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Le Goff J, Le Duc-Banaszuk AS, Lefeuvre C, Pivert A, Ducancelle A, De Pauw H, Arbyn M, Vinay A, Rexand-Galais F. Acceptance of Self-Sampling by Women Not Regularly Participating in Cervical Cancer Screening in Areas with Low Medical Density: A Qualitative Study within the French CapU4 Trial. Cancers (Basel) 2024; 16:2066. [PMID: 38893189 PMCID: PMC11171172 DOI: 10.3390/cancers16112066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Cervical cancer (CC) was diagnosed in 3159 women in France in 2023, and 1117 died from it. Organized screening for cervical cancer is potentially very effective for participating women. However, reaching under-screened populations remains a major challenge. The present qualitative study explored women's opinions on what discourages or encourages them to participate in CC screening and assessed the acceptability of two experimental strategies (urinary or vaginal self-sampling kits) to increase the screening coverage in three rural French administrative departments with low medical density and/or low screening participation rates. Forty-eight semi-structured interviews and four focus groups were conducted by a team of psychologists. Results showed that the participants accepted at-home self-sampling to reach non-participating women in medically underserved areas. However, they suggested that the type of kit sent should be adapted to the patient's profile (embarrassment from earlier exams, cultural aspects, fear of invasiveness, etc.), and that kits should be simple to use (in understandable language taking sociocultural aspects into account). Women wished to be assured that testing on self-samples is accurate and needed information about further actions in case of a positive result.
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Affiliation(s)
- Johane Le Goff
- University of Angers, CLiPsy, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
| | - Anne-Sophie Le Duc-Banaszuk
- Pays de la Loire Regional Cancer Screening Coordination Center (CRCDC Pays de La Loire), F-49000 Angers, France;
| | - Caroline Lefeuvre
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Adeline Pivert
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Alexandra Ducancelle
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Hélène De Pauw
- Unit Cancer Epidemiology, Belgian Cancer Center, Sciensano, B1050 Brussels, Belgium; (H.D.P.); (M.A.)
| | - Marc Arbyn
- Unit Cancer Epidemiology, Belgian Cancer Center, Sciensano, B1050 Brussels, Belgium; (H.D.P.); (M.A.)
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, B9000 Ghent, Belgium
| | - Aubeline Vinay
- University of Angers, CLiPsy, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
| | - Franck Rexand-Galais
- University of Angers, CLiPsy, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
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Le Goff J, Le Duc-Banaszuk AS, Lefeuvre C, Pivert A, Ducancelle A, De Pauw H, Arbyn M, Vinay A, Rexand-Galais F. Acceptability to Healthcare Professionals of Home-Based HPV Self-Sampling for Cervical Screening: A French Qualitative Study Conducted in an Area with Low Access to Health Services. Cancers (Basel) 2023; 15:5163. [PMID: 37958337 PMCID: PMC10648237 DOI: 10.3390/cancers15215163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Self-sampling may improve participation in cervical cancer secondary prevention programs by women who do not respond or respond irregularly when invited to contact a health professional for the collection of a cervical specimen. It could also help resolve access problems in areas with a low physician density. The present qualitative study examined barriers to screening, effective screening strategies, and the advantages and disadvantages of sending women urine or vaginal self-sampling kits in two medically underserved administrative departments in France (Mayenne and Sarthe) showing low cervical screening coverage. As part of the CapU4 randomized trial, a team of psychologists investigated the attitudes and experiences of 59 healthcare professionals (gynecologists, general practitioners, and midwives) through semi-structured interviews. Results indicated that health professionals believe that self-sampling may address the issues of low physician density and underscreening by removing logistical, organizational, financial, and psychological obstacles. They confirmed trust in the use of vaginal self-sampling, with urine self-sampling as an alternative solution (e.g., for women with vaginismus). The health professionals also identified several limitations of the self-sampling kit that will need to be addressed in future screening campaigns (incomplete kit, complex instructions, poor anatomical knowledge, and obesity).
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Affiliation(s)
- Johane Le Goff
- University of Angers, CLIPSY, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
| | - Anne-Sophie Le Duc-Banaszuk
- Pays de la Loire Regional Cancer Screening Coordination Center (CRCDC Pays de La Loire), F-49000 Angers, France;
| | - Caroline Lefeuvre
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Adeline Pivert
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Alexandra Ducancelle
- University of Angers, CHU Angers, HIFIH, SFR ICAT, F-49000 Angers, France; (C.L.); (A.P.); (A.D.)
| | - Hélène De Pauw
- Cancer Epidemiology Unit, Belgian Cancer Center, Sciensano, 1050 Brussels, Belgium; (H.D.P.); (M.A.)
| | - Marc Arbyn
- Cancer Epidemiology Unit, Belgian Cancer Center, Sciensano, 1050 Brussels, Belgium; (H.D.P.); (M.A.)
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Aubeline Vinay
- University of Angers, CLIPSY, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
| | - Franck Rexand-Galais
- University of Angers, CLIPSY, SFR CONFLUENCES, F-49000 Angers, France; (A.V.); (F.R.-G.)
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Li G, Moniod L, Chenafi S, Lamsisi M, Ennaji MM, Bourlet T, Chauleur C. Detection of HPV in urine for cervical cancer screening: Feasibilty of an assay system. J Gynecol Obstet Hum Reprod 2023; 52:102631. [PMID: 37451412 DOI: 10.1016/j.jogoh.2023.102631] [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: 06/01/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
The detection of urine HPV is considered as a promosing alternative to increase the screening coverage of cervical cancer. However, the validated assay of urine HPV is still scarse. We described a nouvel assay syetem for the urine-based detection of HPV in the framework of HPV screening. This sytsem consisted of Automate Nimbus extraction of DNA and Anyplex™ II HPV HR Detection PCR of HPV DNA. We validated this system by spiking HPV-infected cervical cancer cell line HeLa cells into normal urine and compared the prelimary results of cervical samples and urine samples. We found that this system could detect as few as 5 HeLa cells in normal urine model. Some discordances of HPV results between cervical samples and urine samples were observed. We concluded that this assay system could be applied for the detection of HPV in urine. A large scale study is necessary to evaluate the clinical significance of this assay system.
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Affiliation(s)
- Guorong Li
- Department of Urology, North Hospital, CHU Saint-Etienne, Saint-Etienne, France.
| | - Louise Moniod
- Department of Gynecology and Obstetrics, North Hospital, CHU Saint-Etienne, Saint-Etienne, France
| | - Sara Chenafi
- Laboratoire des Agents Infectieux et d'Hygiène, North Hospital, CHU Saint-Etienne, Saint-Etienne, France
| | - Maryame Lamsisi
- Team of Virology, Oncology and Biotechnologies, Laboratory of Virology, Oncology, Biosciences, Environment and New Energies. Faculty of Sciences and Techniques Mohammedia, University Hassan II of Casablanca, Morocco
| | - Moulay Mustapha Ennaji
- Team of Virology, Oncology and Biotechnologies, Laboratory of Virology, Oncology, Biosciences, Environment and New Energies. Faculty of Sciences and Techniques Mohammedia, University Hassan II of Casablanca, Morocco
| | - Thomas Bourlet
- Laboratoire des Agents Infectieux et d'Hygiène, North Hospital, CHU Saint-Etienne, Saint-Etienne, France; GIMAP Team 15, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR5308, University of Saint-Etienne, University of Lyon, France
| | - Céline Chauleur
- Department of Gynecology and Obstetrics, North Hospital, CHU Saint-Etienne, Saint-Etienne, France; Inserm, SAINBIOSE, U1059, Université Jean-Monnet, CIC1408 F- 42055, Saint-Etienne, France
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Waheed DEN, Olivier CW, Riethmuller D, Franco EL, Prétet JL, Baay M, Munoz N, Vorsters A. Prevention and control of HPV and HPV-related cancers in France: the evolving landscape and the way forward - a meeting report. BMC Proc 2023; 17:18. [PMID: 37537651 PMCID: PMC10401732 DOI: 10.1186/s12919-023-00271-0] [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: 08/05/2023] Open
Abstract
Misinformation regarding HPV vaccine safety and benefits has resulted in low coverage within the eligible French population. HPV vaccination is safe and efficacious in preventing HPV infections in adolescents. However, reaching optimal coverage in countries such as France is challenging due to misinformation, among other factors. Moreover, disparities exist in cervical cancer screening programs. To support the government health promotion policy aimed at improving prevention and control of HPV-related cancers in France, the Human Papillomavirus Prevention and Control Board (HPV-PCB), in collaboration with local experts, held a meeting in Annecy, France (December 2021).HPV-PCB is an independent, multidisciplinary board of international experts that disseminates relevant information on HPV to a broad array of stakeholders and provides guidance on strategic, technical and policy issues in the implementation of HPV control programs.After a one-and-a-half-day meeting, participants concluded that multi-pronged strategies are required to expand vaccination coverage and screening. Vaccine acceptance could be improved by: 1) strenghtening existing trust in clinicians by continuous training of current and upcoming/pre-service healthcare professionals (HCPs), 2) improving health literacy among adolescents and the public through school and social media platforms, and 3) providing full reimbursement of the gender-neutral HPV vaccine, as a strong signal that this vaccination is essential.The discussions on HPV infections control focused on the need to: 1) encourage HCPs to facilitate patient data collection to support performance assessment of the national cervical cancer screening program, 2) advance the transition from cytology to HPV-based screening, 3) improve cancer prevention training and awareness for all HCPs involved in screening, including midwives, 4) identifying patient barriers to invitation acceptance, and 5) promoting urine or vaginal self-sampling screening techniques to improve acceptability, while establishing appropriate follow-up strategies for HPV-positive women. This report covers some critical findings, key challenges, and future steps to improve the status of HPV prevention and control measures in the country.
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Affiliation(s)
- Dur-E-Nayab Waheed
- Centre for Evaluation of Vaccination, Vaccine and Infectious Disease Institute University of Antwerp, Antwerp, Belgium
| | | | - Didier Riethmuller
- Department of Obstetrics and Gynecology, University Medical Center of Grenoble, Grenoble, France
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Jean Luc Prétet
- Papillomavirus National Reference Center CHU, Besançon, France
- EA3181 Université Bourgogne Franche-Comté, Besançon, France
| | - Marc Baay
- P95, Epidemiology and Pharmacovigilance Consulting and Services, Leuven, Belgium
| | | | - Alex Vorsters
- Centre for Evaluation of Vaccination, Vaccine and Infectious Disease Institute University of Antwerp, Antwerp, Belgium.
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Li G, Lamsisi M, Chenafi S, Moniod L, Benlghazi A, Ennaji MM, Chauleur C, Bourlet T. Urine-based detection of HPV for cervical cancer screening: Time for standardized tests. J Med Virol 2023; 95:e28737. [PMID: 37185853 DOI: 10.1002/jmv.28737] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
Cervical cancer is preventable because it has an established etiology, mainly attributed to a detectable pathogen, human papillomavirus (HPV). In 2018, the world health organization issued an unprecedented call for global action to eliminate cervical cancer by 2030. The adaptation of regular screening programs is fundamental to achieve the goal of cervical cancer elimination. However, it is still difficult to achieve satisfactory coverage rates of screening in developing countries as well as in developed countries because many women are reluctant to participate in gynecologic examination. HPV detection in urine is a convenient, widely acceptable by women and relatively affordable without the necessity for clinical visits to improve the coverage rates of cervical cancer screening. Unfortunately, the clinical implementation of urine-based tests for HPV detection has been hindered by the lack of standardized tests. Further optimization of protocols and standardization of urinary HPV detection are expected to be realized. With the advantages of urine sampling to overcome cost, personal, and cultural barriers, time has come for the standardized tests to facilitate a wide clinical implementation of urinary HPV detection that will significantly contribute to the WHO's goal, that is, to eliminate the cervical cancer globally.
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Affiliation(s)
- Guorong Li
- Department of Urology, North Hospital, CHU de Saint-Étienne, Saint-Étienne, France
| | - Maryame Lamsisi
- Team of Virology, Oncology and Medical Biotechnologies, Laboratory of Virology, Microbiology, Quality, and Biotechnologies/ETB, Faculty of Science and Techniques Mohammedia, Hassan II University of Casablanca, Mohammedia, Morocco
| | - Sara Chenafi
- Laboratoire des Agents Infectieux et d'Hygiène, North Hospital, CHU de Saint-Étienne, Saint-Étienne, France
| | - Louise Moniod
- Department of Gynecology and Obstetrics, North Hospital, CHU de Saint-Étienne, Saint-Étienne, France
| | - Abdelhamid Benlghazi
- Department of Gynecology and Obstetrics, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Moulay Mustapha Ennaji
- Team of Virology, Oncology and Medical Biotechnologies, Laboratory of Virology, Microbiology, Quality, and Biotechnologies/ETB, Faculty of Science and Techniques Mohammedia, Hassan II University of Casablanca, Mohammedia, Morocco
| | - Céline Chauleur
- Department of Gynecology and Obstetrics, North Hospital, CHU de Saint-Étienne, Saint-Étienne, France
| | - Thomas Bourlet
- Laboratoire des Agents Infectieux et d'Hygiène, North Hospital, CHU de Saint-Étienne, Saint-Étienne, France
- Centre International de Recherche en Infectiologie, GIMAP Team 15, Inserm, U1111, CNRS, University of Saint-Etienne, University of Lyon, Lyon, France
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Corrêa FM, Migowski A, de Almeida LM, Soares MA. Cervical cancer screening, treatment and prophylaxis in Brazil: Current and future perspectives for cervical cancer elimination. Front Med (Lausanne) 2022; 9:945621. [PMID: 36091685 PMCID: PMC9449345 DOI: 10.3389/fmed.2022.945621] [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: 05/16/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
As a middle-income country, Brazil has one of the largest public health systems worldwide, which deals with free and universal access to health care. Regarding cervical cancer, the country possesses a large infrastructure for the screening of premalignant and malignant lesions, but yet based on old technology, having Papanicolaou as the major screening method, followed by colposcopy and treatment. Also, large disparities in access are present, which makes effectiveness of screening and treatment in different regions of the country highly unequal. In this review, we describe and evaluate the current screening, treatment and prophylactic (HPV vaccination) strategies to combat cervical cancer in Brazil, and discuss potential incorporation of more recent technologies in these areas in the country to pave its way toward cervical cancer elimination.
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Affiliation(s)
- Flávia M. Corrêa
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Arn Migowski
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Liz M. de Almeida
- Coordination of Prevention and Surveillance, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Marcelo A. Soares
- Oncovirology Program, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
- Department of Genetics, Universidade Federal Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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