaths from cervical cancer. The Dominican Republic has persistently high rates of cervical cancer, despite the availability of Pap smear screening. This study explored Dominican provider attitudes towards human papillomavirus (HPV) testing and current challenges to effective cervical cancer prevention. In this Consolidated Framework for Implementation Research (CFIR)-driven mixed methods study, we conducted in-depth interviews (N = 21) and surveys (N = 202) with Dominican providers in Santo Domingo and Monte Plata provinces regarding their perspectives on barriers to cervical cancer prevention and their knowledge and attitudes towards HPV testing as an alternative to Pap smear. Providers believed the main barrier to cervical cancer prevention was lack of cervical cancer awareness and resulting inadequate population screening coverage. Providers felt that Pap smear was widely available to women in the Dominican Republic and were unsure how a change to HPV testing for screening would address gaps in current cervical cancer screening programs. A subset of providers felt HPV testing offered important advantages for early detection of cervical cancer and were in favor of more widespread use. Cost of the HPV test and target age for screening with HPV testing were the main barriers to acceptability. Providers had limited knowledge of HPV testing as a screening test. The group was divided in terms of the potential impact of a change in screening test in addressing barriers to cervical cancer prevention in the Dominican Republic. Findings may inform interventions to disseminate global evidence-based recommendations for cervical cancer screening.
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Affiliation(s)
- Erica Liebermann
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Nancy Van Devanter
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Natalia Frías Gúzman
- Instituto Nacional de Cáncer Rosa Emilia Sánchez Pérez de Tavares (INCART), Avenida Correa y Cidrón, 10103, Santo Domingo, Dominican Republic
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA, 02215, USA
| | - Danielle Ompad
- New York University College of Global Public Health, 715 Broadway, Rm 1011, New York, NY, 10003, USA
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12
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Nuche-Berenguer B, Sakellariou D. Socioeconomic Determinants of Participation in Cancer Screening in Argentina: A Cross-Sectional Study. Front Public Health 2021; 9:699108. [PMID: 34504827 PMCID: PMC8423085 DOI: 10.3389/fpubh.2021.699108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Low socioeconomic status is associated with late cancer diagnosis and mortality in Argentina. It is important that cancer screening services are accessible to the whole population so that cancer can be detected early. Our aim in this study was to investigate socioeconomic determinants for the disparities in the use of breast, cervical, and colorectal cancer screening services in Argentina, and to measure the country progress in reducing differences in cancer screening participation across socioeconomic levels. We performed a secondary analysis of cross-sectional data from the 2018 National Survey of Risk Factors of Argentina. The sample included data from 49,170 households. We also compared the results with data from the 2013 wave of the same survey in order to assess progress on cancer screening participation across income and education categories. Income, education, health insurance, disability, and marital status were associated with cancer screening underuse in Argentina. Comparison between 2013 and 2018 demonstrated that there has been some progress toward increasing cancer screening uptake, but this increase is not equitably distributed across the population. To further reduce disparities in cancer participation across socioeconomic levels, cancer screening programs in Argentina should reinforce strategies to become more accessible. It is important to proactively reach those populations that are underusers of cancer screening and ensure that barriers that stop people from accessing cancer screening are explored and adequately addressed.
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13
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Bassette E, Mabachi N, Kennedy M, Mendez-Puac F. Perceptions of Cervical Cancer Screening in Rural Guatemala. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:156-163. [PMID: 34467792 DOI: 10.1177/15404153211024114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cervical cancer (CC) is the second most common cause of cancer-related mortality in the developing world. Globally, the incidence of CC is 13.1 per 100,000, with the highest incidence of CC seen in sub-Saharan Africa, Melanesia, Latin America and the Caribbean, Southcentral Asia, and Southeast Asia. Little data exist regarding perceptions of screening in Guatemala and how this may affect the likelihood that women seek care. This study aimed to assess the attitudes, perceptions, and beliefs of CC screening in women of Rural Guatemala. A cross-sectional mixed method analysis was administered using a survey given to 169 women in San Pedro La Laguna in Sololá, Guatemala. Results showed that none of the indigenous-language-speaking patients and only half of the bilingual patients had knowledge of human papillomavirus; 97% of women indicated that they believed regular Pap smears are important; only 46.4% of women screened had received a Pap smear at some point in their lives, which is slightly above the national average (39.3%). This is due to barriers to access, cost of treatment, and knowledge of CC. Results of this study display a positive perception of CC screening by indigenous women, indicating that efforts should be made to move toward the implementation of low-cost CC screening methods.
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Affiliation(s)
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas School of Medicine, KS, USA
| | - Michael Kennedy
- Department of Family Medicine, University of Kansas School of Medicine, KS, USA
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Pengpid S, Zhang C, Peltzer K. The Prevalence and Associated Factors of Cancer Screening Uptake Among a National Population-Based Sample of Adults in Marshall Islands. Cancer Control 2021; 28:1073274821997497. [PMID: 33890501 PMCID: PMC8204481 DOI: 10.1177/1073274821997497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The study aimed to estimate the prevalence and associated factors of cancer screening among men and women in the general population in Marshall Islands. Methods: The national cross-sectional sub-study population consisted of 2,813 persons aged 21-75 years (Median = 37.4 years) from the “2017/2018 Marshall Islands STEPS survey”. Information about cancer screening uptake included Pap smear or Vaginal Inspection with Acetic Acid (=VIA), clinical breast examination, mammography, faecal occult blood test (FOBT), and colonoscopy. Results: The prevalence of past 2 years mammography screening was 21.7% among women aged 50-74 years, past year CBE 15.9% among women aged 40 years and older, past 3 years Pap smear or VIA 32.6% among women 21-65 years, past year FOBT 21.8% among women and 22.3% among men aged 50-75 years, and past 10 years colonoscopy 9.1% among women and 7.3% among men aged 50-75 years. In adjusted logistic regression, cholesterol screening (AOR: 1.91, 95% CI: 1.07-3.41) was associated with past 2 years mammography screening among women aged 50-74 years. Blood pressure screening (AOR: 2.39, 95% CI: 1.71-3.35), glucose screening (AOR: 1.59, 95% CI: 1.13-2.23), dental visit in the past year (AOR: 1.51, 95% CI: 1.17, 1.96), binge drinking (AOR: 1.88, 95% CI: 1.07-3.30), and 2-3 servings of fruit and vegetable consumption a day (AOR: 1.42, 95% CI: 1.03-1.95) were positively and high physical activity (30 days a month) (AOR: 0.56, 95% CI: 0.41-0.76) was negatively associated with Pap smear or VIA screening among women aged 21-65 years. Higher education (AOR: 2.58, 95% CI: 1.02-6.58), and cholesterol screening (AOR: 2.87, 95% CI: 1.48-5.59), were positively and current smoking (AOR: 0.09, 95% CI: 0.01-0.65) was negatively associated with past 10 years colonoscopy uptake among 50-75 year-olds. Conclusion: The study showed a low cancer screening uptake, and several factors were identified that can assist in promoting cancer screening in Marshall Islands.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, 26685Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Chao Zhang
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa.,Department of Bone and Soft Tissue Tumors, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Karl Peltzer
- Department of Psychology, 37702University of the Free State, Bloemfontein, South Africa
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15
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Reproductive Health and Risk Factors of Non-Comunicable Disease in Female Student Population (Stepwise Approach). SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2020-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
University students are a specific adolescent population which is preparing to take participation in different domains of a society as its integral and creative part. Chronic noncommunicable diseases have a major impact on women’s reproductive health, so their adverse epidemiological situation has significant effects on reproductive health in general. Since non-communicable chronic diseases have been a growing burden on reproductive health, the aim of this paper is asses of reproductive behavior and risk factors of non-communicable disease in female student population on Faculty of Medical Sciences University of Kragujevac. This study was conducted as a prospective cross-sectional study. The sample includes 59 female students of The Faculty of Medical Sciences, University of Kragujevac. The study was conducted in three stages based on the methodology and instruments recommended by STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance of the World Health Organization (STEPS). About 71.2 % of the participants reported that they had a sexual intercourse. In average, the respondents were 18 years old (SD±1.222) at the time of their first sexual intercourse. At that point, a little less than one third of them did not use any type of protection (31.7%). During the last sexual intercourse, about 65.5% did not use protection. About 22.5% of our subjects have morning glycemia with prediabetes values (glycemia cut off ≥ 5.5mmol/L). Hypercholesterolemia is present in 3.4% of the respondents (cut off ≥ 5,2mmol/l). Most respondents are eutrophic (18.8% preobese and 2.1% obese). The android obesity type is the least frequent (about 10%). This results indicates that female students has unhealthy habits in terms of their reproductive health and preventive measures. This activity indicaty a wide array of preventive action which will aim at preserving reproductive health and health in general.
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Paolino M, Gago J, Pera AL, Cinto O, Thouyaret L, Arrossi S. Adherence to triage among women with HPV-positive self-collection: a study in a middle-low income population in Argentina. Ecancermedicalscience 2020; 14:1138. [PMID: 33281930 PMCID: PMC7685770 DOI: 10.3332/ecancer.2020.1138] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Screening for cervical cancer (CC) prevention has substantially changed with the introduction of human papillomavirus (HPV) tests. This technology compared to cytology has increased the detection of pre-malignant and malignant cervical lesions in real-world programmes in different settings. Very importantly, through self-collection, HPV testing can reduce barriers to screening and increase coverage. However, when using HPV self-collection, triage tests are a key step in the CC prevention process, and high adherence to triage has been difficult to obtain in low-middle income settings. The aim of this study was to measure adherence to triage among women with HPV+ self-collection and analysed factors associated with this adherence in a middle-low resource setting in Argentina. We also evaluated key indicators related to the implementation of the HPV self-collection strategy. Methods We analysed data on screening/triage/diagnosis/treatment from women aged 30+ who performed self-collection between 2015 and 2017 (n = 15,763), in the public health system in Tucuman, Argentina. We analysed secondary data from the national screening information system. The primary outcomes were: 1) adherence to cytology triage within the recommended timeframe (120 days) and 2) overall adherence to cytology triage including data at 18 months after screening. Multivariable regression was used to examine the association between age group, year of the screening test, record of the previous Pap-based screening and health insurance status with adherence to triage test as a primary outcome. We reported odds ratios, 95% confidence intervals and p-value of 0.05, which was considered the threshold for p-values). Results We analysed data of 2,389 HPV+ women. The overall adherence to triage at 18 months was 42.9%. The percentage of women completing cytology triage within the recommended timeframe of 120 days was lower (25.2%). Women with the record of a previous Pap-based screening had 1.86 times the odds of having a triage compared to women without a record of a previous Pap-based screening (95% CI: 1.64–2.64, p <0.001). Furthermore, the probability of having triage at the recommended timeframe was higher among women who were older and women with public health insurance. Conclusions Our results showed that adherence to triage in the recommended timeframe was low. In addition, the probability of having triage at the recommended timeframe was higher among women with a record of a previous Pap-based screening, a proxy of the use of health services. Our results showed that adherence to triage in the context of the HPV-self-collection strategy is challenging. The implementation of alternative approaches that might facilitate adherence to triage should be further investigated.
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Affiliation(s)
- Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina.,https://orcid.org/0000-0002-8649-1570
| | - Juan Gago
- Department of Population Health, School of Medicine, New York University (NYU), 550 1st Avenue, New York, NY 10016, USA
| | - Anabella Le Pera
- Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina
| | - Oscar Cinto
- Ministerio de Salud Pública de Tucumán, Av. República del Líbano 956, San Miguel de Tucumán, Tucumán, Argentina.,Retired
| | - Laura Thouyaret
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Julio A, Roca 781, Piso 9, Buenos Aires 1067, Argentina
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires 1193, Argentina.,https://orcid.org/0000-0002-5071-0938
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17
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Quizhpe E, Sebastian MS, Teran E, Pulkki-Brännström AM. Socioeconomic inequalities in women's access to health care: has Ecuadorian health reform been successful? Int J Equity Health 2020; 19:178. [PMID: 33036631 PMCID: PMC7545545 DOI: 10.1186/s12939-020-01294-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/30/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women's health care access. METHODS The present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across three indicators: skilled birth attendance, cervical cancer screening, and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time. RESULTS Access to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a poorer education was observed for modern contraceptive use. CONCLUSIONS While most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities.
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Affiliation(s)
- Edy Quizhpe
- Colegio Ciencias de la Salud, Universidad San Francisco de Quito, USFQ, Quito, Ecuador.
- Department of Epidemiology and Global Health, Umeå University, Umea, Sweden.
| | | | - Enrique Teran
- Colegio Ciencias de la Salud, Universidad San Francisco de Quito, USFQ, Quito, Ecuador
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18
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Barrett BW, Paz-Soldan VA, Mendoza-Cervantes D, Sánchez GM, Córdova López JJ, Gravitt PE, Rositch AF. Understanding Geospatial Factors Associated With Cervical Cancer Screening Uptake in Amazonian Peruvian Women. JCO Glob Oncol 2020; 6:1237-1247. [PMID: 32755481 PMCID: PMC7456312 DOI: 10.1200/go.20.00096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Cervical cancer (CC) is the most common and second-most deadly cancer among Peruvian women. Access to services is strongly associated with CC screening uptake. This study investigated geospatial features contributing to utilization of screening. We used geolocated data and screening information from a Knowledge, Attitudes, and Practice (KAP) survey implemented in Iquitos, Peru in 2017. MATERIALS AND METHODS The KAP collected cross-sectional CC screening history from 619 female interviewees age 18-65 years within 5 communities of varying urbanization levels. We used spatial statistics to determine if screened households tended to cluster together or cluster around facilities offering screening in greater numbers than expected, given the underlying population density. RESULTS On the basis of K-functions, screened households displayed greater clustering among each other as compared with clustering among unscreened households. Neighborhood-level factors, such as outreach, communication, or socioeconomic condition, may be functioning to generate pockets of screened households. Cross K-functions showed that screened households are generally located closer to health facilities than unscreened households. The significance of facility access is apparent and demonstrates that travel and time barriers to seeking health services must be addressed. CONCLUSION This study highlights the importance of considering geospatial features when determining factors associated with CC screening uptake. Given the observed clustering of screened households, neighborhood-level dynamics should be further studied to understand how they may be influencing screening rates. In addition, results demonstrate that accessibility issues must be carefully considered when designing an effective cancer screening program that includes screening, follow-up, and treatment.
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Affiliation(s)
- Benjamin W Barrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Valerie A Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | | | - Graciela Meza Sánchez
- Facultad de Medicina Humana, Universidad Nacional de la Amazonia Peruana, Iquitos, Peru
| | | | - Patti E Gravitt
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Baezconde-Garbanati L, Agurto I, Gravitt PE, Luciani S, Murphy S, Ochoa C, Gallegos K, Barahona R, Rodríguez Y. Barriers and innovative interventions for early detection of cervical cancer. SALUD PUBLICA DE MEXICO 2020; 61:456-460. [PMID: 31430087 DOI: 10.21149/10425] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022] Open
Abstract
Cervical cancer has decreased significantly over the past 30 years in some countries. However, it remains among the leading causes of cancer deaths in low-income, and racial/ethnic minority women. Cervical cancer prevention technologies are not always available. Laboratories are often not well equipped to use them. HPV information has not been widely disseminated. WHO guidelines, and US and Latin American data provide context for strategies on effective interventions to reduce cervical cancer disparities. Systemic, personal and cultural barriers, combined with decision-making guidelines, and impactful messaging can accelerate reductions in cervical cancer health inequities in the Americas.
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Affiliation(s)
- Lourdes Baezconde-Garbanati
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Center for Health Equity in the Americas, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
| | - Irene Agurto
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Chile
| | - Patti E Gravitt
- Department of Global Health, George Washington University Milken Institute School of Public Health. Washington DC, USA
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization. Chile
| | - Sheila Murphy
- Annenberg School for Communication and Journalism, University of Southern California. Los Angeles, California, USA
| | - Carol Ochoa
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
| | - Katia Gallegos
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Instituto Mexicano de Seguro Social. Mexico City, Mexico
| | - Rosa Barahona
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Center for Health Equity in the Americas, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
| | - Yaneth Rodríguez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California. Los Angeles, California, USA.,Center for Health Equity in the Americas, Keck School of Medicine, University of Southern California. Los Angeles, California, USA
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20
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Gottschlich A, Ochoa P, Rivera-Andrade A, Alvarez CS, Mendoza Montano C, Camel C, Meza R. Barriers to cervical cancer screening in Guatemala: a quantitative analysis using data from the Guatemala Demographic and Health Surveys. Int J Public Health 2019; 65:217-226. [PMID: 31838575 PMCID: PMC7049547 DOI: 10.1007/s00038-019-01319-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/21/2019] [Accepted: 12/02/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Examine the association between commonly reported barriers to health care, including discordant spoken languages between patients and providers, and reported previous cervical cancer screening. METHODS Data from the nationally representative Guatemala National Maternal and Child Health Survey from the Demographic and Health Surveys Program were used to explore associations between barriers and screening rates nationwide and in high-risk populations, such as rural and indigenous communities. Negative binomial regressions were run accounting for survey sample weights to calculate prevalence ratios. RESULTS 64.0%, 57.5% and 47.5% of women reported ever screening, in the overall, indigenous, and rural populations, respectively. Overall, never screened for cervical cancer was associated with the following health barriers: needing permission, cost, distance, not wanting to go alone, and primary language not spoken by health providers, even after adjustment for age, ethnicity, and literacy. CONCLUSIONS Offering screening programs alone is not enough to reduce the burden of cervical cancer in Guatemala. Measures need to be taken to reduce barriers to health care, particularly in rural areas, where screening rates are lowest.
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Affiliation(s)
- Anna Gottschlich
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Alvaro Rivera-Andrade
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama-INCAP, Guatemala City, Guatemala
| | - Christian S Alvarez
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Carlos Mendoza Montano
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama-INCAP, Guatemala City, Guatemala
| | - Claudia Camel
- Guatemala Ministry of Health and Social Assistance (MSPAS), Guatemala City, Guatemala
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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21
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Nuche-Berenguer B, Sakellariou D. Socioeconomic determinants of cancer screening utilisation in Latin America: A systematic review. PLoS One 2019; 14:e0225667. [PMID: 31765426 PMCID: PMC6876872 DOI: 10.1371/journal.pone.0225667] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/08/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Cancer incidence and mortality in Latin America are rising. While effective cancer screening services, accessible to the whole population and enabling early cancer detection are needed, existing research shows the existence of disparities in screening uptake in the region. OBJECTIVE We conducted a systematic review to investigate the socioeconomic determinants for the disparities in the use of breast, cervical and colorectal cancer screening services in Latin America. METHODS We searched for studies reporting on socioeconomic determinants impacting on access to breast, cervical and colorectal cancer screening, published from 2009 through 2018. The studies that qualified for inclusion contained original analyses on utilisation of breast, cervical and colorectal cancer screening across socioeconomic levels in Latin America. For each study, paired reviewers performed a quality analysis followed by detailed review and data extraction. RESULTS Twenty-four articles that met the eligibility criteria and were of sufficient quality were included in this review. Thirteen of the included articles were written in English, eight in Portuguese and three in Spanish, and they reported on the use of breast or cervical cancer screening. No studies were found on the socioeconomic determinants regarding the utilisation of colorectal cancer screening in Latin America. Low income, low education level, lack of health insurance and single marital status were all found to be determinants of underuse of breast and cervical cancer screening services. CONCLUSIONS Cancer screening programs in the region must prioritize reaching those populations that underuse cancer screening services to ensure equitable access to preventive services. It is important to develop national screening programmes that are accessible to all (including uninsured people) through, for example, the use of mobile units for mammography and self-screening methods.
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Affiliation(s)
| | - Dikaios Sakellariou
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
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22
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Nevin PE, Blas M, Bayer A, Gutierrez MAC, Rao D, Molina Y. Positive cancer care in Peru: Patient and provider perspectives. Health Care Women Int 2019; 41:510-523. [PMID: 31090496 DOI: 10.1080/07399332.2019.1608206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Peruvian women experience high mortality from reproductive cancers, partially due to suboptimal cancer care utilization and experiences. In this qualitative study, we examined factors contributing to positive cancer care experiences. Our sample included 11 cancer patients and 27 cancer providers who attended the First International Cancer Symposium survivorship conference in Lima, Peru in 2015. We conducted thematic analysis. Emergent themes revealed that, for patients, individualized empathic care by providers was an important facilitator to positive cancer care experiences. For providers, the ability to provide such care depended on provider norms and facility infrastructure to support such patient-centered practices.
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Affiliation(s)
- Paul E Nevin
- University of Washington, Seattle, Washington, USA
| | - Magaly Blas
- University of Washington, Seattle, Washington, USA.,Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angela Bayer
- Univeristy of California Los Angeles, Los Angeles, California, USA
| | | | - Deepa Rao
- University of Washington, Seattle, Washington, USA
| | - Yamilé Molina
- University of Illinois at Chicago, Chicago, Illinois, USA
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Liebermann EJ, VanDevanter N, Shirazian T, Frías Gúzman N, Niles M, Healton C, Ompad D. Barriers to Cervical Cancer Screening and Treatment in the Dominican Republic: Perspectives of Focus Group Participants in the Santo Domingo Area. J Transcult Nurs 2019; 31:121-127. [DOI: 10.1177/1043659619846247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Cervical cancer is the second leading cause of cancer death among women in the Dominican Republic, and high rates persist despite existing Pap smear screening programs. The purpose of this study was to explore Dominican women’s knowledge and attitudes regarding human papillomavirus (HPV) and cervical cancer, cervical cancer screening practices, and perceived barriers and facilitators to early detection of cervical cancer. Method: Six focus groups ( N = 64) were conducted in Spanish in urban, suburban, and rural locations, in private and public school settings, community and workplace settings, in or near Santo Domingo, as part of a larger study on barriers and facilitators to HPV vaccine implementation. Audio recordings were transcribed verbatim and translated from Spanish to English. Qualitative data analysis used inductive and deductive approaches. Results: Knowledge regarding HPV and cervical cancer varied across groups, but all agreed there was significant stigma and fear regarding HPV. Most women reported having Pap screening at least yearly. Follow-up of abnormal Pap testing was less consistent, with cost and uncertainty about provider recommendations identified as barriers. Discussion: Broader examination of provider-level and health system barriers and facilitators to cervical cancer prevention in the Dominican Republic is essential, in order to inform interventions to improve the effectiveness of cervical cancer screening and treatment programs and reduce preventable deaths.
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Affiliation(s)
| | | | | | - Natalia Frías Gúzman
- Instituto Nacional de Cáncer Rosa Emilia Sánchez Pérez de Tavares, Santo Domingo, Dominican Republic
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Baptista AD, Simão CX, Santos VCGD, Melgaço JG, Cavalcanti SMB, Fonseca SC, Vitral CL. Knowledge of human papillomavirus and Pap test among Brazilian university students. Rev Assoc Med Bras (1992) 2019; 65:625-632. [DOI: 10.1590/1806-9282.65.5.625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/24/2018] [Indexed: 11/21/2022] Open
Abstract
SUMMARY OBJECTIVE: Human papillomavirus (HPV) is the most prevalent sexually transmitted virus in the world and is associated with an increased risk of cervical cancer. The most effective approach to cervical cancer control continues to be screening through the preventive Papanicolaou test (Pap test). This study analyzes the knowledge of university students of health science programs as well as undergraduate courses in other areas of knowledge on important questions regarding HPV. METHOD: Four hundred and seventy-three university students completed a questionnaire assessing their overall knowledge regarding HPV infection, cervical cancer, and the Pap test. A descriptive analysis is presented, and multivariate analysis using logistic regression identified factors associated with HPV/cervical cancer information. RESULTS: Knowledge was higher for simple HPV-related and Pap test questions but was lower for HPV interrelations with genital warts and cervical cancer. Being from the health science fields and having high income were factors associated with greater knowledge. Only the minority of the participants recognized all the situations that increased the risk of virus infection presented in the questionnaire. CONCLUSIONS: These findings highlight the need for educational campaigns regarding HPV infection, its potential as a cervical cancer agent and the forms of prevention available.
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Açucena Vieira Alves S, Schiaveto de Souza A, Weller M, Pires Batiston A. Differential Impact of Education Level, Occupation and
Marital Status on Performance of the Papanicolaou Test among
Women from Various Regions in Brazil. Asian Pac J Cancer Prev 2019; 20:1037-1044. [PMID: 31030471 PMCID: PMC6948916 DOI: 10.31557/apjcp.2019.20.4.1037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/01/2019] [Indexed: 11/25/2022] Open
Abstract
Background: In Brazil, little is known regarding the underlying causes of differences among populations regarding socio-economic variables that affect women’s cervical cancer screening behavior. The present study focused on socio-economic variables that affect women’s performance of the Papanicolaou test, comparing two distinct Brazilian populations. Methods: We collected data regarding performance of the Papanicolaou test and socio-economic variables from 559 women in Mato Grosso do Sul (MS), in the Central East region, and 338 women in Paraíba (PB), in the Northeast region of Brazil. Nominal logistic regression modeling was performed to identify independent variables for both groups of data. Results: Of the women interviewed from MS and PB, 116 out of 599 (19.37%) and 94 out of 338 (27.81%), respectively, had not performed the Papanicolaou test within the last three years (p = 0.025). Low educational level characterized 570 (95.16%) and 203 (60.06%) of women from MS and PB, respectively (p = 0.000). Women in PB who had a low educational level and were unemployed had a 2.96-fold (OR = 0.338; 95% CI: 0.121 - 0.939) and 2.40-fold (OR = 0.416; 95% CI: 0.199 - 0.869) lower chance, respectively, to have performed the Papanicolaou test ≥ three times, or once within the last three years (p = 0.029; p = 0.014). The chance of women in MS who did not live in a stable relationship to have performed the test ≥ three times was 1.79-fold (OR = 0.560; 95% CI: 0.348 – 0.901) lower compared to women who reported a stable relationship (p = 0.039). Conclusions: High educational level, employment, and having a stable interpersonal relationship positively associated with performance of the Papanicolaou test among women in PB and MS. Despite having predominantly a low educational level, women in MS performed the Papanicolaou test more frequently than those in PB.
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Affiliation(s)
| | - Albert Schiaveto de Souza
- Institute of Biosciences, Federal University of Mato Grosso do Sul (UFMS), Campo Grande- Mato Grosso do Sul, Brazil
| | - Mathias Weller
- Postgraduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil.
| | - Adriane Pires Batiston
- Instituto Integrado de Saúde, Federal University of Mato Grosso do Sul (UFMS), Campo Grande- Mato Grosso do Sul, Brazil
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Tapera O, Kadzatsa W, Nyakabau AM, Mavhu W, Dreyer G, Stray-Pedersen B, SJH H. Sociodemographic inequities in cervical cancer screening, treatment and care amongst women aged at least 25 years: evidence from surveys in Harare, Zimbabwe. BMC Public Health 2019; 19:428. [PMID: 31014308 PMCID: PMC6480834 DOI: 10.1186/s12889-019-6749-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/04/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cervical cancer is the most commonly diagnosed cancer among women in Zimbabwe; however; access to screening and treatment services remain challenged. The objective of this study was to investigate socio-demographic inequities in cervical cancer screening and utilization of treatment among women in Harare, Zimbabwe. METHODS Two cross sectional surveys were conducted in Harare with a total sample of 277 women aged at least 25 years. In the community survey, stratified random sampling was conducted to select 143 healthy women in Glen View, Cranborne, Highlands and Hopely communities of Harare to present high, medium, low density suburbs and rural areas respectively. In the patient survey, 134 histologically confirmed cervical cancer patients were also randomly selected at Harare hospital, Parirenyatwa Hospital and Island Hospice during their routine visits or while in hospital admission. All consenting participants were interviewed using a validated structured questionnaire programmed in Surveytogo software in an android tablet. Data was analyzed using STATA version 14 to yield descriptive statistics, bivariate and multivariate logistic regression outcomes for the study. RESULTS Women who reported ever screening for cervical cancer were only 29%. Cervical cancer screening was less likely in women affiliated to major religions (p < 0.05) and those who never visited health facilities or doctors or visited once in previous 6 months (p < 0.05). Ninety-two (69%) of selected patients were on treatment. Women with cervical cancer affiliated to protestant churches were 68 times [95% CI: 1.22 to 381] more likely to utilize treatment and care services compared to those in other religions (p = 0.040). Province of residence, education, occupation, marital status, income (personal and household), wealth, medical aid status, having a regular doctor, frequency of visiting health facilities, sources of cervical cancer information and knowledge of treatability of cervical cancer were not associated with cervical cancer screening and treatment respectively. CONCLUSION This study revealed few variations in the participation of women in cervical cancer screening and treatment explained only by religious affiliations and usage of health facilities. Strengthening of health education in communities including churches and universal healthcare coverage are recommended strategies to improve uptake of screening and treatment of cervical cancer.
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Affiliation(s)
- O. Tapera
- University of Pretoria, School of Health Systems and Public Health, Pretoria, South Africa
| | - W. Kadzatsa
- Parirenyatwa Group of Hospitals, Radiotherapy Centre, Harare, Zimbabwe
| | - A. M. Nyakabau
- Parirenyatwa Group of Hospitals, Radiotherapy Centre, Harare, Zimbabwe
| | - W. Mavhu
- Centre for Sexual Health & HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
| | - G. Dreyer
- Department of Obstetrics and Gynaecology, University of Pretoria, Gynaecologic Oncology, Pretoria, South Africa
| | - B. Stray-Pedersen
- Institute of Clinical Medicine, University in Oslo and Womens’ Clinic, Oslo University Hospital, Oslo, Norway
| | - Hendricks SJH
- Sefako Makgatho Health Sciences University, Pretoria, South Africa
- University of Fort Hare, East London, South Africa
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Anaman JA, Correa-Velez I, King J. A survey of cervical screening among refugee and non-refugee African immigrant women in Brisbane, Australia. Health Promot J Austr 2019; 28:217-224. [PMID: 27802410 DOI: 10.1071/he16017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed To compare the level of cervical screening uptake between refugee and non-refugee African immigrant women living in Brisbane, Australia, and examine factors associated with Pap smear testing. Methods Cross-sectional survey with a convenience sample of 254 women aged 21-62 years from 22 African countries (144 refugees, 110 non-refugees). Chi-square tests were used to compare the demographic and health-related characteristics between refugee and non-refugee women. Bivariate and multiple logistic regression analyses were used to assess the relationship between the outcome variable (Pap smear testing) and the independent variables. Results Two-thirds of women had used Pap smear services in Australia. Chi-square test analysis established that non-refugee women were significantly more likely to have used Pap smear services than refugee women (73.6% vs 61.8% respectively; P=0.047). Immigration status, however, was not a significant predictor of cervical screening uptake in the multiple regression analyses. The significant predictors for screening uptake in these analyses were work arrangement, parity, healthcare visit, knowledge about Pap smear and perceived susceptibility to cervical cancer. Conclusion Most women relied on opportunistic screening after receiving invitation letters to screen or after visiting health professionals for antenatal or postnatal care. So what? The findings suggest that organised cervical screening programs are not reaching most African immigrant women living in Brisbane. It is incumbent on the public health sector, including healthcare professionals and settlement agencies working with African communities, to develop health promotion strategies that meaningfully engage African immigrant women, including those from refugee backgrounds, to enhance their knowledge about cervical cancer and screening practices.
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Affiliation(s)
- Judith A Anaman
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Ignacio Correa-Velez
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
| | - Julie King
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
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Dutta T, Haderxhanaj L, Agley J, Jayawardene W, Meyerson B. Association Between Individual and Intimate Partner Factors and Cervical Cancer Screening in Kenya. Prev Chronic Dis 2018; 15:E157. [PMID: 30576277 PMCID: PMC6307831 DOI: 10.5888/pcd15.180182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Cervical cancer is the most prevalent cancer among women in Kenya. Although cervical cancer screening could reduce illness and death, screening rates remain low. Kenyan women’s individual characteristics and intimate partner factors may be associated with cervical cancer screening; however, a lack of nationally representative data has precluded study until recently. The objective of our study was to examine individual and intimate partner factors associated with cervical cancer screening in Kenya. Methods We conducted secondary data analysis of responses by women who completed the cervical cancer screening and domestic violence questions in the Kenya Demographic and Health Survey, 2014 (N = 3,222). By using multivariable regression analyses, we calculated the association of cervical cancer screening with age, religion, education, wealth, recent exposure to family planning on television, head of household’s sex, and experience of intimate partner violence. Results Rates of cervical cancer screening among women in Kenya increased with age. The wealthiest women and women with post-secondary education had greater odds of reporting being screened for cervical cancer than the poorest women and uneducated women. Christians and women exposed to prevention messaging on television had higher odds of screening than Muslims and women with no exposure. Victims of intimate partner violence had lower odds of being screened than women who had not experienced intimate partner violence. Conclusion Identified barriers to screening in this sample mirror previous findings, though with additional nuances. Model fit data and theoretical review suggest that additional, unmeasured variables may contribute to variability in cervical cancer screening rates. Inclusion of additional variables specific to cervical cancer in future national surveys could strengthen the ability to identify factors associated with screening.
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Affiliation(s)
- Tapati Dutta
- Department of Applied Health Science, Indiana University School of Public Health, 1025 E 7th St, Bloomington, IN 47405. .,Indiana Prevention Resource Center, Institute for Research on Addictive Behavior, Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana.,Rural Center for AIDS/STD Prevention, Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana
| | - Laura Haderxhanaj
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana.,Rural Center for AIDS/STD Prevention, Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana
| | - Jon Agley
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana.,Indiana Prevention Resource Center, Institute for Research on Addictive Behavior, Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana
| | - Wasantha Jayawardene
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana.,Indiana Prevention Resource Center, Institute for Research on Addictive Behavior, Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana
| | - Beth Meyerson
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana.,Rural Center for AIDS/STD Prevention, Department of Applied Health Science, Indiana University School of Public Health, Bloomington, Indiana
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Richards SD, Stonbraker S, Halpern M, Amesty S. Cervical cancer screening among transactional female sex workers in the Dominican Republic. Int J STD AIDS 2018; 29:1204-1214. [PMID: 29966506 PMCID: PMC6089663 DOI: 10.1177/0956462418779662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical cancer is the third leading cause of cancer-related death and the second most diagnosed cancer among women in developing countries. We determined the prevalence of abnormal Papanicolaou (Pap), high-risk HPV (hrHPV), and colposcopy among transactional female sex workers (FSWs) in La Romana, Dominican Republic. The results of 144 FSWs of ages 18-54 years who completed a demographic interview and Pap testing with hrHPV detection between June 2015 and April 2016 were analyzed. Women with abnormal results were referred for colposcopy. Risk factors for abnormal Pap were assessed through bivariate and multivariate analyses. Overall, 36.1% (52/144) of Paps were abnormal and 43.4% (62/143) had hrHPV. Of all women with hrHPV and/or abnormal Pap (68/144; 47.2%), 61 (89.7%) were referred and 16 (26.2) underwent colposcopy. HPV16 and/or 18/45 was detected in 33.3% (15/45) of low-grade Paps. Binge drinking, weekly (AOR 5.1, 95% CI: 1.8-14.5) or daily (AOR 4.9, 95% CI: 1.5-16.6), and age at first sexual relation (AOR 1.2, 95% CI: 1.0-1.5) were significantly associated ( p < 0.05) with abnormal Pap. Although almost half of participants had abnormal Pap or hrHPV, few underwent colposcopy. Improving access to cervical cancer screening and follow-up for FSWs is imperative.
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Affiliation(s)
- Sheyla D Richards
- 1 Program for Global and Population Health, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Samantha Stonbraker
- 2 Columbia University School of Nursing, New York, NY, USA
- 3 Clínica de Familia, La Romana, Dominican Republic
| | - Mina Halpern
- 3 Clínica de Familia, La Romana, Dominican Republic
| | - Silvia Amesty
- 1 Program for Global and Population Health, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- 4 Heilbrunn Department of Population and Family Health, Columbia University, Mailman School of Public Health, New York, NY, USA
- 5 Center for Family and Community Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Carvalho PGD, O´Dwer G, Rodrigues NCP. Trajetórias assistenciais de mulheres entre diagnóstico e início de tratamento do câncer de colo uterino. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-1104201811812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O estudo se propôs a analisar as trajetórias na assistência das mulheres residentes no Município do Rio de Janeiro diagnosticadas com câncer de colo uterino que foram encaminhadas para tratamento em unidade de referência na atenção oncológica. Na primeira etapa do estudo, avaliou-se o prazo entre a confirmação do diagnóstico e o início do tratamento das mulheres matriculadas no ano de 2014, tomando como referência o prazo de até 60 dias fixado pela Lei Federal nº 12.372/2012 para início de tratamento do câncer no âmbito do Sistema Único de Saúde (SUS). Na segunda etapa, analisaram-se as narrativas de cinco mulheres sobre os caminhos percorridos na assistência desde a descoberta do diagnóstico até a primeira intervenção terapêutica, a partir de aspectos do cuidado integral em saúde. Observou-se que 88% dos tratamentos se iniciaram após o prazo de 60 dias e que 65,5% das mulheres foram diagnosticadas com doença avançada. A média para início de tratamento foi de 115,4 dias. Os principais problemas apreendidos na análise das trajetórias foram os relacionados à disponibilidade dos serviços e à integração das ações nos diversos níveis de atenção, bem como a falta de informação sobre a doença e o objetivo da realização do exame preventivo.
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Khazaee-Pool M, Yargholi F, Jafari F, Ponnet K. Exploring Iranian women's perceptions and experiences regarding cervical cancer-preventive behaviors. BMC Womens Health 2018; 18:145. [PMID: 30170632 PMCID: PMC6119270 DOI: 10.1186/s12905-018-0635-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/20/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Preventive behaviors regarding cervical cancer are essential for women's health. Even though many studies have addressed women's knowledge and attitudes toward cervical cancer, little information is available about their experiences of cervical cancer-preventive behaviors. Thus, the aim of this study is to explore the perceptions and experiences of Iranian women regarding cervical cancer-preventive behaviors. METHODS This study used a qualitative approach and was conducted in Zanjan, Iran. Participants included 27 women, aged 20-60 years, with no previous history of cervical cancer symptoms or diagnosis. Data were obtained through semi-structured in-depth interviews and focus group discussions. Inductive qualitative content analysis was employed to converge and compare themes through participant data. RESULTS The following six main themes emerged from the analysis: attitudes toward cervical cancer and preventive behaviors, preventive behaviors' concept, self-care, religion and culture, perceived social support, and awareness about cervical cancer and preventive behavior. The findings revealed that several women had misconceptions about cervical cancer and were even superstitious about the causes of it. Fear, shame, and embarrassment were reasons for not undertaking cervical cancer screening. Cervical cancer was also linked to worries about decreased marital satisfaction, sexuality, and femininity. However, religion was considered a positive factor to conducting cancer-preventive behaviors. CONCLUSIONS This study showed that improving knowledge about the causes of cervical cancer, increasing awareness of the potential consequences of it, and creating positive attitudes toward screening behavior might encourage Iranian women to perform cervical cancer-preventive behaviors.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fatemeh Yargholi
- Department of Health Education and Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fatemeh Jafari
- Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
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Anaman JA, Correa-Velez I, King J. Knowledge Adequacy on Cervical Cancer Among African Refugee and Non-Refugee Women in Brisbane, Australia. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:716-723. [PMID: 27796876 DOI: 10.1007/s13187-016-1126-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cervical cancer is a significant public health issue, especially in the developing countries of sub-Saharan Africa. To examine knowledge adequacy on cervical cancer and screening test among African refugee and non-refugee women in Brisbane and further examine whether the level of knowledge vary between refugee and non-refugee women. A cross-sectional survey was conducted among 254 African-born women conveniently sampled from the Brisbane local government area. The outcome measures were knowledge on cervical cancer and Pap smear. In the multivariate logistic regression analysis non-refugees were more likely than refugees to have adequate knowledge about cervical cancer. Also, non-refugee women who were older and educated beyond secondary school, were more likely to have good knowledge about Pap smear test than refugee women. Overall, knowledge level about cervical cancer is limited among the participants and non-refugee women were more likely than refugee women to have good knowledge about cervical cancer and the screening test. These findings may inform the development of health education interventions for the targeted population to improve knowledge and awareness about cervical cancer and the screening guidelines in Australia.
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Affiliation(s)
- Judith A Anaman
- University of Health and Allied Sciences School of Nursing and Midwifery, PMB 31, Ho, Volta Region, Ghana.
- School of Public Health and Social Work, Queensland University of Technology (QUT)-Brisbane, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
| | - Ignacio Correa-Velez
- School of Public Health and Social Work, Queensland University of Technology (QUT)-Brisbane, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Julie King
- School of Public Health and Social Work, Queensland University of Technology (QUT)-Brisbane, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
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Johnson CM, Molina Y, Blas M, Erickson M, Bayer A, Gutierrez MC, Nevin PE, Alva I, Rao D. "The disease is mine, the body is mine, I decide": Individual, interpersonal, and institutional barriers and facilitators among survivors of women's cancers in Andean countries. Health Care Women Int 2018; 39:522-535. [PMID: 29313760 DOI: 10.1080/07399332.2017.1421198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Recent national cancer plans address high cancer mortality in Latin America, particularly in Andean countries. Little is known about which individual, interpersonal, and institutional facilitators and barriers persist, particularly from the perspective of cancer survivors. We conducted 15 semi-structured interviews with survivors of breast and cervical cancers during and after a Pan American Health Organization sponsored conference on women's cancers in Lima, Peru. We analyzed data using an inductive content analysis approach. Patients reported primarily psychosocial barriers and facilitators at individual, interpersonal, and institutional levels. Additionally, survivors provided recom-mendations to refine existing policy to improve the cancer care experience for patients.
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Affiliation(s)
- Caroline M Johnson
- a Department of Global Health, School of Public Health , University of Washington , Seattle , Washington , USA
| | - Yamile Molina
- b School of Public Health , University of Illinois at Chicago , Chicago , Illinois , USA.,c Cancer Prevention, Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Magaly Blas
- a Department of Global Health, School of Public Health , University of Washington , Seattle , Washington , USA.,d School of Public Health and Administration , Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Mallory Erickson
- a Department of Global Health, School of Public Health , University of Washington , Seattle , Washington , USA
| | - Angela Bayer
- d School of Public Health and Administration , Universidad Peruana Cayetano Heredia , Lima , Peru.,e David Geffen School of Medicine , University of California , Los Angeles , California , USA
| | - Marina Chiappe Gutierrez
- d School of Public Health and Administration , Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Paul E Nevin
- a Department of Global Health, School of Public Health , University of Washington , Seattle , Washington , USA
| | - Isaac Alva
- d School of Public Health and Administration , Universidad Peruana Cayetano Heredia , Lima , Peru
| | - Deepa Rao
- a Department of Global Health, School of Public Health , University of Washington , Seattle , Washington , USA.,f Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , Washington , USA
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Liebermann EJ, VanDevanter N, Hammer MJ, Fu MR. Social and Cultural Barriers to Women's Participation in Pap Smear Screening Programs in Low- and Middle-Income Latin American and Caribbean Countries: An Integrative Review. J Transcult Nurs 2018; 29:591-602. [PMID: 29366369 DOI: 10.1177/1043659618755424] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Pap smear screening programs have been ineffective in reducing cervical cancer mortality in most Latin American and Caribbean countries, in part due to low screening rates. The purpose of this review was to analyze recent studies to identify demographic, social, and cultural factors influencing women's participation in Pap screening programs in Latin America and the Caribbean. DESIGN/METHOD For this integrative review, cervical cancer screening in Latin America and the Caribbean was searched using PubMed, CINAHL, EMBASE, and PsycINFO databases. Findings/Results: Demographic barriers to screening were socioeconomic status, education, race/ethnicity, and geography. Social barriers included lack of uniformity in screening guidelines, lack of knowledge regarding cervical cancer, and lack of preventive culture. Cultural barriers were fear/embarrassment and gender roles. CONCLUSIONS There are multilevel barriers to Pap smear utilization among women in Latin America and the Caribbean. IMPLICATIONS FOR PRACTICE Findings highlight a need for health system engagement, promotion of preventive care, and community-generated educational programs and solutions.
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Affiliation(s)
| | | | | | - Mei R Fu
- 1 New York University, New York, NY, USA
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35
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Socio-economic and demographic determinants affecting participation in the Swedish cervical screening program: A population-based case-control study. PLoS One 2018; 13:e0190171. [PMID: 29320536 PMCID: PMC5761876 DOI: 10.1371/journal.pone.0190171] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/08/2017] [Indexed: 12/03/2022] Open
Abstract
Background Cervical screening programs are highly protective for cervical cancer, but only for women attending screening procedure. Objective Identify socio-economic and demographic determinants for non-attendance in cervical screening. Methods Design: Population-based case-control study. Setting: Sweden. Population: Source population was all women eligible for screening. Based on complete screening records, two groups of women aged 30–60 were compared. The case group, non-attending women, (N = 314,302) had no smear registered for 6–8 years. The control group (N = 266,706) attended within 90 days of invitation. Main outcome measures: Risk of non-attendance by 9 groups of socioeconomic and demographic variables. Analysis: Unadjusted odds ratios (OR) and OR after adjustment for all variables in logistic regression models were calculated. Results Women with low disposable family income (adjOR 2.06; 95% confidence interval (CI) 2.01–2.11), with low education (adjOR 1.77; CI 1.73–1.81) and not cohabiting (adjOR 1.47; CI 1.45–1.50) were more likely to not attend cervical screening. Other important factors for non-attendance were being outside the labour force and receiving welfare benefits. Swedish counties are responsible for running screening programs; adjusted OR for non-participation in counties ranged from OR 4.21 (CI 4.06–4.35) to OR 0.54 (CI 0.52–0.57), compared to the reference county. Being born outside Sweden was a risk factor for non-attendance in the unadjusted analysis but this disappeared in certain large groups after adjustment for socioeconomic factors. Conclusion County of residence and socio-economic factors were strongly associated with lower attendance in cervical screening, while being born in another country was of less importance. This indicates considerable potential for improvement of cervical screening attendance in several areas if best practice of routines is adopted.
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Rojas P, Li T, Ravelo GJ, Dawson C, Sanchez M, Sneij A, Wang W, Kanamori M, Cyrus E, De La Rosa MR. Correlates of Cervical Cancer Screening Among Adult Latino Women: A 5-Year Follow-Up. WORLD MEDICAL & HEALTH POLICY 2017; 9:239-254. [PMID: 29034117 DOI: 10.1002/wmh3.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Latinas have the highest incidence rates of cervical cancer in the United States, and Latinas in the United States are less likely to utilize cervical cancer screening. METHOD We used secondary data analysis of a non-clinical convenience sample (n=316 women at baseline; n=285 at five-year follow-up) to examine correlates of cervical cancer screening among adult Latina women. Univariate and multiple logistic regression models using Generalized Estimated Equations (GEE) algorithm were utilized to assess the influence of the independent variables. RESULTS Women who reported their main healthcare source as community health clinics, women who were sexually active, and women who reported that a healthcare provider discussed HIV prevention with them were more likely to report having a cervical cancer screening (aOR=2.06; CI=1.20, 3.52). CONCLUSION The results suggest a need for continued efforts to ensure that medically underserved women (e.g., Latina women) receive counseling and education about the importance of preventive cancer screening.
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Affiliation(s)
- Patria Rojas
- associate research professor at Florida International University
| | - Tan Li
- assistant professor in the Department of Biostatistics at Florida International University
| | | | | | - Mariana Sanchez
- post-doctoral fellow at the Center for Research on US Latinos HIV/AIDS and Drug Abuse at Florida International University
| | - Alicia Sneij
- PhD student in the Robert Stempel School of Social Work and Public Health at Florida International University
| | - Weize Wang
- graduate student the Robert Stempel School of Social Work and Public Health at Florida International University
| | - Mariano Kanamori
- post-doctoral fellow the Robert Stempel School of Social Work and Public Health at Florida International University
| | - Elena Cyrus
- post-doctoral fellow in the Center for Research on US Latinos HIV/AIDS and Drug Abuse at Florida International University
| | - Mario R De La Rosa
- professor and director of the Center for Research on US Latinos HIV/AIDS and Drug Abuse at Florida International University
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Tung WC, Lu M, Smith-Gagen J, Yao Y. Latina Women and Cervical Cancer Screening: Decisional Balance and Self-Efficacy. Clin J Oncol Nurs 2017; 20:E71-6. [PMID: 27206307 DOI: 10.1188/16.cjon.e71-e76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Latina women in the United States have greater cervical cancer mortality rates than non-Latina women because of their low rates of Papanicolau (Pap) smear screening. OBJECTIVES The purpose of this article is to assess differences in perceived benefits, perceived barriers, and self-efficacy among Latina women to obtain Pap smears using the framework of the Transtheoretical Model. METHODS A descriptive design with a snowball sample was used. The researchers assessed demographics, three perceived benefits, 12 barriers, and seven self-efficacy measures for 121 Latina women in northern Nevada. FINDINGS Participants in precontemplation and relapse perceived greater barriers than those in action and maintenance for three items.
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Sano H, Goto R, Hamashima C. Does lack of resources impair access to breast and cervical cancer screening in Japan? PLoS One 2017; 12:e0180819. [PMID: 28704430 PMCID: PMC5509210 DOI: 10.1371/journal.pone.0180819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/21/2017] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess the impact of the quantity of resources for breast and cervical cancer screening on the participation rates in screening in clinical settings in municipalities, as well as to clarify whether lack of resources impairs access to cancer screening in Japan. Methods Of the 1,746 municipalities in 2010, 1,443 (82.6%) and 1,469 (84.1%) were included in the analyses for breast and cervical cancer screening, respectively. In order to estimate the effects of the number of mammography units and of gynecologists on the participation rates in breast and cervical cancer screening in clinical settings, multiple regression analyses were performed using the interaction term for urban municipalities. Results The average participation rate in screening in clinical settings was 6.01% for breast cancer, and was 8.93% for cervical cancer. The marginal effect of the number of mammography units per 1,000 women was significantly positive in urban municipalities (8.20 percent point). The marginal effect of the number of gynecologists per 1,000 women was significantly positive in all municipalities (2.54 percent point) and rural municipalities (3.68 percent point). Conclusions Lack of mammography units in urban areas and of gynecologists particularly in rural areas impaired access to breast and cervical cancer screening. Strategies are required that quickly improve access for the residents and increase their participation rates in cancer screening.
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Affiliation(s)
- Hiroshi Sano
- Faculty of Economics, Shiga University, Hikone, Shiga, Japan
- * E-mail:
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Yokohama, Kanagawa, Japan
| | - Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, Chuo-ku, Tokyo, Japan
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Tung WC, Smith-Gagen J, Lu M, Warfield M. Application of the Transtheoretical Model to Cervical Cancer Screening in Latina Women. J Immigr Minor Health 2016; 18:1168-1174. [DOI: 10.1007/s10903-015-0183-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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The Influences of Health Insurance and Access to Information on Prostate Cancer Screening among Men in Dominican Republic. J Cancer Epidemiol 2016; 2016:7284303. [PMID: 27034669 PMCID: PMC4806283 DOI: 10.1155/2016/7284303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/07/2016] [Accepted: 02/08/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives. Although research demonstrates the public health burden of prostate cancer among men in the Caribbean, relatively little is known about the factors that underlie the low levels of testing for the disease among this population. Study Design. A cross-sectional study of prostate cancer testing behaviours among men aged 40–60 years in Dominican Republic using the Demographic and Health Survey (2013). Methods. We use hierarchical binary logit regression models and average treatment effects combined with propensity score matching to explore the determinants of prostate screening as well as the average effect of health insurance coverage on screening. The use of hierarchical binary logit regression enabled us to control for the effect of unobserved heterogeneity at the cluster level that may affect prostate cancer testing behaviours. Results. Screening varied significantly with health insurance coverage, knowledge of cholesterol level, education, and wealth. Insured men were more likely to test for prostate cancer (OR = 1.65, p = 0.01) compared to the uninsured. Conclusions. The expansion and restructuring of Dominican Republic universal health insurance scheme to ensure equity in access may improve health access that would potentially impact positively on prostate cancer screening among men.
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Luque JS, Opoku S, Ferris DG, Guevara Condorhuaman WS. Social network characteristics and cervical cancer screening among Quechua women in Andean Peru. BMC Public Health 2016; 16:181. [PMID: 26911388 PMCID: PMC4765061 DOI: 10.1186/s12889-016-2878-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Peru has high cervical cancer incidence and mortality rates compared to other Andean countries. Therefore, partnerships between governmental and international organizations have targeted rural areas of Peru to receive cervical cancer screening via outreach campaigns. Previous studies have found a relationship between a person’s social networks and cancer screening behaviors. Screening outreach campaigns conducted by the nonprofit organization CerviCusco created an opportunity for a social network study to examine cervical cancer screening history and social network characteristics in a rural indigenous community that participated in these campaigns in 2012 and 2013. The aim of this study was to explore social network characteristics in this community related to receipt of cervical cancer screening following the campaigns. Methods An egocentric social network questionnaire was used to collect cross-sectional network data on community participants. Each survey participant (ego) was asked to name six other women they knew (alters) and identify the nature of their relationship or tie (family, friend, neighbor, other), residential closeness (within 5 km), length of time known, frequency of communication, topics of conversation, and whether they lent money to the person, provided childcare or helped with transportation. In addition, each participant was asked to report the nature of the relationship between all alters identified (e.g., friend, family, or neighbor). Bivariate and multivariate analyses were used to explore the relationship between Pap test receipt at the CerviCusco outreach screening campaigns and social network characteristics. Results Bivariate results found significant differences in percentage of alter composition for neighbors and family, and for mean number of years known, mean density, and mean degree centrality between women who had received a Pap test (n = 19) compared to those who had not (n = 50) (p’s < 0.05). The final logistic regression model was statistically significant (χ2 (2) = 20.911, p < .001). The model included the variables for percentage of family alter composition and mean density, and it explained 37.8 % (Nagelkerke R2) of the variance in Pap test receipt, correctly classifying 78.3 % of cases. Those women with higher percentages of family alter composition and higher mean density in their ego networks were less likely to have received a Pap test at the CerviCusco campaigns. Conclusions According to this exploratory study, female neighbors more than family members may have provided an important source of social support for healthcare related decisions related to receipt of a Pap test. Future studies should collect longitudinal social network data on participants to measure the network effects of screening interventions in rural indigenous communities in Latin American countries experiencing the highest burden of cervical cancer.
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Affiliation(s)
- John S Luque
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 135 Cannon Street, Ste. 303, MSC 835, Charleston, SC, 29425, USA.
| | - Samuel Opoku
- Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA, USA.
| | - Daron G Ferris
- Augusta University, GRU Cancer Center, Augusta, GA, USA. .,CerviCusco, Cusco, Peru.
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Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, Liedke PER, Soto-Perez-de-Celis E, Dizon D, Cazap E, de Lima Lopes G, Touya D, Nunes JS, St Louis J, Vail C, Bukowski A, Ramos-Elias P, Unger-Saldaña K, Brandao DF, Ferreyra ME, Luciani S, Nogueira-Rodrigues A, de Carvalho Calabrich AF, Del Carmen MG, Rauh-Hain JA, Schmeler K, Sala R, Goss PE. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol 2016; 16:1405-38. [PMID: 26522157 DOI: 10.1016/s1470-2045(15)00218-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022]
Abstract
Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.
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Affiliation(s)
- Kathrin Strasser-Weippl
- Centre for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria; The Global Cancer Institute, Boston, MA, USA
| | - Yanin Chavarri-Guerra
- The Global Cancer Institute, Boston, MA, USA; Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Cynthia Villarreal-Garza
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico; Departmento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Brittany L Bychkovsky
- Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marcio Debiasi
- Hospital Mae de Deus, Porto Alegre, Rio Grande do Sul, Brazil; Hospital Sao Lucas da PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro E R Liedke
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Instituto do Câncer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Don Dizon
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina
| | - Gilberto de Lima Lopes
- Medical Oncology, Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, São Paulo, Brazil; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diego Touya
- Department of Oncology, University of the Republic, Montevideo, Uruguay
| | | | - Jessica St Louis
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Vail
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Bukowski
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Pier Ramos-Elias
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico
| | - Karla Unger-Saldaña
- Cátedra CONACYT, Unidad de Epidemiología, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Mayra E Ferreyra
- Oncology Department, Maria Curie Hospital, Buenos Aires, Argentina
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelica Nogueira-Rodrigues
- Federal University, Minas Gerais, Brazil; EVA-Group Brasileiro de Tumores Ginecológicos, Brazilian Gynecologic Oncology Group, Bahia, Brazil
| | | | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jose Alejandro Rauh-Hain
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Raúl Sala
- Grupo Argentino de Investigación Clínica en Oncología-GAICO, Rosario, Santa Fe, Argentina
| | - Paul E Goss
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Luque JS, Maupin JN, Ferris DG, Guevara Condorhuaman WS. Reaching women in the Peruvian Andes through cervical cancer screening campaigns: assessing attitudes of stakeholders and patients. Patient Prefer Adherence 2016; 10:2107-2116. [PMID: 27799747 PMCID: PMC5077272 DOI: 10.2147/ppa.s119886] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Peru is characterized by high cervical cancer incidence and mortality rates. The country also experiences significant gaps in quality cervical cancer screening coverage for the population. OBJECTIVE This descriptive mixed methods study conducted in Cusco, Peru, aimed to assess the attitudes and perceptions of medical staff, health care workers, and patients toward a cervical cancer screening program that included both clinic-based and community outreach services conducted by a nongovernmental organization clinic (CerviCusco). The study also explored patient knowledge and attitudes around cervical cancer and about the human papillomavirus (HPV) to inform patient education efforts. METHODS The study employed structured interviews with key informants (n=16) primarily from CerviCusco, which provides cervical cancer prevention, screening, diagnosis and treatment services, and surveys with a sample of patients (n=30) receiving services at the clinic and at screening campaigns. RESULTS The majority of key informant medical staff participants felt that the general public had a very negative view of government health services. One theme running throughout the interviews was the perception that the general population lacked a culture of preventive health care and would wait until symptoms were severe before seeking treatment. Regarding services that were received by patients at CerviCusco, the participants responded that the prices were reasonable and more affordable than some private clinics. Patients attending the rural health campaigns liked that the services were free and of good quality. CONCLUSION CerviCusco has demonstrated its capacity to provide screening outreach campaigns to populations who had not previously had access to liquid-based cytology services. The finding that patients had generally low levels of knowledge about cervical cancer and the HPV vaccine prompted the development of culturally and linguistically appropriate educational and promotional materials to improve the educational component of the periodic campaigns conducted primarily in rural areas of Andean Peru.
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Affiliation(s)
- John S Luque
- Department of Public Health Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Correspondence: John S Luque, Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303, MSC 835, Charleston, SC 29425, USA, Tel +1 843 876 2248, Email
| | - Jonathan N Maupin
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ
| | - Daron G Ferris
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
- CerviCusco, Cusco, Peru
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Bychkovsky BL, Ferreyra ME, Strasser-Weippl K, Herold CI, de Lima Lopes G, Dizon DS, Schmeler KM, Del Carmen M, Randall TC, Nogueira-Rodrigues A, de Carvalho Calabrich AF, St. Louis J, Vail CM, Goss PE. Cervical cancer control in Latin America: A call to action. Cancer 2015; 122:502-14. [DOI: 10.1002/cncr.29813] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/03/2015] [Accepted: 11/09/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Brittany L. Bychkovsky
- Department of Breast Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | | | | | - Christina I. Herold
- Department of Breast Oncology; Dana-Farber Cancer Institute; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | - Gilberto de Lima Lopes
- Clinical Oncology, Cancer Institute of Sao Paulo State; Sao Paulo Brazil
- Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Don S. Dizon
- Massachusetts General Hospital Cancer Center, Harvard Medical School; Boston Massachusetts
| | | | - Marcela Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | - Tom C. Randall
- Global Oncology Initiative, Dana-Farber Harvard Cancer Center; Boston Massachusetts
- Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | | | | | - Jessica St. Louis
- The Global Cancer Institute; Boston Massachusetts
- Avon International Breast Cancer Research Program, Massachusetts General Hospital; Boston Massachusetts
| | - Caroline M. Vail
- The Global Cancer Institute; Boston Massachusetts
- Avon International Breast Cancer Research Program, Massachusetts General Hospital; Boston Massachusetts
- University of New England; Biddeford Maine
| | - Paul E. Goss
- The Global Cancer Institute; Boston Massachusetts
- Avon International Breast Cancer Research Program, Massachusetts General Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
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Sadovsky ADID, Poton WL, Reis-Santos B, Barcelos MRB, Silva ICMD. Índice de Desenvolvimento Humano e prevenção secundária de câncer de mama e colo do útero: um estudo ecológico. CAD SAUDE PUBLICA 2015; 31:1539-50. [DOI: 10.1590/0102-311x00073014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 01/09/2015] [Indexed: 11/22/2022] Open
Abstract
Estudo ecológico que analisou a proporção da realização de mamografia e do exame de Papanicolaou e a associação destes com o Índice de Desenvolvimento Humano (IDH), nas 26 capitais brasileiras e Distrito Federal, em 2011, com dados do VIGITEL. A proporção de mamografia em algum momento da vida esteve acima de 70% para todas as capitais estudadas. Entretanto, poucas capitais atingiram a meta de 80% para o Papanicolaou, tanto para a realização em algum momento da vida como nos últimos três anos. Houve forte correlação positiva entre IDH e as proporções desses exames (r = 0,52 e 0,66 para realização de mamografia em algum momento da vida e nos últimos dois anos e r = 0,66 e 0,71 para realização do Papanicolaou em algum momento da vida e nos últimos três anos, respectivamente). A razão de prevalência de mamografia nos últimos dois anos foi 1,06 (IC95%: 1,01-1,10) e para o Papanicolaou nos últimos três anos foi 1,07 (IC95%: 1,04-1,10). A promoção de políticas públicas que incentivem o desenvolvimento socioeconômico das cidades brasileiras favoreceria o aumento da cobertura desses exames.
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Inequities in cervical cancer screening among Colombian women: a multilevel analysis of a nationwide survey. Cancer Epidemiol 2015; 39:229-36. [PMID: 25707752 DOI: 10.1016/j.canep.2015.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/21/2015] [Accepted: 01/25/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To identify factors associated with whether women in Colombia have had a Pap test, evaluate differences in risk factors between rural and urban residence, and evaluate the contextual effect of the lack of education on having ever had a Pap test. METHOD Data used were from the 2010 Colombian National Demographic and Health Survey; 40,392 women reported whether they have had a Pap test. A multilevel mixed logistic regression model was developed with random intercepts to account for clustering by neighbourhood and municipality. The model evaluated whether having a rural/urban area of residence modified the effect of identified risk factors and if the prevalence of no education at the neighbourhood level acted as a contextual effect. RESULTS Most women (87.3%) reported having at least one Pap test. Women from lower socioeconomic quintiles (p=0.002), who were unemployed (p<0.001), and whose final health decisions depended on others (p<0.001) were less likely to have had a Pap test. Women with children were more likely to have had the test (p<0.001), and the effects of education (p=0.03), type of health insurance (p=0.01), age (p<0.001), and region (p<0.001) varied with having a rural/urban area of residence. Women living in rural areas (specifically younger ones, with no health insurance, living in the Atlantic and Amazon-Orinoquía regions, and with no education) were less likely to have had a Pap test when compared to those living in urban areas. Furthermore, women living in a neighbourhood with a higher prevalence of no education were less likely to have ever had a Pap test (p=0.005). CONCLUSIONS In Colombia, the probability of having had a Pap test is associated with personal attributes, area of residence, and prevalence of no education in the neighbourhood. Efforts to improve access to cervical cancer screening should focus on disadvantaged women with limited education, low socioeconomic status, and no health insurance or subsidised insurance, especially those in rural/isolated areas.
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Silva-Caso W, Olivera-Irazábal M, León-Álvarez P, del Valle LJ, Díaz-Estacio S, Vargas M, Ruiz J, Bermúdez-García A, del Valle Mendoza J. Identification of human papillomavirus as a preventive strategy for cervical cancer in asymptomatic women in the Peruvian Andes. ASIAN PAC J TROP MED 2014; 7S1:S121-6. [DOI: 10.1016/s1995-7645(14)60217-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/03/2014] [Accepted: 09/12/2014] [Indexed: 11/28/2022] Open
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