Knowledge, Attitudes and Behavior of Bangkok Metropolitan Women Regarding Cervical Cancer Screening

Epidemiology Characteristics and Potential Cervical Cancer Screening Value of Vulvar Human Papillomavirus in Chinese Women: A Multicenter Cross-Sectional Study

CONTEXT.—

Noninvasive self-sampling is a convenient option that may be highly accepted by women for home-based detection, which could increase the screening rate for cervical cancer (CC) and reduce its incidence and mortality.

OBJECTIVE.—

To compare the distribution of high-risk human papillomavirus (hr-HPV) between the vulva and cervix and to explore the clinical value of vulvar HPV detection in CC screening.

DESIGN.—

The study was nested within a clinical trial on a recombinant HPV 9-valent vaccine for women ages 20 to 45 years. Women with paired vulvar and cervical specimens were included and underwent cytology and HPV detection. The consistency of HPV detection between vulvar and cervical specimens was evaluated using Cohen κ statistics. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to evaluate the diagnostic accuracy of primary CC screening. The primary end points were cervical intraepithelial neoplasia (CIN) grade 2/3 or worse (CIN2+/3+).

RESULTS.—

A total of 7999 women were enrolled, and 83/33 cases were diagnosed as CIN2+/CIN3+. The HPV-positive rate in vulvar specimens (1785 of 7999; 22.32%) was higher than that in cervical specimens (1390 of 7999; 17.38%), and there were no significant differences in the distribution of hr-HPV genotypes between the vulva and cervix in patients with CIN2+/CIN3+. Vulva-based HPV primary screening showed sensitivity, specificity, PPV, and NPV comparable to those for cervix-based HPV primary CC screening in the detection of CIN3+.

CONCLUSIONS.—

The distribution of vulvar and cervical HPV was similar in patients with CIN2+/CIN3+. Vulva-based HPV primary CC screening had acceptable diagnostic efficacy and might be used as a modality for primary CC screening.

Attitude toward human papillomavirus self-sampling and associated factors among Thai women undergoing colposcopy

OBJECTIVE

To compare attitudes toward self-sampling for human papillomavirus (HPV) testing before and after specimen collection in women undergoing colposcopy. The factors associated with the pre-sampling attitude were also studied.

METHODS

This prospective study enrolled women with abnormal cervical cytology and/or positive high-risk HPV who attended colposcopy clinics at 10 cancer centers in Thailand between October 2021 and May 2022. Prior to colposcopy, the attitudes of the women toward self-sampling were surveyed through a questionnaire. Written and verbal instructions for self-sampling were provided before the process and subsequent colposcopy. The attitudes toward self-sampling were reassessed after the actual self-sampling. Factors associated with the attitudes were analyzed.

RESULTS

A total of 499 women were included in this study. The mean age was 39.28±11.36 years. A total of 85.3% were premenopause, and 98.8% had sexual experience. With the full score of 45, the attitude score after self-sampling was significantly higher than the attitude score before self-sampling (39.69±5.16 vs. 37.76±5.71; P<0.001). On univariate analysis, the factors associated with attitude before HPV self-sampling were age, menopausal status, sexual activity, education level, income, knowledge regarding HPV, and prior high-grade squamous intraepithelial lesion histology. The remaining significant factor on multivariate analysis was sexual activity within the past year (B=0.105, 95% confidence interval, 0.014-2.870; P=0.048).

CONCLUSION

Attitudes toward self-sampling improved after the actual self-sampling process, as evidenced by higher attitude scores. Sexual activity was the only independent factor related to the attitude before self-sampling.

Women's motivation towards Pap smear screening based on sexual and screening status: A cross-sectional study using protection motivation theory

INTRODUCTION

Cervical cancer remains a reproductive health burden. Pap smear (PS) screening can detect cervical cancer early but is underused despite being subsidized. Motivational factors play a role in promoting PS screening. This study aimed to determine the women's motivation toward PS screening based on Protection Motivation Theory (PMT), which mainly focused on sexual and screening status.

MATERIALS AND METHODS

The study was conducted electronically throughout Malaysia from January to February 2022 by disseminating Google Form (https://forms.gle/cD7fkUKYR4Cq6kZC8) via multiple WhatsApp groups to reach 526 women aged 21-65 years. The questionnaire consists of 24 items based on seven PMT constructs [perceived vulnerability, perceived severity, self-efficacy, response efficacy, fear (threat appraisal), response costs (coping appraisal), and protection motivation]. The descriptive statistics and independent t-test was used to analyze data using IBM SPSS Statistics software, version 25.

RESULTS

Most respondents were sexually active [80.6% (n = 424)] and have heard of PS screening [95.8% (n = 504)]. More than half of respondents did not have PS screening in the last three years [59.3% (n = 312)]. Sexually active women have heard and have undergone PS screening feel less threatened with low coping appraisals. Undergoing PS screening made women perceived more response efficacy (P =. 011), more self-efficacy (P <. 001), and higher protection motivation (P <. 001) toward PS screening.

CONCLUSIONS

Women's motivation related to PS screening needs to be highlighted. Future development of health education strategy should include motivation focused in emphasizing the threat and coping appraisal into educational plan to ensure women come forward for screening.

Utilizing first void urine for high-risk HPV testing for cervical cancer screening in HIV-positive women in Katete, Zambia

BACKGROUND

The World Health Organization targets to screen 70% of women worldwide twice for cervical cancer by the year 2030, first by age of 35, and again by the age of 45. However, with the current low screening coverage in many developing countries, this may not be achieved because the invasive sampling method is unacceptable to some. In Zambia, for instance, despite the availability of free cervical cancer screening through the establishment of the Cervical Cancer Prevention Programme, some women are still reluctant to go for screening. First void urine sampling is non-invasive and thus has the potential to increase screening coverage. We aimed to determine the performance of first void urine for high-risk human papillomavirus DNA detection, the prevalence of high-risk HPV, and the acceptability of first void urine sampling.

MATERIALS AND METHOD

A comparative cross-sectional study was conducted among 100 HIV- infected women at St Francis' Hospital in Zambia, attending the routine HIV/AIDS services and cervical cancer screening. 17 mL of first void urine sample collected by each participant was immediately mixed with 3 mL of 0.5 M EDTA preservative solution before cervical sample collection by the clinician. For testing, 2 mL of first void urine and 1 mL of the cervical sample were tested using the GeneXpert platform. An interview-based questionnaire was used to gather data on the acceptability of first void urine sampling. Data was analyzed using Stata version 17.

RESULTS

The mean age of the participants was 42.58 years (95% CI 40.98-44.19; SD 8.01). High-risk HPV prevalence was 34% (95% CI 24%-43.9%) in both cervical and first void urine samples. Sensitivity and specificity were 84.8% (95% CI 68.1%-94.9%) and 92.3% (83%-97.5%), respectively. There was 89.80% agreement between the samples (κ = 0.77; 95% CI 0.64-0.91). First void urine sampling was highly accepted.

CONCLUSION

High-risk HPV DNA can be detected in first void urine samples using the GeneXpert, with a substantial agreement with cervical samples. An affordable preservative such as Ethylenediamine tetraacetic acid can prevent DNA degradation. With optimization, first void urine sampling has the potential to increase screening coverage.

Knowledge of Thai women in cervical cancer etiology and screening

Knowledge about cervical cancer screening and Human papilloma virus (HPV) influence on their awareness to the cervical cancer screening program. Most previous studies found inadequate knowledge and attitude among healthy women affect the low rate of screening. This study aimed to assess knowledge of cervical cancer screening and HPV in women who had abnormal cervical cancer screening in Bangkok. Thai women, aged ≥ 18 years old, who had abnormal cervical cancer screening and scheduled to colposcopy clinics of 10 participating hospitals were invited to participate in this cross-sectional study. The participants were asked to complete a self-answer questionnaire (Thai language). The questionnaire composed of 3 parts: (I) demographic data, (II) knowledge about cervical cancer screening and (III) knowledge about HPV. Among 499 women who answered the questionnaires, 2 had missing demographic data. The mean age of the participants was 39.28 ± 11.36 years. 70% of them had experience of cervical cancer screening, with 22.7% had previous abnormal cytologic results. Out of 14 questions, the mean score of knowledge about cervical cancer screening was 10.04 ± 2.37. Only 26.9% had good knowledge about cervical cancer screening. Nearly 96% of woman did not know that screening should be done. After excluding 110 women who had never known about HPV, 25.2% had good knowledge about HPV. From multivariable analysis, only younger age (≤ 40 years) was associated with good knowledge of cervical cancer screening and HPV. In the conclusion, only 26.9% of women in this study had good knowledge regarding cervical cancer screening. Likewise, 20.1% of women who had ever heard about HPV has good knowledge about HPV. Providing information about cervical cancer screening and HPV should improve the women's knowledge and better adherence to the screening procedure.

Women's Satisfaction with Cervical Cancer Screening Services and Associated Factors in Maternal Health Clinics of Jimma Town Public Health Facilities, Southwest Ethiopia

Background

Despite the existence of proven interventions for cervical cancer, low coverage and uptake of existing screening and treatment services remains the main challenge to prevention and control of cervical cancer in developing countries. This study aimed to assess women’s satisfaction with cervical cancer screening services and factors associated with it in public health facilities of Jimma town, Southwest Ethiopia.

Methods

A facility-based cross-sectional study was conducted from March 20 to May 20, 2020. All women aged between 30 and 49 years who visited health facilities during the data collection period were interviewed consecutively. Composite variables were computed from existing data for satisfaction, knowledge, and attitude. A 95% confidence interval was constructed for all outcome variables and multivariate logistic regression was used to identify predictors of satisfaction.

Results

Out of 205 interviewed women, 41% (95% CI: 34–47) were satisfied with cervical cancer screening services. One-hundred and seventeen (57%, 95% CI: 50–64) women had good comprehensive knowledge of cervical cancer screening and 121 (59%, 95% CI: 52–66) had favorable attitude. Satisfaction with cervical cancer screening service was statistically associated with occupational status, religion, perceived length of waiting time to see a provider, and knowledge of cervical cancer.

Conclusion

Satisfaction with cervical cancer screening services was low in public health facilities of Jimma town. Slightly more than half of women had good knowledge and favorable attitude regarding cervical cancer screening. Among the clinical factors, only perceived length of waiting time to see a provider and women’s knowledge of cervical cancer were statistically associated with satisfaction with screening services. Therefore, efforts should be made to improve level of satisfaction, knowledge and attitude of women toward cervical cancer and screening services.

Accuracy of human papillomavirus tests on self-collected urine versus clinician-collected samples for the detection of cervical precancer: a systematic review and meta-analysis

Objective

The human papillomavirus (HPV) test is an effective screening tool to prevent cervical cancer. Urinary sampling for HPV detection improves the accessibility and participation of screening services and reduces the cost and burden on physicians. The clinical accuracy of urinary HPV test has yet to be determined via meta-analysis. This study assessed the clinical accuracy of these tests to detect cervical intraepithelial neoplasia (CIN) 2 or worse.

Methods

Relevant studies were identified using the PubMed, Embase, and Cochrane databases. Research eligibility was based on the clinical accuracy of HPV test on clinician-collected samples as a comparator test, and urine as an index test. The reference standard was the presence of CIN2 or worse. The pooled absolute, relative sensitivity, and specificity of the urinary HPV test versus clinician-collected samples were assessed using a bivariate model.

Results

The pooled sensitivity of urinary HPV test was significantly lower than that of clinician-collected samples (ratio=0.84, 95% confidence interval [CI]=0.78–0.91). However, some polymerase chain reaction (PCR)-based HPV test such as GP5+/6+ (relative sensitivity=0.98, 95% CI=0.91–1.05), SPF10 (relative sensitivity=0.98, 85% CI=0.88–1.08) and non GP5+/6+ PCR (relative sensitivity=1.00, 95% CI=0.88–1.14) showed similar sensitivity in both the urine and clinician-collected samples.

Conclusion

Our findings indicate that HPV test with some PCR-based assay on urine versus clinician-collected samples demonstrate similar clinical accuracy to detect CIN2 or worse. It suggests that urinary HPV test may present itself as a decent alternative screening tool for the detection of cervical pre-cancer.

Trial Registration

PROSPERO identifier: CRD42021227901

Some polymerase chain reaction-based human papillomavirus (HPV) tests showed similar accuracy in urine and cervical samples. Signal amplification or messenger RNA HPV test on urine is less sensitive than cervical test. High-risk HPV assays is the only significant factor to affect test accuracy. Urinary HPV test may be an alternative option for cervical cancer screening.

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

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

Knowledge, Attitudes, and Practices Regarding Cervical Cancer Screening among HIV-infected Women at Srinagarind Hospital: A Cross-Sectional Study

Introduction:

In recent years, the lives of HIV-infected patients in Thailand have improved significantly due to continuous advances in treatment. However, the rate of cancer related to HIV infection (especially cervical cancer) is likely to increase. Although the World Health Organization (WHO) recommends Papanicolaou testing in all HIV-infected women, few of these patients receive this kind of screening in Thailand. Therefore, we conducted this study to evaluate the knowledge, attitudes, and practices of these patients with regard to cervical cancer screening.

Materials and Methods:

This cross-sectional study was conducted in HIV-infected women aged 18-65 years from April to November 2019 via a self-administered cervical cancer screening questionnaire, which consisted of four parts: demographic data, knowledge, attitudes, and practices.

Results:

Three hundred HIV-infected women were recruited. Most of the participants had good attitudes toward screening and practiced adequate screening (75.3% and 71.3%, respectively). However, only 62 participants (20.7%) demonstrated adequate knowledge. The crucial factors that were associated with adequate screening practice were age 40-49 years-old (AOR =3.26, 95%CI=1.02-10.37), CD4 cell count (AOR = 3.41, 95%CI = 1.29-8.99), having been advised about cervical cancer screening (AOR= 6.23, 95%CI 1.84-21.07), and attitude toward screening (AOR= 5.7, 95%CI = 2.23-14.55). The major reasons for not undergoing screening were embarrassment (41.86%), lack of symptoms (41.86%), fear of the results (36.04%), and fear of pain (36.04%).

Conclusion:

The reasons for inadequate testing were disregard and misconceptions about the procedure. To prevent invasive cervical lesions in HIV-infected women, health care providers should inform these patients about the importance of regular cervical cancer screening.

Agreement of self- and physician-collected samples for detection of high-risk human papillomavirus infections in women attending a colposcopy clinic in Thailand

Objective

To study the concordance between vaginal self- and endocervical physician-collected high-risk (hr) HPV testing in Thai women who attended a colposcopy clinic. Vaginal samples were obtained by self-sampling with a dry brush before endocervical samples were obtained by physicians. Both specimens were analyzed for hrHPV by Cobas4800 HPV test.

Results

Of the 247 pairs of samples, overall hrHPV prevalence from self- and physician-collected samples was 41.3 and 36.0%, respectively. The overall agreement between the methods was 74.5% with κ 0.46 (P < 0.001). Our study revealed moderate agreement between self- and physician-collected methods for hrHPV testing.