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Bendahhou K, Serhier Z, Diouny S, Ouadii K, Barkouk A, Niyonsaba A, Bennani Othmani M. Women's Knowledge and Attitudes Towards Cervical Cancer Screening in Morocco. Cureus 2023; 15:e37989. [PMID: 37223139 PMCID: PMC10202561 DOI: 10.7759/cureus.37989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
High incidence rates of cervical cancer are still common in low- and middle-income countries (LMICs) with ineffective prevention policies. This study assessed Moroccan women's knowledge and practices regarding the cervical cancer screening program. A cross-sectional study was conducted in 2019 in four primary healthcare centers in Casablanca. Women over the age of 18 who came to these centers during the study period were invited to participate in the study. The variables collected were related to women's knowledge of cervical cancer, the screening program, and their reasons for not participating in the screening program. The main risk factors identified by the participants were multiple sexual partners (4.3%) and sexually transmitted diseases (4%). About 77% of the cases (95% confidence interval (CI): 72.1%; 80.4%) knew that a cervical cancer screening program exists in Morocco. However, a small proportion had an idea about the population targeted by the program (46%) and the recommended interval between two screening tests (20%). Only 28% (95% CI: 19.2%; 38.2%) of eligible women had ever been screened for cervical cancer. These results underline the importance of implementing a communication strategy to increase women's awareness of the cervical screening program and their involvement in it.
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Affiliation(s)
| | - Zineb Serhier
- Medical Informatics Laboratory, Hassan II University, Casablanca, MAR
- Clinical Neuroscience and Mental Health Laboratory, Hassan II University, Casablanca, MAR
| | - Samir Diouny
- Clinical Neuroscience and Mental Health Laboratory, Faculty of Dentistry, Hassan II University, Casablanca, MAR
| | - Karima Ouadii
- Medical School, Hassan II University, Casablanca, MAR
| | - Amal Barkouk
- Medical School, Hassan II University, Casablanca, MAR
| | | | - Mohamed Bennani Othmani
- Clinical Neuroscience and Mental Health Laboratory, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, MAR
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Wang W, Arcà E, Sinha A, Hartl K, Houwing N, Kothari S. Cervical cancer screening guidelines and screening practices in 11 countries: A systematic literature review. Prev Med Rep 2022; 28:101813. [PMID: 35637896 PMCID: PMC9142642 DOI: 10.1016/j.pmedr.2022.101813] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/04/2022] [Accepted: 04/30/2022] [Indexed: 11/06/2022] Open
Abstract
Screening guidelines and practices are heterogenous across 11 countries researched. Differences persist between screening guidelines and practices within countries. Only 6 of 11 countries here examined have national screening registries in place. Robust data infrastructure is essential to evaluate screening performance.
The World Health Organization (WHO) advocates population-based screening programs to reduce the global incidence of cervical cancer. However, screening guidelines and practice continually change to reflect scientific developments. Here we describe and compare cervical cancer screening guidelines and clinical practice in 11 countries across North America, Europe, and Asia-Pacific. We conducted a systematic literature review (SLR) complemented by a targeted literature review (TLR) to identify relevant peer-reviewed publications and policy documents, which include 120 publications, of which 86 were identified from the SLR and 34 from the TLR. Only six of 11 countries assessed have population-based screening programs in place. Considerable differences persist across countries’ screening guidelines, even among comparable systems. Moreover, methods of data collection are also heterogenous, and systematic data collection is often not established. As future changes in screening guidelines and clinical practice occur (e.g., when the first cohorts of women vaccinated against HPV reach screening age), systematic collection of screening data is essential to monitor and improve screening performance.
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Lozar T, Nagvekar R, Rohrer C, Dube Mandishora RS, Ivanus U, Fitzpatrick MB. Cervical Cancer Screening Postpandemic: Self-Sampling Opportunities to Accelerate the Elimination of Cervical Cancer. Int J Womens Health 2021; 13:841-859. [PMID: 34566436 PMCID: PMC8458024 DOI: 10.2147/ijwh.s288376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
The persisting burden of cervical cancer in underserved populations and low-resource regions worldwide, worsened by the onset of the COVID-19 pandemic, requires proactive strategies and expanded screening options to maintain and improve screening coverage and its effects on incidence and mortality from cervical cancer. Self-sampling as a screening strategy has unique advantages from both a public health and individual patient perspective. Some of the barriers to screening can be mitigated by self-sampling, and resources can be better allocated to patients at the highest risk of developing cervical cancer. This review summarizes the implementation options for self-sampling and associated challenges, evidence in support of self-sampling, the available devices, and opportunities for expansion beyond human papillomavirus testing.
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Affiliation(s)
- Taja Lozar
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
- University of Ljubljana, Ljubljana, Slovenia
| | - Rahul Nagvekar
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Charles Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Racheal Shamiso Dube Mandishora
- University of Zimbabwe College of Health Sciences, Department of Medical Microbiology, Harare, Zimbabwe
- Early Detection, Prevention and Infections Group, International Agency for Research on Cancer, Lyon, France
| | - Urska Ivanus
- University of Ljubljana, Ljubljana, Slovenia
- National Cervical Cancer Screening Programme and Registry ZORA, Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Association of Slovenian Cancer Societies, Ljubljana, 1000, Slovenia
| | - Megan Burke Fitzpatrick
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Immigration and Adherence to Cervical Cancer Screening: A Provincewide Longitudinal Matched Cohort Study Using Multistate Transitional Models. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:813-823. [PMID: 31130182 DOI: 10.1016/j.jogc.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/04/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Previous studies highlighting inequities in cancer screening between immigrants and non-immigrants have been methodologically limited. This longitudinal matched cohort study used a multistate modelling framework to examine associations between immigration status and cervical cancer screening adherence. METHODS A 1:1 matched cohort of women aged 25 and older from 1992-2014 who were residing in Ontario was examined. For each woman, the proportion of time spent being non-adherent was determined. Disparities in cervical screening adherence, and specifically the association between immigration status and the rate of becoming adherent, were investigated with a three-state transitional model. The model was adjusted for individual- and physician-level characteristics, which were updated annually and incorporated as time-varying covariates. RESULTS The matched cohort consisted of 1 156 720 immigrant and non-immigrant women. The median proportion of time spent non-adherent was 38.9% for immigrants and 24.7% for non-immigrants. The rate of becoming adherent among immigrants was lower than that among non-immigrants, after accounting for individual- and physician-level characteristics (relative rate 0.933; 95% CI 0.928-0.937). Other characteristics such as socioeconomic status, immigrant region of origin, presence of primary physician, and physician's sex were found to be significantly associated with cervical screening adherence. CONCLUSION This study assessed the association between immigration status and adherence to cervical cancer screening. The insights from this work can be used to target groups of women vulnerable to underscreening and to minimize their time spent non-adherent to cancer screening. The methodology serves as a useful framework for examining adherence to other types of cancer screening.
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Tavasoli SM, Kane E, Chiarelli AM, Kupets R. Women's Behaviors Toward Mammogram and Pap Test: Opportunities to Increase Cervical Cancer Screening Participation Rates among Older Women. Womens Health Issues 2018; 28:42-50. [DOI: 10.1016/j.whi.2017.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/13/2017] [Accepted: 10/19/2017] [Indexed: 12/18/2022]
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Madzima TR, Vahabi M, Lofters A. Emerging role of HPV self-sampling in cervical cancer screening for hard-to-reach women: Focused literature review. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:597-601. [PMID: 28807952 PMCID: PMC5555324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To provide a focused critical review of the literature on the acceptability, feasibility, and uptake of human papillomavirus (HPV) self-sampling among hard-to-reach women. QUALITY OF EVIDENCE A focused search to obtain relevant literature published in English between 1997 and 2015 was done using PubMed and EMBASE using search terms including HPV self-test or HPV self-sample or HPV kit in combination with acceptability or feasibility. Only studies that focused on never-screened or underscreened populations were included in this review. MAIN MESSAGE Human papillomavirus self-sampling was found to be highly acceptable and feasible among these hard-to-reach women across most studies. Mailing of self-sampling kits has been shown to increase participation among hard-to reach women. Some concerns remain regarding adherence to further follow-up among high-risk women with positive test results for HPV after screening. CONCLUSION There is a strong body of evidence to support the usefulness of HPV self-sampling in increasing participation of hard-to-reach women in screening programs (level I evidence). Convenience, privacy, ease of use, and, likely, cost-effectiveness of HPV self-sampling are driving forces in its emerging role in cervical cancer screening among hard-to-reach women. Key barriers to participation could be addressed by overcoming disparities in HPV-related knowledge and perceptions about cervical cancer screening.
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Affiliation(s)
- Tina R Madzima
- Diagnostic radiology resident in the Department of Medical Imaging at the University of Toronto in Ontario
| | - Mandana Vahabi
- Associate Professor at the Daphne Cockwell School of Nursing at Ryerson University and Co-Director of the Ryerson Centre for Global Health and Health Equity in Toronto
| | - Aisha Lofters
- Assistant Professor in the Department of Family and Community Medicine at the University of Toronto, a scientist at the Centre for Urban Health Solutions at St Michael's Hospital, and a staff physician for St Michael's Hospital Academic Family Health Team in Toronto.
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Mema SC, Yang H, Vaska M, Elnitsky S, Jiang Z. Integrated Cancer Screening Performance Indicators: A Systematic Review. PLoS One 2016; 11:e0161187. [PMID: 27518708 PMCID: PMC4982666 DOI: 10.1371/journal.pone.0161187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/01/2016] [Indexed: 12/30/2022] Open
Abstract
Cancer screening guidelines recommend that women over 50 years regularly be screened for breast, cervical and colorectal cancers. Population-based screening programs use performance indicators to monitor uptake for each type of cancer screening, but integrated measures of adherence across multiple screenings are rarely reported. Integrated measures of adherence that combine the three cancers cannot be inferred from measures of screening uptake of each cancer alone; nevertheless, they can help discern the proportion of women who, having received one or two types of screening, may be more amenable to receiving one additional screen, compared to those who haven't had any screening and may experience barriers to access screening such as distance, language, and so on. The focus of our search was to identify indicators of participation in the three cancers, therefore our search strategy included synonyms of integrated screening, cervical, breast and colorectal cancer screening. Additionally, we limited our search to studies published between 2000 and 2015, written in English, and pertaining to females over 50 years of age. The following databases were searched: MEDLINE, EMBASE, EBM Reviews, PubMed, PubMed Central, CINAHL, and Nursing Reference Center, as well as grey literature resources. Of the 78 initially retrieved articles, only 7 reported summary measures of screening across the three cancers. Overall, adherence to cervical, breast and colorectal cancer screening ranged from around 8% to 43%. Our review confirms that reports of screening adherence across breast, cervical and colorectal cancers are rare. This is surprising, as integrated cancer screening measures can provide additional insight into the needs of the target population that can help craft strategies to improve adherence to all three screenings.
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Affiliation(s)
- Silvina C. Mema
- Interior Health Authority, Kelowna, British Columbia, Canada
| | - Huiming Yang
- Alberta Health Services, Calgary, Alberta, Canada
| | - Marcus Vaska
- Alberta Health Services, Calgary, Alberta, Canada
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Wood B, Burchell AN, Escott N, Little J, Maar M, Ogilvie G, Severini A, Bishop L, Morrisseau K, Zehbe I. Using community engagement to inform and implement a community-randomized controlled trial in the anishinaabek cervical cancer screening study. Front Oncol 2014; 4:27. [PMID: 24600584 PMCID: PMC3928568 DOI: 10.3389/fonc.2014.00027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/29/2014] [Indexed: 11/13/2022] Open
Abstract
Social, political, and economic factors are directly and indirectly associated with the quality and distribution of health resources across Canada. First Nations (FN) women in particular, endure a disproportionate burden of ill health in contrast to the mainstream population. The complex relationship of health, social, and historical determinants are inherent to increased cervical cancer in FN women. This can be traced back to the colonial oppression suffered by Canadian FN and the social inequalities they have since faced. Screening - the Papinacolaou (Pap) test - and early immunization have rendered cervical cancer almost entirely preventable but despite these options, FN women endure notably higher rates of diagnosis and mortality due to cervical cancer. The Anishinaabek Cervical Cancer Screening Study (ACCSS) is a participatory action research project investigating the factors underlying the cervical cancer burden in FN women. ACCSS is a collaboration with 11 FN communities in Northwest Ontario, Canada, and a multidisciplinary research team from across Canada with expertise in cancer biology, epidemiology, medical anthropology, public health, virology, women's health, and pathology. Interviews with healthcare providers and community members revealed that prior to any formal data collection education must be offered. Consequently, an educational component was integrated into the existing quantitative design of the study: a two-armed, community-randomized trial that compares the uptake of two different cervical screening modalities. In ACCSS, the Research Team integrates community engagement and the flexible nature of participatory research with the scientific rigor of a randomized controlled trial. ACCSS findings will inform culturally appropriate screening strategies, aiming to reduce the disproportionate burden of cervical disease in concert with priorities of the partner FN communities.
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Affiliation(s)
- Brianne Wood
- Thunder Bay Regional Research Institute , Thunder Bay, ON , Canada
| | - Ann N Burchell
- Ontario HIV Treatment Network , Toronto, ON , Canada ; Dalla Lana School of Public Health , Toronto, ON , Canada
| | - Nicholas Escott
- Department of Pathology and Laboratory Medicine, Thunder Bay Regional Health Sciences Centre , Thunder Bay, ON , Canada
| | - Julian Little
- Department of Epidemiology and Community Medicine, University of Ottawa , Ottawa, ON , Canada
| | - Marion Maar
- Faculty of Human Sciences, Northern Ontario School of Medicine , Sudbury, ON , Canada
| | - Gina Ogilvie
- Clinical Prevention Services, BC Centre for Disease Control , Vancouver, BC , Canada
| | - Alberto Severini
- Viral Exanthemata and STD Section, National Microbiology Laboratory, Public Health Agency of Canada , Winnipeg, MB , Canada
| | - Lisa Bishop
- Biology Department, Lakehead University , Thunder Bay, ON , Canada
| | - Kyla Morrisseau
- Biology Department, Lakehead University , Thunder Bay, ON , Canada
| | - Ingeborg Zehbe
- Thunder Bay Regional Research Institute , Thunder Bay, ON , Canada
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Mosavi-Jarrahi A, Kliewer EV. Cervical cancer incidence trends in Canada: a 30-year population-based analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:620-626. [PMID: 23876639 DOI: 10.1016/s1701-2163(15)30877-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To use the most recent data to update the trend in cervical cancer incidence in Canada over the 30 year period from 1978 to 2009. METHODS Registered cases of cervical cancer and the corresponding person years for the Canadian population were retrieved from an online data repository of the International Agency on Research on Cancer and from Statistics Canada for the period 1978 to 2009. Annual age-standardized rates were estimated for all data combined and for each province separately. The ages of cases were aggregated into three groups: 25 to 39, 40 to 59, and 60 to 75 years. Joinpoint regression analysis was used to describe the trend across age groups and provinces. RESULTS Between 1978 and 2006, the age-adjusted cervical cancer rate in Canada decreased from 20.05 to 12.66 per 100 000 females; after 2006 the rate increased. Greater reductions were observed in the older age groups. The average annual percentage change (AAPC) was -1.1% (95% CI -1.1% to 0.09%), -1.8% (95% CI -2.5% to -1.2%), and -2.6% (95% CI -3.9% to -1.4%) for age groups 25 to 39, 40 to 60, and 60 to 75, respectively. The AAPC varied between provinces, ranging from -0.22% (95% CI -1.4% to 0.9%) in Saskatchewan to -3.02% (95% CI -4.5% to -1.5%) in Newfoundland and Labrador. In Ontario the incidence of cervical cancer increased annually between 2006 and 2009. The trend in British Columbia included a significant change of slope in 1984. CONCLUSION The incidence of cervical cancer decreased in Canada and across all provinces between 1978 and 2009. The decrease was greater in older women.
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Affiliation(s)
- Alireza Mosavi-Jarrahi
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC; Department of Social Medicine, Medical School, Shaheed Beheshti University of Medical Sciences and Health Services, Tehran, Iran; Cancer Control Research, British Columbia Cancer Agency, Vancouver BC
| | - Erich V Kliewer
- Cancer Control Research, British Columbia Cancer Agency, Vancouver BC; Community Health Sciences, University of Manitoba, Winnipeg MB; Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg MB
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