Factors Affecting Uptake of Cervical Cancer Screening Among African Women in Klang Valley, Malaysia

Socioeconomic disparities in Papanicolaou test utilization in Western Iran

BACKGROUND

Cervical cancer remains the fourth most frequently diagnosed cancer among women, and its impact is particularly significant in women residing in less developed countries. This study aims to assess socioeconomic inequality in using Papanicolaou tests, commonly known as Pap tests, which are crucial for detecting cervical cancer. The research also seeks to decompose this inequality, identifying its contributing factors. This investigation is conducted within a sizable population-based study focused on the Kurdish population, with an additional examination of potential variations between urban and rural areas.

METHOD

The study utilized baseline data from the Ravansar Non-Communicable Disease Cohort Study (RaNCD), involving 3,074 ever-married women aged 35-65. Asset data was employed to determine socioeconomic status (SES), and Principal Component Analysis was applied. The uptake of Papanicolaou tests was assessed for inequality using the Concentration Index (Cn). Additionally, decomposition analysis was conducted to identify and understand the factors contributing to socioeconomic inequality.

RESULTS

The study found that overall, 86% of women reported having undergone cervical cancer screening at least once in their lifetime. The Concentration Index (Cn) for the total population was 0.21 (p < 0.0001), indicating a higher concentration of Papanicolaou test uptake among wealthier groups. In urban areas, the Cn was 0.34 (p < 0.0001), reflecting a significant concentration among the rich. However, in rural areas, the Cn was -0.10 (p = 0.3006), suggesting no significant socioeconomic inequality. Factors such as socioeconomic status (SES), education, and age contributed to reducing inequality, explaining 62.7%, 36.0%, and 1.7% of the observed inequality, respectively. Interestingly, place of residence had a negative influence on inequality.

CONCLUSION

The uptake of Papanicolaou tests varies across different socioeconomic status levels, with a higher concentration among wealthier groups. The results enable health policymakers and researchers to tailor health intervention toward increasing public awareness, especially among women with lower levels of education women in economically deprived groups.

Cervical Cancer: Early Detection and Prevention in Reproductive Age Group

Cancer has been one of the major illnesses faced by people over many generations. Despite the advancements made in medicine, there are still many problems faced by humankind. Every year a large number of people are diagnosed with cervical cancer. It is the most common type of cancerous condition prevalent among females, especially females over thirty years of age. Like any other cancer, cervical cancer also occurs because of the rapid uncontrolled division of the body cells. A primary reason for its development is the longstanding infection of certain types of human papillomavirus (HPV). A screening test is done to confirm the presence of the virus in the cervix. Many screening tests are available today for accurate diagnosis or confirmation of the condition being suffered from. The main goal of screening is early detection and making certain lifestyle changes to deduce the potential harm of the disease and start the treatment as soon as possible. A thorough study of the already published articles by scholars, professors, and doctors is carried out to conclude the necessity of cervical cancer screening and early detection.

Increasing cervical cancer screening in Iran: effectiveness of a theory-based educational intervention

Purpose of study

The high mortality rate of cervical cancer in developing countries is mainly related to inefficient screening programs. The aim of the present study was, thus, to determine the effect of an educational intervention based on BASNEF (Belief, Attitudes, Subjective Norms, and Enabling Factors) model on increasing the rate of cervical cancer screening (CCS) in Bandar Deir in the south of Iran.

Methods

A quasi-experimental educational intervention was made with 202 women participants (101 in the intervention group (IG) and 101 in the control group (CG)) in 2019–20. The sampling was convenience in type. The data were collected using a reliable and valid tripartite questionnaire (demographic information, knowledge, BASNEF constructs). A total number of 14 training sessions were held each taking 60 min, at two levels, personal and interpersonal (for family members, health workers and healthcare givers). Finally, there was a three-month follow-up held in December 2021.

Results

After the training, a statistically significant difference was found between the IG and CG in all model constructs (p < 0.001). Before the intervention, in the IG, the personal health score was 4.35 ± 2.52, which was increased to 5.25 ± 0.753 after the training (p < 0.001). However, in the CG, the difference was not statistically significant (p < 0.030). 63.4% of women in the IG and 32.7% in the CG performed the CCS and the between-group difference was statistically significant (p < 0.001). Attitude, enabling factors and behavioral intention were the main predictors of CCS.

Conclusion

The present findings showed though the training intervention based on the BASNEF model had limited resources and was run in a short time, it managed to motivate women to perform the CCS. It could maximally remove barriers at both personal and interpersonal levels and suggest strategies in the light of these barriers to achieve a successful screening program.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01489-5.

Cervical cancer is the fourth most prevalent fatal cancer among women on a global scale, and is one of the few cancers that can be prevented through screening. The high mortality rate of cervical cancer in developing countries, including Iran, has been largely attributed to inefficient screening programs. In developing countries cervical cancer screening programs are far from qualified. Yet, theory-based educational interventions can play an important role in promoting CCS behavior. Therefore, the present study was designed to determine the effect of an educational intervention based on the Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF model on increasing CCS in women in the south of Iran. BASNEF model includes beliefs about behavioral outcomes, attitudes toward behavior, subjective norms and enabling factors. The most significant construct in BASNEF model is the behavior change. Beliefs and attitudes are influenced by culture, values, traditions, education, media, and personal experiences. Subjective norms include family, society, social media, and peer pressure. Enabling factors include income, women’s status, time, and skills. This model can be proposed as a new educational method. A quasi-experimental two-group (pretest–posttest) study was conducted in 2019–2020 on 202 women (101 in the intervention group, and 101 in the control group). In the intervention group, 14 training sessions (10 at the personal level and 4 at the interpersonal level) were held between 40 and 60 min’ long. In the control group, 1 training session was held in 6 groups of 15–20. It was 60 min’ long. The follow-up was held three months after the intervention. The results showed that the educational intervention, by affecting the BASNEF constructs, significantly affected women’s CCS behavior. Maximizing barriers at both personal and interpersonal levels and suggesting strategies based on these barriers can help achieve a successful screening program. In particular, we call for the implementation of goal-oriented training programs according to health education and health promotion models to increase the rate of CCS behavior.

Understanding the Pap Testing Behaviors of African Immigrant Women in Developed Countries: A Systematic Review

BACKGROUND

African immigrant (AI) women remain burdened by cervical cancer, but the prevalence and correlates of Pap testing remains unclear in this population.

OBJECTIVE

To review studies on the prevalence and determinants of Pap testing among AI women living in developed countries.

METHODS

PubMed, CINAHL, Embase, and Scopus were searched for relevant articles that included African-born immigrant participants; were published in English; addressed the prevalence of Pap testing; conducted in a developed country; and identified correlates of Pap testing behavior. The Andersen Behavioral Model guided synthesis of the key findings.

RESULTS

Sixteen studies met the inclusion criteria. The prevalence of Pap testing ranged from 4.6% to 73.0%. Having a female provider and access to primary care facilitated Pap testing. Barriers to Pap testing included low income, male healthcare providers, and no history of gynecological exam.

CONCLUSIONS

Healthcare providers and social determinants-particularly income and healthcare access, play an important role in improving Pap testing among AI women. Larger qualitative and mixed methods studies are needed to explore other important determinants of Pap testing such as disease knowledge, self-efficacy, health literacy to reduce the burden of cervical cancer among AI women.

Cervical Cancer Screening Utilization and Associated Factors Among Women Aged 30 to 49 Years in Dire Dawa, Eastern Ethiopia

BACKGROUND

Cervical cancer is a public health problem and one of the leading causes of death in women worldwide. In Ethiopia, the government expands cervical cancer screening centers and recommends services to age-eligible and high-risk groups of women. However, evidence indicates that the utilization of services among eligible and high-risk women in the country has remained very low, and data are scarce in Dire Dawa. Therefore, this study aimed to assess cervical cancer screening service utilization and associated factors among women aged 30 to 49 years in Dire Dawa, eastern Ethiopia.

METHODS

A facility-based cross-sectional study was undertaken in Dire Dawa from February 01 to March 01, 2017. Only two facilities provided the screening service in Dire Dawa Administration. Six- hundred and one women aged 30 to 49 years were selected using a systematic sampling method. Data were collected using a pretested face-to-face interview administered questionnaire. Data were entered using EpiData 3.1, and analyzed using the Statistical Package for Social Science Version 21. Multivariable logistic regression was used to examine the factors associated with cervical cancer screening utilization. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used, and a p-value <0.05 was considered statistically significant.

RESULTS

In this study, the magnitude of cervical cancer screening service utilization was 4.0% (95% CI: 2.5-5.7). The factors associated with cervical cancer screening service utilization were older age (AOR = 4.2; 95% CI:1.3-13.8), attending private health facilities (AOR = 8.9; 95% CI: 2.8-28.0), being employed (AOR = 3.3; 95% CI: 1.3-8.8), visiting the gynecology departments (AOR = 3.8; 95% CI: 1.5-9.8), being knowledgeable (AOR = 4.8; 95% CI: 1.5-15.5), being counseled by health professionals (AOR = 4.1; 95% CI: 1.5-11.3), and user's of family planning (AOR = 4.9; 95% CI: 1.2-20.0).

CONCLUSION

The magnitude of cervical cancer screening utilization was very low. Hence, to improve the screening service utilization of cervical cancer, a campaign on community awareness, strengthening service linkage among departments, expansion of the centers for cervical cancer screening, and promotion of family planning method utilization are recommended.

Barriers to and Facilitators of Cervical Cancer Screening among Women in Southeast Asia: A Systematic Review

In Southeast Asia, cervical cancer is the second most common cancer in women. Low coverage for cervical cancer screening (CCS) becomes a roadblock to disease detection and treatment. Existing reviews on CCS have limited insights into the barriers and facilitators for SEA. Hence, this study aims to identify key barriers and facilitators among women living in SEA. A systematic literature review was conducted on Pubmed, Embase, PsycINFO, CINAHL, and SCOPUS. Primary qualitative and quantitative studies published in English that reported barriers and facilitators to CCS were included. The Mix Methods Appraisal Tool was used for the quality assessment of the included studies. Among the 93 included studies, pap smears (73.1%) were the most common screening modality. A majority of the studies were from Malaysia (35.5%). No studies were from Timor-Leste and the Philippines. The most common barriers were embarrassment (number of articles, n = 33), time constraints (n = 27), and poor knowledge of screening (n = 27). The most common facilitators were related to age (n = 21), receiving advice from healthcare workers (n = 17), and education status (n = 11). Findings from this review may inform health policy makers in developing effective cervical cancer screening programs in SEA countries.

Developing an evidence assessment framework and appraising the academic literature on migrant health in Malaysia: a scoping review

BACKGROUND

A large number of international migrants in Malaysia face challenges in obtaining good health, the extent of which is still relatively unknown. This study aims to map the existing academic literature on migrant health in Malaysia and to provide an overview of the topical coverage, quality and level of evidence of these scientific studies.

METHODS

A scoping review was conducted using six databases, including Econlit, Embase, Global Health, Medline, PsycINFO and Social Policy and Practice. Studies were eligible for inclusion if they were conducted in Malaysia, peer-reviewed, focused on a health dimension according to the Bay Area Regional Health Inequities Initiative (BARHII) framework, and targeted the vulnerable international migrant population. Data were extracted by using the BARHII framework and a newly developed decision tree to identify the type of study design and corresponding level of evidence. Modified Joanna Briggs Institute checklists were used to assess study quality, and a multiple-correspondence analysis (MCA) was conducted to identify associations between different variables.

RESULTS

67 publications met the selection criteria and were included in the study. The majority (n=41) of studies included foreign workers. Over two-thirds (n=46) focused on disease and injury, and a similar number (n=46) had descriptive designs. The average quality of the papers was low, yet quality differed significantly among them. The MCA showed that high-quality studies were mostly qualitative designs that included refugees and focused on living conditions, while prevalence and analytical cross-sectional studies were mostly of low quality.

CONCLUSION

This study provides an overview of the scientific literature on migrant health in Malaysia published between 1965 and 2019. In general, the quality of these studies is low, and various health dimensions have not been thoroughly researched. Therefore, researchers should address these issues to improve the evidence base to support policy-makers with high-quality evidence for decision-making.

Comparisons of Papanicolaou Utilization and Cervical Cancer Detection between Rural and Urban Women in Taiwan

Using the claims data of one million insured residents in Taiwan from 1996–2013, this study identified 12,126 women in an urban city (Taichung) and 7229 women in a rural county (Yunlin), aged 20 and above. We compared Papanicolaou (Pap) test uses and cervical cancer detection rates between urban and rural women. Results showed that the Pap screening rate was slightly higher in rural women than in urban women (86.1 vs. 81.3 percent). The cervical cancer incidence was much greater for women without Pap test than women with the test (35.8 vs. 9.00 per 1000 in rural women and 20.3 vs. 7.00 per 1000 in urban women). Nested case-control analysis showed that Pap test receivers had an adjusted odds ratio (OR) of 0.35 (95% CI = 0.25–0.51) to be diagnosed with cervical cancer as compared to those who did not receive the test. The rural women had an adjusted OR of 1.46 (95% CI = 1.03–2.06) to be diagnosed with cervical cancer as compared to urban women. In conclusion, women in rural area are at higher cancer risk than city women. Women who do not undergo Pap tests deserve timely intervention of Pap test to prevent the onset of cancer, particularly in rural women with low income.

[Silencing long non-coding RNA HIF1A-AS2 inhibits proliferation, invasion and migration of cervical cancer cells in vitro]

OBJECTIVE

To explore the inhibitory effects of silencing long non-coding RNA (LncRNA) HIF1A-AS2 on epithelialmesenchymal transition (EMT) and tumor stem cell-like phenotype in cervical cancer cells.

METHODS

We designed 3 shRNA constructs for silencing HIF1A-AS2 in CaSki cells, and the shRNA with the strongest interference effect was selected for subsequent experiment. CaSki cells were transfected with shRNA-NC or Sh-HIF1A-AS2, and the changes in cell viability, invasion ability, EMT, expressions of EMT-related proteins, formation of cell spheres and expressions of stem cell markers were detected.

RESULTS

Transfection with shRNA-NC and Sh-HIF1A-AS2 did not significantly affected the viability of CaSki cells (P > 0.05). Compared with the cells transfected with shRNA-NC, the cells transfected with Sh- HIF1A-AS2 showed significantly reduced invasion ability, expressions of vimentin N-cadherin, and cell sphere formation ability. HIF1A-AS2 silencing obviously lowered the rate of ABCG2-positive cells, significantly reduced the mRNA and protein expressions of Nanog, OCT4, and SOX2, and strongly enhanced the expression of E-cadherin in CaSki cells (P < 0.05).

CONCLUSIONS

Silencing HIF1A-AS2 can inhibit proliferation, invasion and migration of cervical cancer cells in vitro.

Knowledge of Cervical Cancer and Associated Factors Among Women Attending Public Health Facilities in Eastern Ethiopia

Purpose

This study was done to assess women’s knowledge of cervical cancer and associated factors.

Materials and Methods

We conducted a facility-based cross-sectional study in eastern Ethiopia from January 1 to May 30, 2019. A convenient sampling technique was used to include 1181 women in this study. Information on socio-demographic characteristics, sexual history, knowledge and awareness of women was collected using face-to-face interview. The data were cleaned, coded and entered into EPI‑info version 3.5.4 and then exported to Statistical Package for Social Science version 23.0 software for analysis. The associations between independent variables and outcome variables were assessed using bivariate and multivariable logistic regressions. The results of these analyses were reported as odds ratios with 95% confidence intervals. We declared statistically significant variables at a p-value less than 0.05.

Results

Nearly half (574, 48.6%) of the participants have ever heard about cervical cancer. One hundred and thirty-nine (24.2%) of them did not know any of the risk factors. The majority of them mentioned bleeding after intercourse (329, 57.4%) as a symptom of the disease. Overall knowledge assessment revealed that 288 (55.7%) participants had adequate knowledge about cervical cancer. Participants’ age in the range of 40–49 years (AOR: 2.58, 95% CI 1.99–5.57), having educational level above 12th grade (AOR: 12.11, 95% CI 4.57–32.09) and receiving information about the disease from healthcare professionals (AOR: 2.72, 95% CI 1.69–4.37) were independently associated with adequate knowledge of cervical cancer.

Conclusion

The knowledge of women towards cervical cancer in our study area was inadequate. The respondents’ age, educational status and source of information were independently associated with study participants’ knowledge of cervical cancer. Young women with no formal education should get special focus in prevention strategies and we also recommend regular and effective counselling, and education about cervical cancer at health institutions.

Acceptability and Feasibility of HPV Self-Sampling as an Alternative Primary Cervical Cancer Screening in Under-Screened Population Groups: A Cross-Sectional Study

Background: Cervical cancer is one of the most common cancers in women and about 90% of cervical cancer can be reduced by regular screening. The Pap smear has been well in place as a primary cervical screening method since 1950s; however, coverage is still not optimal. This study explored the feasibility of HPV self-sampling in two under-screened population groups in Hong Kong (HK): never screened and not regularly screened females, to estimate the uptake rate and preference rate in the future. Materials and Methods: This was a cross-sectional study to explore the acceptability and feasibility of HPV self-sampling in two age groups: aged 25–35 and aged ≥45, which were reported as the highest proportion of the under-screened population in HK between 2017 and 2018. The study invited eligible women from an HPV study cohort to perform HPV self-sampling at home by themselves. The number of specimens returned from participants was recorded and used to determine the feasibility of HPV self-sampling in the community. The participants were asked to fill in the questionnaires before and after HPV self-sampling to indicate their attitudes, acceptability, and future preference for HPV self-sampling as an acceptable alternative primary cervical cancer screening method. Results: A total of 177 subjects participated in the present study and have achieved a good overall uptake rate of 73% (129/177) who returned the self-collected cervicovaginal sample for HPV testing. Among the under-screened population, there was a higher response rate in aged ≥45 than those aged 25–35. The findings also revealed that women who were under-screened, including those who have never been screened, were more likely to prefer HPV self-sampling than those who had regular screening. This study found that the acceptability of HPV self-sampling was fairly positive among the respondents. The findings also indicated that HPV self-sampling was not only beneficial to enhance their health awareness but also to promote the cervical cancer screening uptake rate, especially among the under-screened or never screened populations. Conclusions: HPV self-sampling would be a solution to overcome the perceived barriers in clinician-based screening. The findings also indicated that it could be feasible to use as an alternative primary cervical cancer screening.

Women's knowledge of and attitudes toward cervical cancer and cervical cancer screening in Zanzibar, Tanzania: a cross-sectional study

Background

Cervical cancer is the most common cancer and the leading cause of cancer death among women in Tanzania. Knowledge of and willingness to receive a cervical cancer screening are important determinants of prevention. This study aimed to describe women’s awareness of cervical cancer and to explore the attitudes toward, acceptability of and barriers to cervical cancer screening (CCS) in Zanzibar.

Methods

A cross-sectional study was conducted from March to June 2018 involving 1483 women from 10 districts in Zanzibar who responded to questionnaires concerning their general demo-graphic characteristics, screening willingness and awareness of cervical cancer. Chi-square tests, analysis of variance (ANOVA) and stepwise multiple regression were conducted using STATA 15.1 software.

Results

The average total knowledge score (TKS) was 7.84 ± 5.32 on a 23-point scale. Educational level and family income were positively correlated with the TKS. Previous schistosomiasis history and family genetic disease history were strong predictors of screening willingness. Women were less likely to be screened freely if they had 7 or more deliveries and were unaware of any previous family tumor history. Age and educational level were negatively associated non-free screening willingness, while family income was positively associated; being divorced/widowed or single and being unaware of any previous family tumor history were predictors of screening reluctance, while previous disease history was a strong predictor of non-free screening willingness. Fear of screening and inconvenience were the primary concerns among the Zanzibari interviewees. Compared to the 20–49 age group, more women in the less than 20 and 50 or more age groups thought cervical cancer screening was not necessary. The highest rate of cognitive accuracy in regard to cervical cancer warning signs and risk factors was only 37.76%.

Conclusions

The findings revealed that knowledge of cervical cancer was poor. Educational level, family income and awareness of previous disease history were significant influencing factors of screening uptake. Specific awareness programs to increase knowledge of cervical cancer and screening willingness should be designed and implemented in the public without delay, especially for younger and elderly women.

Recruiting African Immigrant Women for Community-Based Cancer Prevention Studies: Lessons Learned from the AfroPap Study

Recruitment in research can be challenging, particularly for racial/ethnic minorities and immigrants. There remains a dearth of research identifying the health and sociocultural needs of these populations related to recruitment. To describe our experiences and lessons learned in recruiting African immigrant (AI) women for the AfroPap study, a community-based study examining correlates of cervical cancer screening behaviors. We developed several recruitment strategies in collaboration with key informants and considered published recruitment methods proven effective in immigrant populations. We also evaluated the various recruitment strategies using recruitment records and study team meeting logs. We enrolled 167 AI women in the AfroPap study. We used the following recruitment strategies: (1) mobilizing African churches; (2) utilizing word of mouth through family and friends; (3) maximizing research team's cultural competence and gender concordance; (4) promoting altruism through health education; (5) ensuring confidentiality through the consenting and data collection processes; and (6) providing options for data collection. Online recruitment via WhatsApp was an effective recruitment strategy because it built on existing information sharing norms within the community. Fear of confidentiality breaches and time constraints were the most common barriers to recruitment. We were successful in recruiting a "hard-to-reach" immigrant population in a study to understand the correlates of cervical cancer screening behaviors among AI women by using a variety of recruitment strategies. For future research involving African immigrants, using the internet and social media to recruit participants is a promising strategy to consider.

Access to Health Care, Beliefs, and Behaviors about Colorectal Cancer Screening among Korean Americans

Background: Colorectal cancer (CRC) is one of the most common cancers among Korean Americans (KAs) and their CRC screening rates are low. To raise the rates of CRC screening among KAs, it is necessary to improve our understanding of factors that influence their CRC screening behaviors. This study examined socio-demographics, access to health care, health and cultural beliefs, and behaviors about the fecal occult blood test (FOBT) for CRC screening among KAs aged 50 and older. Methods: Based on the health belief model, the cultural assessment model for health, and the Powe fatalism model, this study measured socio-demographics (age, gender, years in the U.S., marital status, education, employment, income, and acculturation), health care access (health insurance, having a regular doctor, physician recommendation, and trust in doctor), health beliefs (susceptibility, severity, benefits, barriers, and self-efficacy), and cultural beliefs (physical space, health temporal orientation, personal control, and fatalism) and FOBT. A cross-sectional survey (n=202) was conducted. Data analysis was conducted using descriptive analysis, Pearson correlation, and multivariate logistic regression. Results: This study found that physician recommendation was the strongest factor in lifetime FOBT utilization in KAs. The results also revealed a positive association among health temporal orientation, health fatalism, and lifetime FOBT among KAs, while previous research found a negative association between fatalism and cancer screening. Years in the U.S., employment, and having a regular doctor were significantly associated with having had a FOBT in the previous year. Conclusion: Study results suggested the need for public education programs to increase physician recommendation among KAs. Furthermore, the positive relationships among health temporal orientation, health fatalism, and FOBT utilization in KAs suggests that KAs have a desire to maintain health and find cancer early despite their fatalistic view on health.