1
|
Agénor M, Noh M, Eiduson R, LeBlanc M, Line EC, Goldman RE, Potter J, Austin SB. Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States. BMC Womens Health 2024; 24:362. [PMID: 38907205 PMCID: PMC11191319 DOI: 10.1186/s12905-024-03151-7] [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: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism. METHODS We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development. RESULTS Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct. CONCLUSIONS Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.
Collapse
Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, MPH Box G-S121-4, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Rose Eiduson
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Merrily LeBlanc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Sociology, Northeastern University, Boston, MA, USA
| | - Emmett C Line
- Teachers College, Columbia University, New York, NY, USA
| | - Roberta E Goldman
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Mengesha MB, Chekole TT, Hidru HD. Uptake and barriers to cervical cancer screening among human immunodeficiency virus-positive women in Sub Saharan Africa: a systematic review and meta-analysis. BMC Womens Health 2023; 23:338. [PMID: 37370091 DOI: 10.1186/s12905-023-02479-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of disability and mortality among women in Africa. Despite a significant correlation between HIV/AIDS and cervical cancer, there is unacceptably low coverage of the uptake of cervical cancer screening among human immunodeficiency virus-positive women in Sub-Saharan Africa. Individual primary studies are limited in explaining the patterns of uptake of cervical cancer screening. This review therefore considers the uptake of cervical cancer screening and its barriers among human immunodeficiency virus-positive women in Sub-Saharan Africa. METHODS We systematically searched articles published until December 31, 2019, from the PubMed, Cochrane Library, POP LINE, Google Scholar, African Journals Online and JURN databases. The quality of the included articles was assessed by using the Newcastle‒Ottawa Scale, and the coverage of uptake of cervical cancer screening was pooled after checking for heterogeneity and publication bias. The random effect model was used, and subgroup analysis estimates were performed by country. RESULTS Twenty-one studies comprising 20,672 human immunodeficiency virus-positive women were included. Applying a random effect model, the overall cervical cancer screening uptake among this group of women in Sub-Saharan Africa was estimated to be 30% (95% CI: 19, 41, I2 = 100%). The main barriers to uptake of cervical screening include poor knowledge about cervical cancer and screening, low risk perception of cervical cancer, fear of test result and fear of screening as painful, lack of access to screening services, high cost of screening service, and poor partner attitude and acceptance of the service. The perception of an additional burden of having a cervical cancer diagnosis was found to be a unique barrier among this population of women. CONCLUSION The unacceptably low coverage of uptake of cervical cancer screening would indicate that the need to scale up the opportunities to these groups of women as well. This review revealed that in addition to structural and health care system barriers, sociocultural and personal barriers are powerful barriers in HIV-positive women. For these cohorts of population, a particular obstacle was discovered to be perception of an additional burden of having cervical cancer.
Collapse
Affiliation(s)
- Meresa Berwo Mengesha
- Department of Midwifery, College of Medicine and Health Science, Adigrat University, Adigrat, Tigray, Ethiopia.
| | | | - Hagos Degefa Hidru
- Department of Public Health, College of Medicine and Health Science, Adigrat University, Adigrat, Tigray, Ethiopia
| |
Collapse
|
3
|
Phung MT, An PL, Vinh NN, Le HHTC, McLean K, Meza R, Mukherjee B, Lee AW, Pearce CL. A comparative study on behavior, awareness and belief about cervical cancer among rural and urban women in Vietnam. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001817. [PMID: 37279208 DOI: 10.1371/journal.pgph.0001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/12/2023] [Indexed: 06/08/2023]
Abstract
Cervical cancer is the second most common gynecologic cancer in Vietnam but based on the literature, only ~25% of Vietnamese women reported ever being screened for cervical cancer. To inform strategies to reduce the cervical cancer burden in Southern Vietnam where disease incidence is higher than the national average, this study examined behaviors, awareness, barriers, and beliefs about cervical cancer screening among rural and urban women in this geographical region. In October-November 2021, we conducted a cross-sectional study among 196 rural and 202 urban women in Southern Vietnam; participants completed a cervical cancer screening questionnaire. Descriptive analyses and rural-urban differences in screening behavior, awareness, barriers, and beliefs are presented. About half of the rural and urban participants reported ever being screened for cervical cancer. Most participants showed high perceived severity of cervical cancer and benefits of screening. Further, they reported that they would screen if it was recommended by doctors and/or friends/family. However, most women showed low awareness and perceived susceptibility to cervical cancer. Logistical and psychosocial barriers to physician-based screening methods were reported. Based on our results, the World Health Organization 2030 goals for cervical cancer screening are not currently met in Southern Vietnam. Increasing health literacy and engaging doctors and family members/social networks emerged as important avenues to improve screening. HPV (Human papillomavirus) self-sampling is also a potential approach to increase uptake of cervical cancer screening given the identified psychosocial and logistical barriers.
Collapse
Affiliation(s)
- Minh Tung Phung
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Pham Le An
- Grant and Innovation Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Family Medicine Training Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Nhu Vinh
- Family Medicine Training Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hong H T C Le
- Grant and Innovation Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Karen McLean
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Gynecologic Oncology and Department of Pharmacology & Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Bhramar Mukherjee
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| | - Alice W Lee
- Department of Public Health, California State University, Fullerton, Fullerton, California, United States of America
| | - Celeste Leigh Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
| |
Collapse
|
4
|
Shero AA, Kaso AW, Tafa M, Agero G, Abdeta G, Hailu A. Cervical cancer screening utilization and associated factors among women attending antenatal care at Asella Referral and Teaching Hospital, Arsi zone, South Central Ethiopia. BMC Womens Health 2023; 23:199. [PMID: 37118809 PMCID: PMC10148404 DOI: 10.1186/s12905-023-02326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/02/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Cervical cancer is a major public health problem affecting women worldwide. It is the second cause of mortality among women in Ethiopia. Early Cervical cancer screening has a tremendous impact on reducing morbidity and mortality related to cervical cancer infection. Therefore, this study aimed to assess cervical cancer screening utilization and associated factors among women attending Antenatal Care at Asella referral and teaching hospital, Arsi Zone, south-central Ethiopia. METHOD This study employed a facility-based cross-sectional study among 457 Antenatal Care mothers from December 2020 to February 2021. Data collection was performed using interviewer-administered structured questionnaires. Data were entered into EpiInfo Version 7 and transferred to SPSS V.21 for analysis. A logistic regression model was used to determine the factors associated with cervical cancer screening utilization and an adjusted odds ratio with a 95% confidence interval at p-value < 0.05 was computed to determine the level of statistical significance. RESULT The magnitude of cervical cancer screening utilization was found to be 7.2%(95% CI: 5.2, 10.6). Educational status of secondary and above (AOR = 2.92; 95%CI = 1.078-7.94), getting screened for any reproductive healthcare services(AOR = 4.95; 95%CI = 2.24-10.94), having multiple sexual partners(AOR = 4.55; 95%CI = 1.83-11.35), and satisfactory knowledge of cervical cancer screening(AOR = 3.89; 95%CI = 1.74-8.56) were significantly associated factors with cervical cancer screening utilization. CONCLUSION Utilization of cervical cancer screening was low among women attending Antenatal care at Asella Referral and Teaching hospital, Southcentral Ethiopia. Educational status, history of multiple sexual partners, getting screened for any reproductive healthcare services, and knowledge of cervical cancer screening were significant factors associated with the utilization of cervical cancer screening. Hence, to improve the utilization of Cervical cancer screening, there should be the implementation of programmed health education and awareness creation on the benefits of screening as well as the promotion of reproductive healthcare services at health facilities.
Collapse
Affiliation(s)
- Abdulmenan Ahmed Shero
- Bokoji primary Hospital Clinical Governance and Quality Improvement Unit Coordinator, Oromia Health Bureau, Bokoji, Ethiopia
| | - Abdene Weya Kaso
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia.
| | - Mesfin Tafa
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Gebi Agero
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Gizachew Abdeta
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Alemayehu Hailu
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
5
|
Zhang E, Dai Z, Wang S, Wang X, Zhang X, Fang Q. Vaccine Literacy and Vaccination: A Systematic Review. Int J Public Health 2023; 68:1605606. [PMID: 36866001 PMCID: PMC9970990 DOI: 10.3389/ijph.2023.1605606] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Objectives: Vaccine literacy (VL) is an essential component of health literacy and is regarded as the promising technique for eliminating vaccine hesitancy. This review summarizes the relationship between VL and vaccination, including vaccine hesitancy, vaccination attitude, vaccination intention, and vaccination uptake. Methods: A systematic search was conducted in the PubMed, Embase, Web of Science, CINAHL, PsycINFO, and Cochrane Library databases. Studies that explored the relationship between VL and vaccination were included, and the PRISMA recommendations were followed. Results: 1523 studies were found, and 21 articles were selected. The earliest article was published in 2015 and focused on the HPV vaccination and VL of female college students. Three studies surveyed parents' VL about childhood vaccinations, and the remaining 17 focused on COVID-19 VL in different groups. Conclusion: Although VL plays a role in determining the level of vaccine hesitancy across various populations, the association remains unclear. In the future, additional assessment methods could be developed and used to conduct prospective cohort and longitudinal studies to determine the causal relationship between VL and vaccination.
Collapse
Affiliation(s)
- Enming Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Zhengyue Dai
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Suxing Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaolong Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Xian Zhang
- Nursing Department, Caohejing Community Health Service Center, Shanghai, China,*Correspondence: Xian Zhang, ; Qiong Fang,
| | - Qiong Fang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China,*Correspondence: Xian Zhang, ; Qiong Fang,
| |
Collapse
|
6
|
La Frinere-Sandoval QNNB, Cubbin C, DiNitto DM. Racial and ethnic disparities in cervical and breast cancer screenings by nativity and length of U.S. residence. ETHNICITY & HEALTH 2023:1-17. [PMID: 36774194 DOI: 10.1080/13557858.2023.2174254] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Previous studies of disparities in breast and cervical cancer screenings have focused on broad racial/ethnic groups or nativity status without accounting for immigration histories. Recent theoretical work argues for using intersectional approaches and examining within-group inequalities. Utilizing multiple years of National Health Interview Survey (NHIS) data, we examined between- and within-group Papanicolaou (Pap) test and mammogram screening based on nativity and length of U.S. residence for Asian and Hispanic women, along with non-Hispanic Black and White women. DESIGN The study samples consist of 54,900 women ages 21-64 without a hysterectomy who responded to questions about Pap test screening and 36,300 women ages 40-64 who responded to questions about mammogram screening. Asian and Hispanic women were further stratified by nativity and, for immigrants, length of time in the United States. Logistic regression analysis was used to identify significant associations with Pap test and mammogram screenings. RESULTS Recent Asian and Hispanic immigrants had the lowest Pap test and mammogram rates among all other groups, while Black (and White women for mammograms) women had the highest rates. After accounting for age, marital status, health insurance, education, employment status, and income, both Asian groups had lower odds, and Black and all Hispanic groups had higher odds of Pap test screening compared with White women. Similar results were observed for mammogram screening, except that long-term immigrant/U.S.-born Asian and U.S.-born Hispanic women did not have significantly different odds compared with White women. In general, the strength and direction of most sociodemographic variables were similar across groups for Pap test screening but differed for mammogram screening. CONCLUSIONS The between-group differences identified emphasize the disparities in screening between racial/ethnic groups while the within-group differences suggest the need to examine whether more targeted outreach efforts and prevention messages can increase screening for specific groups.
Collapse
Affiliation(s)
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas, Austin, Austin, TX, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, The University of Texas, Austin, Austin, TX, USA
| |
Collapse
|
7
|
Ma GX, Zhu L, Zhai S, Lin TR, Tan Y, Johnson C, Fang CY, Belinson JL, Wang MQ. Empowering Low-Income Asian American Women to Conduct Human Papillomavirus Self-Sampling Test: A Community-Engaged and Culturally Tailored Intervention. Cancer Control 2022; 29:10732748221076813. [PMID: 35193408 PMCID: PMC8874186 DOI: 10.1177/10732748221076813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Asian American women face disproportionate burden of cervical cancer (CC) than non-Hispanic white women in the U.S. The goal of this study was to assess the feasibility and impact of a culturally tailored intervention to promote Human papillomavirus (HPV) self-sampling test among hard-to-reach Asian American women. METHODS We adopted the community-based participatory research (CBPR) approach to conduct this efficacy study. A total of 156 female participants (56 Chinese, 50 Korean, and 50 Vietnamese) were recruited from community-based organizations (CBOs) in the greater Philadelphia metropolitan area. The intervention components included HPV-related education, HPV self-sampling test kit and instructions, group discussions, and patient navigations, all available in Asian languages. We examined several outcomes, including the completion of HPV self-sampling, HPV-related knowledge, perceived social support, self-efficacy, and comfort with the self-sampling test at post-intervention assessment. RESULTS The majority of Asian American women had low annual household income (62.3% earned less than $20,000) and low educational attainment (61.3% without a college degree). We found significant increase in participants' knowledge on HPV (baseline: 2.83, post: 4.89, P <.001), social support (baseline: 3.91, post: 4.09, P < .001), self-efficacy (baseline: 3.05, post: 3.59, P < .001), and comfortable with HPV self-sample test (baseline: 3.62, post: 4.06, P < .001). CONCLUSION To the best of our knowledge, this is the first intervention study that promoted HPV self-sampling test among Asian American women. Our findings showed that CBPR culturally tailored intervention of self-sampling was highly effective in empowering low-income Asian American women to conduct HPV self-sampling tests.
Collapse
Affiliation(s)
- Grace X. Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shumenghui Zhai
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Timmy R. Lin
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Cicely Johnson
- Hunter College Center for Cancer Health Disparities Research, New York, NY, USA
| | - Carolyn Y. Fang
- Cancer Prevention and Control, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Jerome L. Belinson
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| |
Collapse
|
8
|
Racial-Ethnic Comparison of Guideline-Adherent Gynecologic Cancer Care in an Equal-Access System. Obstet Gynecol 2021; 137:629-640. [PMID: 33706355 DOI: 10.1097/aog.0000000000004325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare receipt of National Comprehensive Cancer Network Guideline-adherent treatment for gynecologic cancers, inclusive of uterine, cervical, and ovarian cancer, between non-Hispanic White women and racial-ethnic minority women in the equal-access Military Health System. METHODS We accessed MilCanEpi, which links data from the Department of Defense Central Cancer Registry and Military Health System Data Repository administrative claims data, to identify a cohort of women aged 18-79 years who were diagnosed with uterine, cervical, or ovarian cancer between January 1, 1998, and December 31, 2014. Information on tumor stage, grade, and histology was used to determine which treatment(s) (surgery, chemotherapy, radiotherapy) was indicated for each patient according to the National Comprehensive Cancer Network Guidelines during the period of the data (1998-2014). We compared non-Hispanic Black, Asian, and Hispanic women with non-Hispanic White women in their likelihood to receive guideline-adherent treatment using multivariable logistic regression models given as adjusted odds ratios (aORs) and 95% CIs. RESULTS The study included 3,354 women diagnosed with a gynecologic cancer of whom 68.7% were non-Hispanic White, 15.6% Asian, 9.0% non-Hispanic Black, and 6.7% Hispanic. Overall, 77.8% of patients received guideline-adherent treatment (79.1% non-Hispanic White, 75.9% Asian, 69.3% non-Hispanic Black, and 80.5% Hispanic). Guideline-adherent treatment was similar in Asian compared with non-Hispanic White patients (aOR 1.18, 95% CI 0.84-1.48) or Hispanic compared with non-Hispanic White women (aOR 1.30, 95% CI 0.86-1.96). Non-Hispanic Black patients were marginally less likely to receive guideline-adherent treatment compared with non-Hispanic White women (aOR 0.73, 95% CI 0.53-1.00, P=.011) and significantly less likely to receive guideline-adherent treatment than either Asian (aOR 0.65, 95% CI 0.44-0.97) or Hispanic patients (aOR 0.56, 95% CI 0.34-0.92). CONCLUSION Racial-ethnic differences in guideline-adherent care among patients in the equal-access Military Health System suggest factors other than access to care contributed to the observed disparities.
Collapse
|
9
|
Cudjoe J, Budhathoki C, Roter D, Gallo JJ, Sharps P, Han HR. Exploring Health Literacy and the Correlates of Pap Testing Among African Immigrant Women: Findings from the AfroPap Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:441-451. [PMID: 32410109 PMCID: PMC7666038 DOI: 10.1007/s13187-020-01755-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
African immigrant (AI) women have low rates of Pap testing. Health literacy plays a pivotal role in health behaviors. Sources and types of health information could shape health literacy and inform the Pap testing behaviors of AI women. However, the influences of health literacy, sources, and types of health information along with cultural and psychosocial correlates on the Pap testing behaviors of AI women are poorly understood. To examine how sources and types of health information impact health literacy, and in turn, how health literacy and cultural and psychosocial factors influence the Pap testing behaviors of AI women. An adapted Health Literacy Skills Framework guided the selection of variables for this cross-sectional study. Convenience sampling was used to recruit 167 AI women, 21-65 years. Multivariate logistic regression was used to assess correlates of Pap testing after adjusting for covariates (age, education, English proficiency, employment, income, health insurance, access to primary care, marital status, and healthcare provider recommendation). Most participants (71%) had received a Pap test in the past and used multiple (two or more) sources (65%) and types (57%) of health information. Using multiple sources of health information (aOR 0.11, p < 0.01) but not types of health information was associated with Pap testing. Having negative cultural beliefs (aOR 0.17, p = 0.01) and having high self-efficacy (aOR 9.38, p < 0.01) were significantly associated with Pap testing after adjusting for covariates. High health literacy (OR 3.23, p < 0.05) and high decisional balance (OR 5.28, p < 0.001) were associated with Pap testing in bivariate models but did not remain significant after controlling for covariates. Cultural beliefs was a significant correlate of AI women's Pap testing behaviors regardless of other known social determinants of health (education, English proficiency, age, access to primary care). Disseminating health information through various sources has the potential to promote Pap testing among AI women. Larger studies which utilize a robust sampling strategy and include a diverse group of AI women are needed in order to optimize health interventions aimed at improving Pap test screening behaviors among AI women.
Collapse
Affiliation(s)
- Joycelyn Cudjoe
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA.
- Inova Health System, 8110 Gatehouse Road Suite 200W, Falls Church, VA, 22042, USA.
| | - Chakra Budhathoki
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Debra Roter
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Joseph J Gallo
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Phyllis Sharps
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Hae-Ra Han
- Johns Hopkins School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, USA
| |
Collapse
|
10
|
Lee HY, Li Q, Luo Y, Wang K, Hendrix S, Lee J, Yoon S, Nguyen Vu QH. Is Pap Test Awareness Critical to Pap Test Uptake in Women Living in Rural Vietnam? Asian Pac J Cancer Prev 2021; 22:903-908. [PMID: 33773556 PMCID: PMC8286658 DOI: 10.31557/apjcp.2021.22.3.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Cervical cancer is the second leading cause of cancer death among Vietnamese females. By detecting precancerous cells, Pap test screening plays a critical role in the fight against cervical cancer. The present study aims to investigate health-related factors associated with receipt of Pap test among Vietnamese females living in rural Vietnam, particularly examining the correlation between awareness level of the Pap test and the receiving of Pap test. Methods: Anderson’s Behavioral Model of Health Services Use was utilized as the present study’s theoretical framework. A self-administrated questionnaire was completed among 193 females residing in Quantri City, Vietnam. Results: Only 15.5% (N=30) of participants in our sample have had a Pap test. Pap test awareness (OR = 18.38, p<.001) was a strong predictor of Pap test receipt. Participants who had heard about Pap test were 18.38 times more likely to take a Pap test compared to those who had no prior knowledge. Besides the awareness, variables including employment (OR = .18, p<.05), and health insurance coverage (OR = 10.75, p<.05) were significantly associated with Pap test uptake. Conclusion: Findings from the present study suggests interventions should be provided through public health efforts to enhance awareness of Pap test by aiming at increasing primary prevention of cervical cancer, especially among Vietnamese women living in rural areas, in order to reduce cancer health disparities.
Collapse
Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL
| | - Qingyi Li
- School of Social Work, University of Alabama, Tuscaloosa, AL
| | - Yan Luo
- School of Social Work, University of Alabama, Tuscaloosa, AL
| | - Kun Wang
- School of Social Work, University of Alabama, Tuscaloosa, AL
| | - Sara Hendrix
- Department of Health Sciences, University of Alabama, Tuscaloosa, AL
| | - Jongwook Lee
- Department of Agricultural Economics and Rural Development, Seoul National University, Building, Seoul, Republic of Korea
| | - Sangchul Yoon
- Department of Global Health, Graduate School of Public School, Yonsei University, Seoul, South Korea
| | | |
Collapse
|
11
|
Fernández-Esquer ME, Nguyen FM, Atkinson JS, Le YC, Chen S, Huynh TN, Schick V. Sức Khỏe là Hạnh Phúc (Health is Happiness): promoting mammography and pap test adherence among Vietnamese nail salon workers. Women Health 2020; 60:1206-1217. [PMID: 32990199 DOI: 10.1080/03630242.2020.1811834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Vietnamese nail salon workers have low cancer screening rates and confront multiple socioeconomic disparities as immigrants to the US. The Sức Khỏe là Hạnh Phúc (Vietnamese for "Health is Happiness") program was adapted to the cultural and work needs of this population and implemented at nail salons to increase cancer screening adherence. A total of 186 study participants were recruited from 59 nail salons in a neighborhood with mostly Asian population. After being pretested, workers were enrolled in a cancer education session delivered by Vietnamese lay health workers. Non-adherent cases were offered navigation to cancer screening services to a local federally qualified health center. Participants completed a posttest survey five months, on average. At posttest, navigated non-adherent participants were more likely to report a recent Pap test compared to cases not navigated (83.8% vs. 50.0%), an effect not observed for mammography uptake (77.3% vs. 71.4%). Time in the US, marital status, insurance status, having a primary care provider and/or a gynecologist were significantly associated with cancer screening adherence. Low rates of adherence to cancer screening among Vietnamese nail salons workers can be improved by community based programs addressing cultural and work-related barriers confronted by this population.
Collapse
Affiliation(s)
- Maria Eugenia Fernández-Esquer
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center , Houston, TX, USA
| | - Frances M Nguyen
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center , Houston, TX, USA
| | - John S Atkinson
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center , Houston, TX, USA
| | - Yen-Chi Le
- McGovern Medical School, The University of Texas Health Science Center , Houston, TX, USA
| | | | | | - Vanessa Schick
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center , Houston, TX, USA
| |
Collapse
|
12
|
Abstract
OBJECTIVES This study explored the prognostic factors and developed a prediction model for Chinese-American (CA) cervical cancer (CC) patients. We compared two alternative models (the restricted mean survival time (RMST) model and the proportional baselines landmark supermodel (PBLS model, producing dynamic prediction)) versus the Cox proportional hazards model in the context of time-varying effects. SETTING AND DATA SOURCES A total of 713 CA women with CC and available covariates (age at diagnosis, International Federation of Gynecology and Obstetrics (FIGO) stage, lymph node metastasis and radiation) from the Surveillance, Epidemiology and End Results database were included. DESIGN We applied the Cox proportional hazards model to analyse the all-cause mortality with the proportional hazards assumption. Additionally, we applied two alternative models to analyse covariates with time-varying effects. The performances of the models were compared using the C-index for discrimination and the shrinkage slope for calibration. RESULTS Older patients had a worse survival rate than younger patients. Advanced FIGO stage patients showed a relatively poor survival rate and low life expectancy. Lymph node metastasis was an unfavourable prognostic factor in our models. Age at diagnosis, FIGO stage and lymph node metastasis represented time-varying effects from the PBLS model. Additionally, radiation showed no impact on survival in any model. Dynamic prediction presented a better performance for 5-year dynamic death rates than did the Cox proportional hazards model. CONCLUSIONS With the time-varying effects, the RMST model was suggested to explore diagnosis factors, and the PBLS model was recommended to predict a patient's w-year dynamic death rate.
Collapse
Affiliation(s)
- Lixian Li
- Department of Medical Matters, Puning People's Hospital, Puning, China
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Zijing Yang
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| | - Yawen Hou
- Department of Statistics, School of Economics, Jinan University, Guangzhou, China
| | - Zheng Chen
- Department of Biostatistics, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, China
| |
Collapse
|
13
|
Sutaria T, Sparks AD, Rao YJ, Lopez-Acevedo M, Long B. Trends in guideline-adherent fertility-sparing surgery for early-stage cervical cancer before and after the Affordable Care Act. Gynecol Oncol 2020; 158:424-430. [PMID: 32534810 DOI: 10.1016/j.ygyno.2020.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess trends in guideline-adherent fertility-sparing surgery (GA-FSS) for early-stage cervical cancer relative to Patient Protection and Affordable Care Act (ACA) implementation. METHODS National Cancer Database patients treated for Stage IA1-IB1 cervical cancer from 2004 to 2016 were included. Multivariable logistic regression was used to determined trends in GA-FSS relative to the ACA and identify patient factors independently associated with GA-FSS. RESULTS Odds of GA-FSS increased in the post- compared to pre-ACA cohort (aOR = 1.65; 95%CI: 1.34-2.03). Decreasing age, Asian/Pacific Islander race, higher education and income levels, more recent treatment year, and lower clinical stage were independently associated with increased odds of receiving GA-FSS. In the pre- and post-ACA samples, decreasing age (per 1 year age increase; pre-ACA aOR = 0.87, 95%CI:0.85-0.90; post-ACA aOR = 0.85, 95%CI:0.83-0.87), higher education level (top vs. lowest education quartile; pre-ACA aOR = 2.08, 95%CI:1.19-3.65; post-ACA aOR = 2.00, 95%CI:1.43-2.80), and lower clinical stage (stages IA2 [pre-ACA aOR = 0.19, 95%CI:0.09-0.41; post-ACA aOR = 0.29, 95%CI:0.19-0.45] and IB1 [pre-ACA aOR = 0.06, 95%CI:0.06-0.16; post-ACA aOR = 0.16, 95%CI: 0.12-0.20] relative to stage IA1) were independently associated with increased odds of GA-FSS receipt. After the ACA, Asian/Pacific Islander race (aOR = 2.81, 95%CI: 1.81-4.36) and more recent treatment year (Spearman's ρ = 0.0348, p-value = 0.008) were also independently associated with increased odds of GA-FSS receipt. When adjusted for the pre- vs. post-ACA treatment periods, Medicaid patients were less likely to undergo GA-FSS than privately-insured patients (aOR = 1.65; 95%CI:1.34-2.03). CONCLUSIONS Patients were more likely to receive GA-FSS post-ACA. Though the proportion of publicly-insured women increased after ACA implementation, women on Medicaid remained less likely to receive GA-FSS than women with private insurance.
Collapse
Affiliation(s)
- Tarangi Sutaria
- The George Washington University School of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Washington, D.C., United States of America.
| | - Andrew D Sparks
- The George Washington University Medicine and Health Sciences, Department of Surgery, Washington, D.C., United States of America
| | - Yuan James Rao
- The George Washington University Medicine and Health Sciences, Department of Radiation Oncology, Washington, D.C., United States of America
| | - Micael Lopez-Acevedo
- The George Washington University Medicine and Health Sciences, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington, D.C., United States of America
| | - Beverly Long
- The George Washington University Medicine and Health Sciences, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington, D.C., United States of America
| |
Collapse
|
14
|
Lee HY, Beltran R, Kim NK, Lee DK. Racial Disparities in Cervical Cancer Screening: Implications for Relieving Cervical Cancer Burden in Asian American Pacific Islander Women. Cancer Nurs 2020; 42:458-467. [PMID: 30624249 DOI: 10.1097/ncc.0000000000000642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While cervical cancer is considered preventable and the overall Papanicolaou (Pap) test utilization rate has gradually increased in the United States, certain Asian American Pacific Islander (AAPI) women consistently rate lower in Pap test receipt compared with non-Latina whites (NLWs), leading to a higher cervical cancer mortality rate for various AAPI women. Few studies, however, have focused on female AAPI college students' cervical cancer screening behavior in comparison with NLW students. OBJECTIVE This study aimed to investigate cervical cancer screening behaviors among college-aged females by (1) determining AAPIs' and NLWs' screening rates, (2) assessing their knowledge about Pap tests, and (3) discovering factors associated with Pap test receipt. Andersen's Health Behavioral Model was used as a theoretical framework. METHODS Using a simple random sampling strategy, 2270 female students (15% AAPIs, 85% NLWs) completed an online health survey. RESULTS Results indicate AAPI students had significantly lower Pap test knowledge and Pap test receipt rate compared with NLW students. Age, nativity, human papillomavirus vaccination completion, frequency of obstetrician/gynecologist (OB/GYN) visits, and the number of sexual partners were associated with AAPI students' lower rate of Pap test receipt, whereas the Pap test receipt rate for NLW students was influenced by the same factors with the addition of having increased prior knowledge about Pap tests. CONCLUSION Results show the importance of OB/GYN visits in obtaining Pap tests for AAPI and NLW students. IMPLICATION FOR PRACTICE Health practitioners should pay attention to students' race/ethnicity in their practice and provide corresponding ethnic group-specific preventive care.
Collapse
Affiliation(s)
- Hee Yun Lee
- Author Affiliations: School of Social Work, University of Alabama, Tuscaloosa (Dr Lee); and School of Social Work (Ms Beltran), Department of Educational Psychology (Mr Kim), and School of Medicine (Mr Lee), University of Minnesota, Twin Cities
| | | | | | | |
Collapse
|
15
|
Shankar A, Roy S, Rath GK, Chakraborty A, Kamal VK, Biswas AS. Impact of Cancer Awareness Drive on Generating Awareness of and Improving Screening for Cervical Cancer: A Study Among Schoolteachers in India. J Glob Oncol 2019; 4:1-7. [PMID: 30241246 PMCID: PMC6223415 DOI: 10.1200/jgo.17.00074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose Cervical cancer is the second most common cancer in India. Our study assessed the level and impact of awareness programs in the adoption of safe practices in prevention and early detection. Methods This assessment was part of a Pink Chain Campaign, the mission of which is to fight cancer. During cancer awareness events from 2013 to 2015 at various women’s colleges in different parts in India, a pretest related to cervical cancer was followed by an awareness program. A post-test was conducted 6 months and 1 year later. Results A total of 872 of 985 teachers participated in the study, for a response rate of 88.5%. Mean age of the population was 42.4 years. There was a significant increase in the level of knowledge regarding cervical cancer at 6 months, which was sustained at 1 year. Regarding cervical cancer screening, knowledge and practice of the Papanicolaou (Pap) test as a screening test for cervical cancer among teachers were changed significantly at 6 months and 1 year. More than 75% of teachers were educated by physicians about the Pap test. At the time of the post-test, there was a significant change in alcohol and smoking habits. The main reasons for not undergoing a screening test were ignorance (50%), lethargic attitude (44.8%), and lack of time (34.6%). Conclusion The level of knowledge of cervical cancer was poor. A significant increase in the level of knowledge of cervical cancer among the population was found after this study. To inculcate safe lifestyle practices, awareness programs should be conducted more widely and frequently.
Collapse
Affiliation(s)
- Abhishek Shankar
- Abhishek Shankar and Goura Kishor Rath, Dr BR Ambedkar Institute Rotary Cancer Hospital; Abhishek Shankar, Goura Kishor Rath, and Vineet Kumar Kamal, All India Institute of Medical Sciences; Shubham Roy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi; Abhijit Chakraborty, Netaji Subhas Chandra Bose Cancer Research Institute; and Aalekhya Sharma Biswas, Maulana Abul Kalam Azad University of Technology, Kolkata, India
| | - Shubham Roy
- Abhishek Shankar and Goura Kishor Rath, Dr BR Ambedkar Institute Rotary Cancer Hospital; Abhishek Shankar, Goura Kishor Rath, and Vineet Kumar Kamal, All India Institute of Medical Sciences; Shubham Roy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi; Abhijit Chakraborty, Netaji Subhas Chandra Bose Cancer Research Institute; and Aalekhya Sharma Biswas, Maulana Abul Kalam Azad University of Technology, Kolkata, India
| | - Goura Kishor Rath
- Abhishek Shankar and Goura Kishor Rath, Dr BR Ambedkar Institute Rotary Cancer Hospital; Abhishek Shankar, Goura Kishor Rath, and Vineet Kumar Kamal, All India Institute of Medical Sciences; Shubham Roy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi; Abhijit Chakraborty, Netaji Subhas Chandra Bose Cancer Research Institute; and Aalekhya Sharma Biswas, Maulana Abul Kalam Azad University of Technology, Kolkata, India
| | - Abhijit Chakraborty
- Abhishek Shankar and Goura Kishor Rath, Dr BR Ambedkar Institute Rotary Cancer Hospital; Abhishek Shankar, Goura Kishor Rath, and Vineet Kumar Kamal, All India Institute of Medical Sciences; Shubham Roy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi; Abhijit Chakraborty, Netaji Subhas Chandra Bose Cancer Research Institute; and Aalekhya Sharma Biswas, Maulana Abul Kalam Azad University of Technology, Kolkata, India
| | - Vineet Kumar Kamal
- Abhishek Shankar and Goura Kishor Rath, Dr BR Ambedkar Institute Rotary Cancer Hospital; Abhishek Shankar, Goura Kishor Rath, and Vineet Kumar Kamal, All India Institute of Medical Sciences; Shubham Roy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi; Abhijit Chakraborty, Netaji Subhas Chandra Bose Cancer Research Institute; and Aalekhya Sharma Biswas, Maulana Abul Kalam Azad University of Technology, Kolkata, India
| | - Aalekhya Sharma Biswas
- Abhishek Shankar and Goura Kishor Rath, Dr BR Ambedkar Institute Rotary Cancer Hospital; Abhishek Shankar, Goura Kishor Rath, and Vineet Kumar Kamal, All India Institute of Medical Sciences; Shubham Roy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi; Abhijit Chakraborty, Netaji Subhas Chandra Bose Cancer Research Institute; and Aalekhya Sharma Biswas, Maulana Abul Kalam Azad University of Technology, Kolkata, India
| |
Collapse
|
16
|
Sarpel U, Huang X, Austin C, Gany F. Barriers to Care in Chinese Immigrants with Hepatocellular Carcinoma: A Focus Group Study in New York City. J Community Health 2018; 43:1161-1171. [PMID: 29948526 DOI: 10.1007/s10900-018-0536-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of hepatocellular carcinoma (HCC) is rising sharply in the United States and deaths from HCC have increased at the highest rate of all cancers. Though Asians have the highest incidence of HCC of all ethnicities in the US, racial/ethnic minorities, including Asians, have worse survival from HCC. We sought to identify barriers to care in treatment of HCC among affected individuals in the NYC Chinese immigrant community. We held focus groups with Chinese immigrant patients in NYC with HCC. 29 individuals participated in the focus groups. We analyzed focus group data using grounded theory methodology. Barriers to care identified included insurance, money, time, language, residency status, and stigma. The impact of provider bias and culture were also discussed. Knowledge gathering with minority patients with HCC is essential for us to fully comprehend the barriers to healthcare experienced by this community. Future policy and intervention efforts must be founded in this reality.
Collapse
Affiliation(s)
- Umut Sarpel
- Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, 19 E 98th St., Ste 7A, New York, NY, 10029, USA.
| | - Xiaoxiao Huang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Francesca Gany
- Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
17
|
Abulizi G, Abulimiti T, Li H, Abuduxikuer G, Mijiti P, Zhang SQ, Maimaiti A, Tuergan M, Simayi A, Maimaiti M. Knowledge of cervical cancer and Pap smear among Uyghur women from Xinjiang, China. BMC WOMENS HEALTH 2018; 18:21. [PMID: 29343254 PMCID: PMC5773149 DOI: 10.1186/s12905-018-0512-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 01/07/2018] [Indexed: 12/22/2022]
Abstract
Background Cervical cancer is a significant public health issue in Xinjiang China. In order to provide scientific basis for cervical cancer intervention in Xinjiang, women’s knowledge of cervical cancer was investigated in this study. Besides, relations between Uyghur women’s awareness and their age, educational background, yearly household were evaluated. Methods Questionnaire survey was conducted to 7100 Uyghur women from Karkax Hotan and Payzivat Kashgar during 2008 and 2009. Women aged 21 to 70 years, had sexual activity, no history of cervical lesion or cervical cancer were considered to be eligible to the study. Information include participants’ socio-demographic background, personal data, awareness about Pap smear, about cervical cancer and HPV, sources of information acquisition was investigated. Results 65.1% of the 7100 respondents with primary education level, and 95.0% participants were farmers. Only 7.4% had undertaken Pap smears before, not aware of the importance of the test (97.4% of 7100) was the main reason for not performing Pap smears. 29.3% of total participants had heard about cervical cancer, and only 0.14% (10 out of 7100) had heard about HPV. Top three route of knowledge acquire were television advertises (39.1%), neighbors (21.0%) and health care providers (15.0%). Women younger than 40 years, with higher educational levels and higher income had better awareness of cervical cancer and more willing to accept regular Pap smears. Conclusions Uyghur women in Xinjiang had poor knowledge of cervical cancer and HPV infection. Low awareness of women was associated with less household income and lower educational levels. TV shows and education from health care providers may increase women’s participation in cervical cancer control and prevention. Electronic supplementary material The online version of this article (doi: 10.1186/s12905-018-0512-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Guzhalinuer Abulizi
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, No.789, Suzhou East Road, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China.
| | - Tangnuer Abulimiti
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, No.789, Suzhou East Road, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Hua Li
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, No.789, Suzhou East Road, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Guzhalinuer Abuduxikuer
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, No.789, Suzhou East Road, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Patiman Mijiti
- 5th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, No.789, Suzhou East Road, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Su-Qin Zhang
- Surgery Department of Gynecological Oncology, Cancer Center of Guangzhou Medical University, No.78 Heng Ji Gang Road, Guangzhou, 510095, China
| | - Ayinuer Maimaiti
- 6th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, No.789, Suzhou East Road, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Muyasier Tuergan
- 6th Department of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, No.789, Suzhou East Road, Urumqi, Xinjiang Uyghur Autonomous Region, 830054, China
| | - Ayiguli Simayi
- Department of Gynecology, Kelamayi Central Hospital, No.67 Zhun Ge Er Road, Kelamayi, Xinjiang Uyghur Autonomous Region, 834000, China
| | - Miherinisha Maimaiti
- Department of Gynecology, People's Hospital of Xinjiang Uyghur Autonomous Region, No. 91 Tian Chi Road, Urumqi, Xinjiang Uyghur Autonomous Region, 834000, China
| |
Collapse
|
18
|
Seo JY, Li J, Li K. Cervical Cancer Screening Experiences Among Chinese American Immigrant Women in the United States. J Obstet Gynecol Neonatal Nurs 2018; 47:52-63. [PMID: 29144960 PMCID: PMC6260927 DOI: 10.1016/j.jogn.2017.10.003] [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] [Accepted: 10/01/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To understand the experiences and perceptions of having cervical cancer screening tests and to explore the extant barriers to having the tests among first-generation Chinese American women in the United States. DESIGN Qualitative, descriptive, phenomenological research. SETTING Los Angeles, California. PARTICIPANTS Snowball and purposive sampling of 12 Chinese American immigrant women ages 20 to 65 years. METHODS Individual face-to-face, in-depth, semistructured interviews in which participants were asked about their experiences and perceptions about cervical cancer screening. Interviews were audiotaped, transcribed, and translated into English. Data analysis included comparing and distinguishing, collecting and counting, and presupposing and inferring. RESULTS Through the analysis process, we identified four major themes that reflected the experiences, perceptions, and barriers to having cervical cancer screening among Chinese American women: Belief in a Healthy Lifestyle, Maintaining Privacy for Female Health Problems, Fear of Losing Control, and Feeling Vulnerable in an Unfamiliar Health Care System. These themes indicated that Chinese immigrant women in the United States face challenges to their cultural health beliefs and practices with regard to decision-making and health-seeking behaviors related to cervical cancer screening. They felt more vulnerable as immigrants because of systematic barriers to navigation of the unfamiliar health care system and limited resources. CONCLUSION Women's health care providers should be aware of and give consideration to cultural differences through the provision of more educational information and comfort to Chinese immigrant women who seek cervical cancer screening. Ultimately, the development of culturally appropriate and affordable cancer prevention programs with effective strategies is important to ease Chinese American women's senses of vulnerability.
Collapse
|
19
|
Soares MBO, Silva SRD. Interventions that facilitate adherence to Pap smear exam: integrative review. Rev Bras Enferm 2017; 69:404-14. [PMID: 27280579 DOI: 10.1590/0034-7167.2016690226i] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 12/26/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: identificar produções científicas que apresentem intervenções relevantes para implementar o Programa de Prevenção do Câncer Cérvico-Uterino, aumentando a adesão à realização do exame. Método: revisão integrativa da literatura, realizada por busca on-line, nas bases de dados: LILACS, SciELO e Pubmed®, abrangendo artigos publicados de 2009 a 2014. Resultados: trinta e oito artigos compuseram a amostra final do estudo. Estes indicaram as seguintes intervenções: utilização de gerente de caso, contato telefônico, carta-convite, atividades educativas, divulgação na mídia, agentes de saúde da comunidade, parcerias, rastreamento de base populacional e múltiplas intervenções. Conclusão: as pesquisas concentram-se entre mulheres provenientes de países em desenvolvimento, e estas intervenções são eficazes no aumento da adesão e do conhecimento destas mulheres em relação à prevenção do câncer cérvico-uterino.
Collapse
Affiliation(s)
- Maurícia Brochado Oliveira Soares
- Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Atenção à Saúde, Uberaba MG , Brazil, Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Atenção à Saúde. Uberaba-MG, Brasil., Universidade Federal do Triângulo Mineiro
| | - Sueli Riul da Silva
- Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Atenção à Saúde, Uberaba MG , Brazil, Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Atenção à Saúde. Uberaba-MG, Brasil., Universidade Federal do Triângulo Mineiro
| |
Collapse
|
20
|
Hopfer S, Garcia S, Duong HT, Russo JA, Tanjasiri SP. A Narrative Engagement Framework to Understand HPV Vaccination Among Latina and Vietnamese Women in a Planned Parenthood Setting. HEALTH EDUCATION & BEHAVIOR 2017; 44:738-747. [PMID: 28854812 DOI: 10.1177/1090198117728761] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Disparities in cervical cancer and human papillomavirus (HPV) vaccination persist among Vietnamese and Latina women. Through a partnership with Planned Parenthood of Orange and San Bernardino Counties (PPOSBC) in Southern California, we conducted in-depth interviews with young adult Latina ( n = 24) and Vietnamese ( n = 24) women, and PPOSBC staff ( n = 2). We purposively sampled vaccinated women to elicit HPV vaccine decision narratives to uncover rich data on motivators, cultural values, and implicit vaccine attitudes. Unvaccinated women were interviewed to identify barriers. Women were also asked to discuss their observations of men's HPV vaccine attitudes. Narrative engagement theory guided the study privileging the meaning women ascribed to their experiences and conversations related to vaccine decision making. Vaccine decision narratives included (a) mother-daughter narratives, (b) practitioner recommendation of HPV vaccination, (c) independence narratives among Vietnamese women, (d) HPV (un)awareness narratives, and (d) school exposure to HPV knowledge. Barriers to vaccinating included trust in partner HPV status, and family silence and stigma about sexual health. Participants conveyed the importance of including messages aimed at reaching men. Practitioners described insurance barriers to offering same day vaccination at PPOSBC health center visits. Narrative communication theory and methodology address health equity by privileging how Vietnamese and Latina women ascribe meaning to their lived experiences and conversations about HPV vaccination. Identifying authentic and relatable vaccine decision narratives will be necessary to effectively engage Vietnamese and Latina women. These findings will guide the process of adapting an existing National Cancer Institute research-tested HPV vaccine intervention.
Collapse
|
21
|
Impact of a student-led community education program to promote Pap test screening among Asian-American women. J Am Soc Cytopathol 2017; 6:145-154. [PMID: 31043267 DOI: 10.1016/j.jasc.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Among ethnic groups, Asian-American women have the highest incidence of cervical cancer, low cervical cancer screening rates, and are more likely to state they have "never thought about" and/or "do not need" Pap testing. Through a Patient Advocacy grant awarded by the American Society of Cytopathology Foundation, we developed a culturally sensitive educational outreach program to encourage Pap screening among Asian-Americans in our community. MATERIALS AND METHODS Educational materials, translated into three languages, were shared at nine community events by undergraduate and medical student volunteers. Pre- and post-education surveys on awareness, knowledge, and attitudes towards screening were administered. Results were tallied and reported as raw percentages. RESULTS A total of 328 surveys were completed; 80% were Asian respondents. Twenty percent of respondents were not up to date (NUTD) with Pap screening. Knowledge of Pap tests reported as "excellent"/"good" rose from 46% before to 85% after education. Those reporting "very likely"/"likely" to schedule a Pap test increased from 72% to 92% in the NUTD group and from 84% to 97% in the 21-29 age group. Those reporting "very likely"/"likely" to recommend a Pap test to others increased from 68% to 98% in the NUTD group and 77% to 97% in those aged 21-29. CONCLUSIONS A student-led community-based culturally sensitive outreach approach improved Pap test knowledge and awareness among Asian-Americans. The largest increase in likelihood to obtain a Pap test and recommend the test to others was the NUTD and 21-29 age groups, suggesting influence on those in need of screening.
Collapse
|
22
|
Burton-Jeangros C, Cullati S, Manor O, Courvoisier DS, Bouchardy C, Guessous I. Cervical cancer screening in Switzerland: cross-sectional trends (1992-2012) in social inequalities. Eur J Public Health 2017; 27:167-173. [PMID: 28177486 PMCID: PMC5421499 DOI: 10.1093/eurpub/ckw113] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Incidence and mortality of cervical cancer declined thanks to Pap smear screening. However cervical cancer screening (CCS) inequalities are documented, including in high income countries. This population-based study aims to assess the importance and 20-year trends of CCS inequalities in Switzerland, where healthcare costs and medical coverage are among the highest in the world. Methods: We analyzed data from five waves of the population-based Swiss Health Interview Survey (SHIS) covering the period 1992–2012. Multivariable Poisson regression were used to estimate weighted prevalence ratios (PR) of CCS and 95% Confidence Intervals (CI) adjusting for socio-economic, socio-demographic characteristics, family status, health status, and use of healthcare. Results: The study included 32’651 women aged between 20 and 70 years old. Between 1992 and 2012, rates of CCS over the past 3 years fluctuated between 71.7 and 79.6% (adjusted P < 0.001). Lower CCS was observed among women with low education, low income, those having limited emotional support, who were non-Swiss, single, older, living in non-metropolitan area or in the French-speaking region, overweight. Over the analyzed period, differences in CCS across age groups diminished while rates among women who visited a GP over the previous year, versus those who did not, increased. Conclusions : While important changes occurred in screening recommendations and in social circumstances of the targeted population, CCS rates remained fairly stable in Switzerland between 1992 and 2012. At the same time, inequalities in CCS persisted over that period.
Collapse
Affiliation(s)
- Claudine Burton-Jeangros
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
- Swiss National Centre of Competence for Research ‘LIVES - Overcoming Vulnerability: Life Course Perspectives’, Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Swiss National Centre of Competence for Research ‘LIVES - Overcoming Vulnerability: Life Course Perspectives’, Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
| | - Orly Manor
- School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Christine Bouchardy
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Department of Epidemiology, Emory University, Atlanta, GA, USA
- Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
23
|
Shankar A, Roy S, Malik A, Rath GK, Julka PK, Kamal VK, Barnwal K, Upadhyaya S, Singh R, Srivastava V. Level of Awareness of Various Aspects of Lung Cancer Among College Teachers in India: Impact of Cancer Awareness Programmes in Prevention and Early Detection. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:709-714. [PMID: 26687206 DOI: 10.1007/s13187-015-0960-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Lung cancer is one of the most common causes of cancer mortality among men in India and incidence is increasing, but actually, they are largely preventable diseases. In India, advanced stage at the time of presentation is responsible for high mortality and morbidity and early detection is the only way to reduce it. The purpose of this study is to know the level of awareness of various aspects of lung cancer among college teachers and impact of awareness programmes in its prevention and early detection. This assessment was part of Pink Chain Campaign-a campaign on cancer awareness. During the cancer awareness events in 2011-2013 at various women colleges in different parts in India, pre-test related to lung cancer was followed by awareness programme. Post-test using the same questionnaire was conducted at the end of interactive session, at 6 months and 1 year. A total of 872 out of 985 teachers participated in the study (overall response rate was 88.5 %). Mean age of the study population was 41.6 years (range 26-59 years). There was a significant increase in the level of knowledge regarding lung cancer at 6 months, and this was sustained at 1 year. Among teachers who were just asked yes or no question, 117 teachers (13.4 %) were smokers and 241 teachers (27.6 %) were alcoholics. Magazines and newspapers were sources for knowledge in 50-60 % of teachers, whereas approximately 30 % of teachers were educated by TV and Internet regarding various aspects of lung cancer. Post awareness at 6 months and 1 year, Pink Chain Campaign was the major source of knowledge related to lung cancer in more than 90 % of teachers by continuous and timely update on subject. Post awareness at 6 months and 1 year, there was a significant change in alcohol and smoking habits. Major reasons for not going for check-up were ignorance (83.1 %), fear (30.1 %) and lethargic attitude (29.3 %) initially, but over time, lack of time, lethargic attitude and hesitation became important factors after knowing various aspects of lung cancer. Knowledge of lung cancer was very low among teachers. Overall awareness of risk factors, sign and symptoms, screening modalities of lung cancer has improved in a year along with practices related to smoking and alcohol, but there was not much improvement in people undergoing regular check-ups. To inculcate safe practices in the lifestyle of people, awareness programmes such as the Pink Chain Campaign should be conducted more widely and frequently.
Collapse
Affiliation(s)
- Abhishek Shankar
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India.
| | - Shubham Roy
- Department of Paediatrics, VMMC and Safdarjung Hospital, Delhi, India
| | - Abhidha Malik
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - G K Rath
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - P K Julka
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Vineet Kumar Kamal
- Department of Bio-statistics, All India Institute of Medical Sciences, AIIMS, Delhi, India
| | | | | | - Rajan Singh
- Pink Chain Campaign, Punarjeevan, Bihar, India
| | | |
Collapse
|
24
|
Mwaka AD, Orach CG, Were EM, Lyratzopoulos G, Wabinga H, Roland M. Awareness of cervical cancer risk factors and symptoms: cross-sectional community survey in post-conflict northern Uganda. Health Expect 2016; 19:854-67. [PMID: 26205470 PMCID: PMC4957614 DOI: 10.1111/hex.12382] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lack of awareness of risk factors and symptoms for cancer may lead to late diagnosis and poor prognosis. OBJECTIVE We assessed community awareness about cervical cancer risk factors and symptoms and perceptions about prevention and cure of cervical cancer in order to contribute data to inform interventions to improve cervical cancer survival. DESIGN Cross-sectional population-based survey. SETTING AND PARTICIPANTS We conducted this study in Gulu, a post-conflict district in Uganda in 2012. The sample included 448 persons aged 18 years and above, selected through a multi-stage stratified cluster sampling process. DATA COLLECTION METHODS AND ANALYSIS We collected data using a pretested structured questionnaire. Logistic regressions were used to determine magnitudes of associations between socio-demographic and outcome variables. RESULTS Most participants (444/448) had heard about cervical cancer. Known risk factors including multiple sexual partners, human papillomavirus infection, and early onset of sexual activity, were recognized by 88%, 82%, and 78% of respondents respectively. 63% of participants believed that prolonged use of family planning pills and injections caused cervical cancer. The majority of participants recognized symptoms of cervical cancer including inter-menstrual bleeding (85%), post-menopausal bleeding (84%), and offensive vaginal discharge (83%). 70% of participants believed that cervical cancer is preventable and 92% believed that it could be cured if diagnosed at an early stage. DISCUSSION AND CONCLUSIONS Recognition of cervical cancer risk factors and symptoms was high among study participants. Targeted interventions including increasing availability of HPV vaccination, population-based cervical screening and diagnostic services can translate high awareness into actual benefits.
Collapse
Affiliation(s)
- Amos D Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christopher G Orach
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Georgios Lyratzopoulos
- Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Henry Wabinga
- Kampala Cancer Registry, Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martin Roland
- Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| |
Collapse
|
25
|
Lee HY, Koopmeiners JS, McHugh J, Raveis VH, Ahluwalia JS. mHealth Pilot Study: Text Messaging Intervention to Promote HPV Vaccination. Am J Health Behav 2016; 40:67-76. [PMID: 26685815 PMCID: PMC5207484 DOI: 10.5993/ajhb.40.1.8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To test the feasibility and efficacy of a culturally-tailored mobile health intervention designed to increase knowledge about, intent to obtain, and receipt of the HPV vaccine. METHODS A 7-day text message HPV intervention was developed using a quasi-experimental research design for 30 Korean-American women. RESULTS Participants demonstrated significant increases in knowledge of HPV with an intent to get vaccinated within one year, and 30% of participants received the first dose of the HPV vaccine. CONCLUSIONS Mobile health technology could be a promising tool in reducing the cancer burden for underserved populations.
Collapse
Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Minnesota, St. Paul, MN, USA.
| | | | - Jennifer McHugh
- School of Social Work, University of Minnesota, St. Paul, MN, USA
| | | | | |
Collapse
|
26
|
Shankar A, Rath G, Roy S, Malik A, Bhandari R, Kishor K, Barnwal K, Upadyaya S, Srivastava V, Singh R. Level of awareness of cervical and breast cancer risk factors and safe practices among college teachers of different states in india: do awareness programmes have an impact on adoption of safe practices? Asian Pac J Cancer Prev 2015; 16:927-32. [PMID: 25735384 DOI: 10.7314/apjcp.2015.16.3.927] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast and cervical cancers are the most common causes of cancer mortality among women in India, but actually they are largely preventable diseases. Although early detection is the only way to reduce morbidity and mortality, there are limited data on breast and cervical cancer knowledge, safe practices and attitudes of teachers in India. The purpose of this study is to assess the level of awareness and impact of awareness programs in adoption of safe practices in prevention and early detection. MATERIALS AND METHODS This assessment was part of a pink chain campaign on cancer awareness. During cancer awareness events in 2011 at various women colleges in different parts in India, a pre-test related to cervical cancer and breast cancer was followed by an awareness program. Post-tests using the same questionnaire were conducted at the end of the interactive session, at 6 months and 1 year. RESULTS A total of 156 out of 182 teachers participated in the study (overall response rate was 85.7 %). Mean age of the study population was 42.4 years (range- 28-59 yrs). There was a significant increase in level of knowledge regarding cervical and breast cancer at 6 months and this was sustained at 1 year. Adoption of breast self examination (BSE) was significantly more frequent in comparison to CBE, mammography and the Pap test. Magazines and newspapers were sources for knowledge regarding screening tests for breast cancer in more than 60% of teachers where as more than 75% were educated by doctors regarding the Pap test. Post awareness at 6 months and 1 year, there was a significant change in alcohol and smoking habits. Major reasons for not doing screening test were found to be ignorance (50%), lethargic attitude (44.8%) and lack of time (34.6%). CONCLUSIONS Level of knowledge of breast cancer risk factors, symptoms and screening methods was high as compared to cervical cancer. There was a significant increase in level of knowledge regarding cervical and breast cancer at 6 months and this was sustained at 1 year. Adoption of BSE was significantly greater in comparison to CBE, mammography and the Pap test. To inculcate safe practices in lifestyle of people, awareness programmes such as pink chain campaign should be conducted more widely and frequently.
Collapse
Affiliation(s)
- Abhishek Shankar
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India E-mail :
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Nghiem VT, Davies KR, Chan W, Mulla ZD, Cantor SB. Disparities in cervical cancer survival among Asian-American women. Ann Epidemiol 2015; 26:28-35. [PMID: 26552330 DOI: 10.1016/j.annepidem.2015.10.004] [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: 04/07/2015] [Revised: 09/22/2015] [Accepted: 10/02/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE We compared overall survival and influencing factors between Asian-American women as a whole and by subgroup with white women with cervical cancer. METHODS Cervical cancer data were from the Surveillance, Epidemiology, and End Results registry; socioeconomic information was from the Area Health Resource File. We used standard tests to compare characteristics between groups; the Kaplan-Meier method with log-rank test to assess overall survival and compare it between groups; and Cox proportional hazards models to determine the effect of race and other covariates on overall survival (with and/or without age stratification). RESULTS Being 3.3 years older than white women at diagnosis (P < .001), Asian-American women were more likely to be in a spousal relationship, had more progressive disease, and were better off socioeconomically. Women of Filipino, Japanese, and Korean origin had similar clinical characteristics compared to white women. Asian-American women had higher 36- and 60-month survival rates (P = .004 and P = .013, respectively), higher overall survival rates (P = .049), and longer overall survival durations after adjusting for age and other covariates (hazard ratio = 0.77, 95% confidence interval: 0.68-0.86). Overall survival differed across age strata between the two racial groups. With the exception of women of Japanese or Korean origin, Asian-American women grouped by geographic origin had better overall survival than white women. CONCLUSIONS Although Asian-American women, except those of Japanese or Korean origin, had better overall survival than white women, their older age at cervical cancer diagnosis suggests that they have less access to screening programs.
Collapse
Affiliation(s)
- Van T Nghiem
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston; Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, Houston; Department of Management, Policy and Community Health, The University of Texas School of Public Health, Houston
| | - Kalatu R Davies
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Wenyaw Chan
- Department of Biostatistics, The University of Texas School of Public Health, Houston
| | - Zuber D Mulla
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso; Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston.
| |
Collapse
|
28
|
Sly J, Jandorf L, Erwin DO. Who's Missing? Predictors of Attrition Following Participation in Culturally Targeted Educational Breast and Cervical Cancer Outreach Programs for Latinas. JOURNAL OF HEALTH COMMUNICATION 2015; 20:851-858. [PMID: 26010727 DOI: 10.1080/10810730.2015.1018596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Rates of breast and cervical cancer screening among Latinas are suboptimal. The Esperanza y Vida program was developed to increase awareness of screening methods among Latinas. Lay health advisor cancer survivors are trained to deliver the program and use a narrative communication approach to promote breast and cervical cancer awareness and screening. This study aimed to identify characteristics of participants, within the larger study, who were lost, due to attrition, for follow-up assistance. Participants (N = 908) completed questionnaires that assessed knowledge, perceptions, and beliefs about breast and cervical cancer and were contacted after the program to assess screening and offer assistance in obtaining screening exams. Latinas who were younger than 40 years of age and who felt that the survivor's story would prompt them to make an appointment for screening were more likely to be lost to follow-up at 2 months. These findings have implications for future breast and cervical cancer outreach programs and interventions.
Collapse
Affiliation(s)
- Jamilia Sly
- a Department of Oncological Sciences , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | | | | |
Collapse
|
29
|
Ma GX, Fang C, Tan Y, Feng Z, Ge S, Nguyen C. Increasing cervical cancer screening among Vietnamese Americans: a community-based intervention trial. J Health Care Poor Underserved 2015; 26:36-52. [PMID: 25981087 PMCID: PMC5604232 DOI: 10.1353/hpu.2015.0064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
UNLABELLED Vietnamese women experience a significant health disparity in incidence and mortality rates and screening of cervical cancer. This study is to evaluate the effectiveness of a multifaceted and culturally appropriate intervention in increasing Pap testing rates to reduce cervical cancer disparity in this high-risk population. METHODS A total of 30 Vietnamese community organizations were randomized to either intervention or control condition. Participants (n=1,416) completed 12-month follow-up of Pap testing, their self-reported and medical record data were collected and analyzed. RESULTS The findings showed a statistically significant increase in Pap testing among intervention group than control group (significance p<.0001). The self-reported Pap test screening rate is in high agreement with that of validated medical records. CONCLUSION Results indicate the screening rate was significantly higher in Vietnamese women in the intervention group compared with the control. Despite large intervention effect, there still remains a gap to reach Healthy People 2020 goal of 93% screening rate.
Collapse
|
30
|
Lee HY, Kwon M, Vang S, DeWolfe J, Kim NK, Lee DK, Yeung M. Disparities in Human Papillomavirus Vaccine Literacy and Vaccine Completion Among Asian American Pacific Islander Undergraduates: Implications for Cancer Health Equity. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2015; 63:316-323. [PMID: 25836058 DOI: 10.1080/07448481.2015.1031237] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Low rates of human papillomavirus (HPV) vaccination among young Asian American and Pacific Islander (AAPI) women need to be addressed, particularly given the high incidence of cervical cancer in this population. The current study aims to investigate predictors of HPV vaccination in young AAPI and non-Latina white (NLW) women. METHODS A secondary data analysis was conducted of a health survey administered to college-aged women (N = 2,270) at a large public university in the Midwest. Andersen's behavioral model of health services utilization guided the study theoretically, and hierarchical logistic regression analysis was conducted to investigate research aim. RESULTS NLW women had a significantly higher rate of vaccine completion than AAPI women (NLW = 60.7%; AAPI = 38.6%). NLW women also scored higher on all 5 measures of HPV vaccine literacy than AAPI women. Both groups of undergraduate women reported that increasing age, knowledge about HPV, greater use of gynecological services, and knowing someone who had cancer were significant factors related to HPV vaccination completion. In the NLW group, father's income was also found to be a predictor of HPV vaccination completion. CONCLUSIONS Rate and predictors of HPV vaccination completion vary between NLW and AAPI women. Greater promotion of HPV literacy and gynecological service use should be made to young AAPI women to increase their HPV uptake. Further research should examine sociocultural factors that could hinder or promote HPV vaccination in young AAPI women.
Collapse
|
31
|
Abstract
Previous studies have shown an association between cervical cancer screening and racial/ethnic minority status, no usual source of care, and lower socioeconomic status. This study describes the demographics and health beliefs of women who report never being screened for cervical cancer by area of residence. Data from the 2010 Behavioral Risk Factor Surveillance System were used to study women aged 21-65 years who reported never being screened for cervical cancer. Multivariate logistic regression modeling was used to calculate predicted marginals to examine associations between never being screened and demographic characteristics and health belief model (HBM) constructs by metropolitan statistical area (MSA). After adjusting for all demographics and HBM constructs, prevalence of never being screened was higher for the following women: non-Hispanic Asians/Native Hawaiians/Pacific Islanders (16.5 %, 95 % CI = 13.7 %, 19.8 %) who live in MSAs; those with only a high school diploma who live in MSAs (5.5 %, 95 % CI = 4.7 %, 6.5 %); those living in non-MSAs who reported "fair or poor" general health (4.1 %, 95 % CI = 3.1 %, 5.4 %); and those living in either MSAs and non-MSAs unable to see a doctor within the past 12 months because of cost (MSA: 4.4 %, 95 % CI = 4.0 %, 4.8 %; non-MSA: 3.4 %, 95 % CI = 2.9 %, 3.9 %). The Affordable Care Act will expand access to insurance coverage for cervical cancer screening, without cost sharing for millions of women, essentially eliminating insurance costs as a barrier. Future interventions for women who have never been screened should focus on promoting the importance of screening and reaching non-Hispanic Asians/Native Hawaiians/Pacific Islanders who live in MSAs.
Collapse
|
32
|
Tripathi N, Kadam YR, Dhobale RV, Gore AD. Barriers for early detection of cancer amongst Indian rural women. South Asian J Cancer 2014; 3:122-7. [PMID: 24818108 PMCID: PMC4014643 DOI: 10.4103/2278-330x.130449] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Breast and cervical cancer are the most common causes of cancer mortality among women worldwide, but actually they are largely preventable diseases. Healthcare providers in developing countries regularly see women with advanced, incurable cancers. Health of a rural Indian women and her access to health facility is compromised due to sociocultural, economical, and environmental factors. AIMS To know the problems associated with early detection of cancers in rural women. SETTINGS AND DESIGN Rural area and cross-sectional. SUBJECTS AND METHODS STUDY SUBJECT: Women of 35 years and above. EXCLUSION CRITERIA Not willing to participate. SAMPLE SIZE All eligible women of selected villages. SAMPLING TECHNIQUE Random selection of villages. Study duration: 2 months. Study tools: Pretested questionnaire. STATISTICAL ANALYSIS USED Percentages, χ(2) test, analysis of variance (ANOVA), multivariate analysis. RESULTS Awareness about symptoms, possibility of early detection, available tests, possibility of cure of disease was low. Main barrier for screening was cognitive, that is, 'don't know' answer by 83.99% women for cancer cervix, 84.93%, for cancer breast, and 67.26% for oral cancer. Awareness score was significantly associated with age (χ(2) = 17.77, P = 0.001), education (χ(2) = 34.62, P = 0.000), and income (χ(2) = 16.72, P = 0.002); while attitude score with age (χ(2) = 16.27, P = 0.012) and education (χ(2) = 25.16, P = 0.003). Practice score was significantly associated with age (χ(2) = 11.28, P = 0.023), education (χ(2) = 32.27, P = 0.003), and occupation (χ(2) = 10.69, P = 0.03). Awareness, attitude, and practice score of women having history of cancer in family or relative was significantly high than women without history. CONCLUSIONS Cognitive barrier was the important barrier which has to be taken care of.
Collapse
Affiliation(s)
- Neha Tripathi
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra, India
| | - Yugantara R Kadam
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra, India
| | - Randhir V Dhobale
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra, India
| | - Alka D Gore
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra, India
| |
Collapse
|
33
|
Zhao N, Huh J, Murphy ST, Chatterjee JS, Baezconde-Garbanati L. Self-Construal as a Predictor of Korean American Women's Intention to Vaccinate Daughters against Human Papillomavirus. ASIAN AMERICAN JOURNAL OF PSYCHOLOGY 2014; 5:96-105. [PMID: 25558309 PMCID: PMC4278380 DOI: 10.1037/a0036097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Korean Americans represent one of the fastest growing Asian subpopulations in the United States. Despite a dramatic reduction in incidence nationwide, cervical cancer remains a major threat for Korean American women. By preventing the strains of the Human Papillomavirus (HPV) known to cause cervical cancer, the HPV vaccines appear to be a promising solution to reduce the persistent disparities in cervical cancer among not only Korean Americans, but also other racial and ethnic minorities more generally. However, current literature lacks a better understanding of how cultural and behavioral factors influence Korean American women's intention to vaccinate their adolescent daughters against HPV. This manuscript presents the results of testing the mechanisms through which interdependent self-construal (an orientation of self in which individuals define themselves primarily through their relationships with others), attitudes, and subjective norms impact Korean American mothers' intention to vaccinate their daughters. Our findings suggest that self-construal holds promise for health communication research to not only uncover the rich variance of health-related beliefs among individuals of shared cultural descent, but also to understand the context in which these beliefs are embedded.
Collapse
Affiliation(s)
- Nan Zhao
- Annenberg School for Communication & Journalism, University of Southern California, Los Angeles, CA 90089
| | - Jimi Huh
- Institute of Health Promotion & Disease Prevention Research, Division of Behavioral Research, Department of Preventive Medicine and Sociology, Keck School of Medicine of USC, And Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033
| | - Sheila T Murphy
- Annenberg School for Communication & Journalism, University of Southern California, Los Angeles, CA 90089
| | - Joyee S Chatterjee
- Annenberg School for Communication & Journalism, University of Southern California, Los Angeles, CA 90089
| | - Lourdes Baezconde-Garbanati
- Institute of Health Promotion & Disease Prevention Research, Division of Behavioral Research, Department of Preventive Medicine and Sociology, Keck School of Medicine of USC, And Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033
| |
Collapse
|
34
|
Lee SJ, Chung C. Comparisons of Health Conditions of Immigrant and Domestic Women in Korea and China Using Propensity Score Matching. Health Care Women Int 2013; 34:989-1004. [PMID: 23627370 DOI: 10.1080/07399332.2012.741636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
35
|
|
36
|
Ma GX, Gao W, Fang CY, Tan Y, Feng Z, Ge S, Nguyen JA. Health beliefs associated with cervical cancer screening among Vietnamese Americans. J Womens Health (Larchmt) 2013; 22:276-88. [PMID: 23428284 DOI: 10.1089/jwh.2012.3587] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vietnamese American women represent one of the ethnic subgroups at great risk for cervical cancer in the United States. The underutilization of cervical cancer screening and the vulnerability of Vietnamese American women to cervical cancer may be compounded by their health beliefs. OBJECTIVE The objective of this study was to explore the associations between factors of the Health Belief Model (HBM) and cervical cancer screening among Vietnamese American women. METHODS Vietnamese American women (n=1,450) were enrolled into the randomized controlled trial (RCT) study who were recruited from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey. Participants completed baseline assessments of demographic and acculturation variables, health care access factors, and constructs of the HBM, as well as health behaviors in either English or Vietnamese. RESULTS The rate of those who had ever undergone cervical cancer screening was 53% (769/1450) among the participants. After adjusting for sociodemographic variables, the significant associated factors from HBM included: believing themselves at risk and more likely than average women to get cervical cancer; believing that cervical cancer changes life; believing a Pap test is important for staying healthy, not understanding what is done during a Pap test, being scared to know having cervical cancer; taking a Pap test is embarrassing; not being available by doctors at convenient times; having too much time for a test; believing no need for a Pap test when feeling well; and being confident in getting a test. CONCLUSION Understanding how health beliefs may be associated with cervical cancer screening among underserved Vietnamese American women is essential for identifying the subgroup of women who are most at risk for cervical cancer and would benefit from intervention programs to increase screening rates.
Collapse
Affiliation(s)
- Grace X Ma
- Department of Public Health, Center for Asian Health, Temple University, Philadelphia, Pennsylvania 19122, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Lee SSJ. Lessons Learned From the U.S. Public Health Service Syphilis Study at Tuskegee: Incorporating a Discourse on Relationships Into the Ethics of Research Participation Among Asian Americans. ETHICS & BEHAVIOR 2012. [DOI: 10.1080/10508422.2012.730002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
38
|
Correlates of cervical cancer screening among Vietnamese American women. Infect Dis Obstet Gynecol 2012; 2012:617234. [PMID: 23008526 PMCID: PMC3449126 DOI: 10.1155/2012/617234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/17/2012] [Accepted: 07/23/2012] [Indexed: 12/12/2022] Open
Abstract
Objective. Vietnamese American women are at the greatest risk for cervical cancer but have the lowest cervical cancer screening rates. This study was to determine whether demographic and acculturation, healthcare access, and knowledge and beliefs are associated with a prior history of cervical cancer screening among Vietnamese women. Methods. Vietnamese women (n = 1450) from 30 Vietnamese community-based organizations located in Pennsylvania and New Jersey participated in the study and completed baseline assessments. Logistic regression analyses were performed. Results. Overall levels of knowledge about cervical cancer screening and human papillomavirus (HPV) are low. Factors in knowledge, attitude, and beliefs domains were significantly associated with Pap test behavior. In multivariate analyses, physician recommendation for screening and having health insurance were positively associated with prior screening. Conclusion. Understanding the factors that are associated with cervical cancer screening will inform the development of culturally appropriate intervention strategies that would potentially lead to increasing cervical cancer screening rates among Vietnamese women.
Collapse
|
39
|
Wee LE, Koh GCH, Chin RT, Yeo WX, Seow B, Chua D. Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention. Prev Med 2012; 55:61-7. [PMID: 22561028 DOI: 10.1016/j.ypmed.2012.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 04/06/2012] [Accepted: 04/18/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Inequalities in cancer screening are little studied in Asian societies. We determined whether area and individual measures of socio-economic status (SES) affected cancer screening participation in Singapore and prospectively evaluated an access-enhancing community-based intervention. METHODS The study population involved all residents aged >40 years in two housing estates comprising of owner-occupied (high-SES area) and rental (low-SES area) flats. From 2009 to 2011, non-adherents to regular screening for colorectal/breast/cervical cancer were offered free convenient screening over six months. Pre- and post-intervention screening rates were compared with McNemar's test. Multi-level logistic regression identified factors of regular screening at baseline; Cox regression analysis identified predictors of screening post-intervention. RESULTS Participation was 78.2% (1081/1383). In the low-SES area, 7.7% (33/427), 20.4% (44/216), and 14.3% (46/321) had regular colorectal, cervical and breast cancer screening respectively. Post-intervention, screening rates in the low-SES area rose significantly to 19.0% (81/427), 25.4% (55/216), and 34.3% (74/216) respectively (p<0.001). Area SES was more consistently associated with screening than individual SES at baseline. Post-intervention, for colorectal cancer screening, those with higher education were more likely to attend (p=0.004); for female cancer screening, the higher-income were less likely to attend (p=0.032). CONCLUSIONS Access-enhancing community-based interventions improve participation among disadvantaged strata of Asian societies.
Collapse
Affiliation(s)
- Liang En Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | | | | | | | | | | |
Collapse
|
40
|
Ward KK, Shah NR, Saenz CC, McHale MT, Alvarez EA, Plaxe SC. Changing demographics of cervical cancer in the United States (1973-2008). Gynecol Oncol 2012; 126:330-3. [PMID: 22668881 DOI: 10.1016/j.ygyno.2012.05.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 05/22/2012] [Accepted: 05/27/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe changes in the cervical cancer population. METHODS The SEER database 9 registries from 1973 to 2008 were queried to perform a retrospective cohort study of women with invasive cervical cancer. Estimated annual percent change (EAPC) in incidence rates and 95% confidence intervals (CI) over the entire study period were compared according to age, stage, race, and cell type (squamous [SCC] and adenocarcinoma [ACA]). Proportions and odds ratios (OR) were calculated for patients diagnosed during the second half (1990-2008) compared to first half (1973-89) of the study period. RESULTS 40,363 women with cervical cancer were entered into SEER. The EAPC are falling fastest among those with localized disease (-2.5%; 95% CI -2.8 to -2.1), age≥50 (-3.0%; 95% CI=-3.2 to -2.8), and black women (-3.8%; 95% CI=-4.1 to -3.6). The odds of a newly diagnosed cervical cancer patient having advanced disease are 10% higher, being less than age 50 are 37% higher, and being Asian or Pacific Islander are 68% higher in the second time period as compared to the first. CONCLUSIONS In the US, the population with cervical cancer is changing. Patients are presently significantly more likely to be pre-menopausal, Asian or Pacific Islander, and more frequently have non-squamous histology than previously. These progressive and cumulative changes could be due to the disparate impact of current population based screening and prevention strategies. Understanding the implications of these evolving population characteristics may facilitate planning targeted studies and interventions for cervical cancer prevention, screening and treatment in the future.
Collapse
Affiliation(s)
- Kristy K Ward
- Rebecca and John Moores UCSD Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, La Jolla, CA, USA.
| | | | | | | | | | | |
Collapse
|