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Alfareh M, Obeid D, Alhoshan H, Basri R, Alhamlan FS. Low uptake of Pap test as a cervical cancer screen among Saudi women: Findings from a national survey. Int J Gynaecol Obstet 2024. [PMID: 38641900 DOI: 10.1002/ijgo.15532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE The present study aimed to assess the current knowledge and uptake of Papanicolaou (Pap) tests for cervical screening among Saudi women, including barriers to undergoing the test and the availability of related services. METHODS A cross-sectional study was conducted using a health questionnaire administered through the Absher portal between April 1, 2019, and March 31, 2020. The questionnaire consisted of five questions and took less than 5 min to complete. Descriptive and inferential statistics were employed to analyze demographic variables, and chi-square tests were used to examine the association between these variables and Pap test uptake. RESULTS The questionnaire included 8194 Saudi women, with the majority from Makkah (24.40%), Riyadh (21.92%), and Eastern (14.44%) regions. Only 22.52% of respondents had ever received a Pap test, and among them, 17.48% did so based on their physician's recommendation. Private clinics accounted for 10.73% of Pap test locations, while public clinics accounted for 8.97%. The primary reasons for not undergoing the test were lack of knowledge regarding its importance (40.24%) and lack of information from physicians (16.96%). Knowledge of the Pap test as a cervical screening method was significantly associated with marital status, Saudi region, and age group. CONCLUSIONS This study revealed low awareness of the Pap test for cervical screening among Saudi women, particularly in younger age groups. Targeted educational initiatives are essential to increase awareness and emphasize the significance of regular screenings, especially among younger individuals, to enhance early detection and reduce the burden of cervical cancer in Saudi Arabia.
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Affiliation(s)
- Manal Alfareh
- Research and Advocacy, Rofaida Women's Health Organization, Riyadh, Saudi Arabia
| | - Dalia Obeid
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hala Alhoshan
- Research and Advocacy, Rofaida Women's Health Organization, Riyadh, Saudi Arabia
| | - Rawan Basri
- Research and Advocacy, Rofaida Women's Health Organization, Riyadh, Saudi Arabia
| | - Fatimah S Alhamlan
- Research and Advocacy, Rofaida Women's Health Organization, Riyadh, Saudi Arabia
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Emerson A, Dogan M, Hawes E, Wilson K, Chana SM, Kelly PJ, Comfort M, Ramaswamy M. Cervical cancer screening barriers and facilitators from the perspectives of women with a history of criminal-legal system involvement and substance use. Health Justice 2024; 12:9. [PMID: 38407688 PMCID: PMC10895855 DOI: 10.1186/s40352-024-00262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The wide availability of routine screening with Papanicolaou (Pap) tests and vaccinations against human papillomavirus has resulted in a decline in rates of cervical cancer. As with other diseases, however, disparities in incidence and mortality persist. Cervical cancer, is found more often, at later stages, and has worse outcomes in people who live in rural areas, identify as Black or Hispanic, and in people who are incarcerated. Studies report 4-5 times higher rates of cervical cancer incidence in people detained in jails and prisons than in community-based samples. Studies to explain cervical cancer differences have been inconclusive, though there is broad consensus that issues of access play a role. In this study, we sought to learn more from people who have a history of criminal-legal system involvement and substance use about what barriers and facilitators they perceive in accessing cervical cancer preventive health and other support services in the community. RESULTS We conducted semi-structured interviews with open-ended questions by telephone with 20 self-identified women, ages 22-58, in Birmingham, Alabama. Interviews were audio recorded and transcribed and the transcripts analyzed using immersion-crystallization techniques. Our team identified two main themes, making connections: the importance of interpersonal communication, which stressed barriers and facilitators related to what makes for effective and humanistic interactions in cervical health prevention and other services, and getting it done: the logistics of access and availability, which highlighted elements of cost and payment; scheduling; transportation; and clinic policies. CONCLUSIONS People with a history of criminal-legal system involvement and substance abuse meet with a variety of enabling and impeding factors at personal and interpersonal as well as systemic levels in obtaining cervical health services. To better ensure that women in this high-risk group have equitable access to cervical cancer prevention and treatment-and thus better cancer outcomes-will require multilevel efforts that include an emphasis on improving the human connection in health care encounters and improving the nuts-and-bolts logistics related to accessing that care.
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Affiliation(s)
- Amanda Emerson
- KU School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66180, USA.
| | - Marissa Dogan
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Elizabeth Hawes
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Kiana Wilson
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Sofía Mildrum Chana
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham-Heersink School of Medicine, 530 Beacon Parkway West (Suite 701), Birmingham, AL, 35209, USA
| | - Patricia J Kelly
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA
| | | | - Megha Ramaswamy
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66106, USA
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Ouh YT, Kim HY, Yi KW, Lee NW, Kim HJ, Min KJ. Enhancing Cervical Cancer Screening: Review of p16/Ki-67 Dual Staining as a Promising Triage Strategy. Diagnostics (Basel) 2024; 14:451. [PMID: 38396493 PMCID: PMC10888225 DOI: 10.3390/diagnostics14040451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Cervical cancer, primarily caused by high-risk human papillomavirus (HR-HPV) types 16 and 18, is a major global health concern. Persistent HR-HPV infection can progress from reversible precancerous lesions to invasive cervical cancer, which is driven by the oncogenic activity of human papillomavirus (HPV) genes, particularly E6 and E7. Traditional screening methods, including cytology and HPV testing, have limited sensitivity and specificity. This review explores the application of p16/Ki-67 dual-staining cytology for cervical cancer screening. This advanced immunocytochemical method allows for simultaneously detecting p16 and Ki-67 proteins within cervical epithelial cells, offering a more specific approach for triaging HPV-positive women. Dual staining and traditional methods are compared, demonstrating their high sensitivity and negative predictive value but low specificity. The increased sensitivity of dual staining results in higher detection rates of CIN2+ lesions, which is crucial for preventing cervical cancer progression. However, its low specificity may lead to increased false-positive results and unnecessary biopsies. The implications of integrating dual staining into contemporary screening strategies, particularly considering the evolving landscape of HPV vaccination and changes in HPV genotype prevalence, are also discussed. New guidelines and further research are necessary to elucidate the long-term effects of integrating dual staining into screening protocols.
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Affiliation(s)
| | | | | | | | | | - Kyung-Jin Min
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Ansan-si 15355, Gyeonggi-do, Republic of Korea; (Y.-T.O.); (H.Y.K.); (K.W.Y.); (N.-W.L.); (H.-J.K.)
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Safari-Faramani B, Safari-Faramani R, Najafi F, Zavareh DK, Karyani AK, Darbandi M. Socioeconomic disparities in Papanicolaou test utilization in Western Iran. BMC Public Health 2024; 24:471. [PMID: 38355473 PMCID: PMC10868049 DOI: 10.1186/s12889-024-17927-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Cervical cancer remains the fourth most frequently diagnosed cancer among women, and its impact is particularly significant in women residing in less developed countries. This study aims to assess socioeconomic inequality in using Papanicolaou tests, commonly known as Pap tests, which are crucial for detecting cervical cancer. The research also seeks to decompose this inequality, identifying its contributing factors. This investigation is conducted within a sizable population-based study focused on the Kurdish population, with an additional examination of potential variations between urban and rural areas. METHOD The study utilized baseline data from the Ravansar Non-Communicable Disease Cohort Study (RaNCD), involving 3,074 ever-married women aged 35-65. Asset data was employed to determine socioeconomic status (SES), and Principal Component Analysis was applied. The uptake of Papanicolaou tests was assessed for inequality using the Concentration Index (Cn). Additionally, decomposition analysis was conducted to identify and understand the factors contributing to socioeconomic inequality. RESULTS The study found that overall, 86% of women reported having undergone cervical cancer screening at least once in their lifetime. The Concentration Index (Cn) for the total population was 0.21 (p < 0.0001), indicating a higher concentration of Papanicolaou test uptake among wealthier groups. In urban areas, the Cn was 0.34 (p < 0.0001), reflecting a significant concentration among the rich. However, in rural areas, the Cn was -0.10 (p = 0.3006), suggesting no significant socioeconomic inequality. Factors such as socioeconomic status (SES), education, and age contributed to reducing inequality, explaining 62.7%, 36.0%, and 1.7% of the observed inequality, respectively. Interestingly, place of residence had a negative influence on inequality. CONCLUSION The uptake of Papanicolaou tests varies across different socioeconomic status levels, with a higher concentration among wealthier groups. The results enable health policymakers and researchers to tailor health intervention toward increasing public awareness, especially among women with lower levels of education women in economically deprived groups.
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Affiliation(s)
- Bahare Safari-Faramani
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Social Development and Health Promotion Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Farid Najafi
- Social Development and Health Promotion Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Davoud Khorasani Zavareh
- Department of Health in Emergencies and Disasters, Workplace Health Promotion Research Center (WHPRC), School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Family Medicine and Primary Care, Huddinge, Sweden
| | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mitra Darbandi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Qin Y, Deng J, Ling Y, Chen T, Gao H. Our experience diagnosing 225 patients with cervical glandular lesions: current technologies, lessons learned, and areas for improvement. Diagn Pathol 2024; 19:22. [PMID: 38279171 PMCID: PMC10811820 DOI: 10.1186/s13000-023-01428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/13/2023] [Indexed: 01/28/2024] Open
Abstract
OBJECTIVE To explore the relative sensitivity of different methods for detecting cervical glandular lesions. METHODS A total of 225 patients with cervical glandular lesions diagnosed from January 2018 to February 2023 were retrieved from the pathology database of Guangdong Maternal and Child Health Hospital, and their clinicopathological features were reviewed. RESULTS Four human papillomavirus (HPV) genotypes: HPV18, 16, 45, and 52, dominated all glandular lesions, and accounting for 74.10% of HPV-positive tumors. Furthermore, 36.89% of abnormal squamous cells were diagnosed as abnormal based on cytological examinations leading to the detection of cervical glandular lesions; only 16.89% were diagnosed based on the initial detection of abnormal glandular cytology. The most common abnormal cervical screening result was ASC-US on cytology (14.22%), followed by HSIL (11.56%). Only few number of patients were diagnosed with or suspected of having cervical adenopathy via a Pap test (18.22%). Nearly one-third of cervical glandular lesions cases were not detected on the Pap test; but were diagnosed upon cervical biopsy or based on the histological examination of ECC, LEEP, or CKC specimens. The LEEP or CKC biopsy specimens had negative margins in 49 cases (40.83%), while the margins were positive in the other 71 cases (59.17%). Five cases (10.20%) with negative margins still had residual lesions following total hysterectomy, and 19 (26.76%) with positive margins had no residual lesions after total hysterectomy. CONCLUSION The ability to detect cervical glandular lesions varies for routine HPV genotyping, Pap test, or biopsy/ECC, with different sensitivities and advantages and disadvantages for each method.
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Affiliation(s)
- Yan Qin
- Department of Pathology, Guangdong Women and Children Hospital, Guangzhou, 511400, China
| | - Junyi Deng
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yuexian Ling
- Department of Pathology, Guangdong Women and Children Hospital, Guangzhou, 511400, China
| | - Tao Chen
- Yangjiang Key Laboratory of Respiratory Disease, People's Hospital of Yangjiang, Yangjiang, Guangdong, 529500, China
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Hongyi Gao
- Department of Pathology, Guangdong Women and Children Hospital, Guangzhou, 511400, China.
- Guangdong Women and Children Hospital, No. 521, Xingnan Avenue, Panyu District, Guangzhou, China.
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Okayama K, Kakinuma M, Teruya K, Oda M, Fujii M, Kimura H, Sasagawa T, Okodo M. Predictive Value of Various Atypical Cells for the Detection of Human Papillomavirus in Cervical Smears. Int J Mol Sci 2024; 25:1212. [PMID: 38279211 PMCID: PMC10816237 DOI: 10.3390/ijms25021212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
It is thought that numerous genotypes of human papillomavirus (HPV) are associated with various atypical cells, such as multinucleated cells, koilocytes, binucleated cells, parakeratotic cells, and giant cells, in the cervix. We previously showed the specificity of HPV genotypes for koilocytes and multinucleated cells. Therefore, in this study, we analyzed the association among HPV genotypes and binucleated cells, parakeratotic cells, and giant cells in Papanicolaou (Pap) smears. We detected HPV genotypes and atypical cells in 651 cases of liquid-based cytology with an abnormal Pap smear. The HPV genotypes associated with atypical cells were evaluated using stepwise logistic regression with backward elimination and a likelihood ratio test for model construction. Polymerase chain reaction was used to determine the HPV genotypes in whole liquid-based cytology samples and microdissected cell samples from Pap smear slides. Binucleated cells were significantly associated with HPV genotype 42. Moreover, parakeratotic cells were significantly associated with certain HPV genotypes, such as HPV40. However, it was difficult to detect specific HPV genotypes by the manual microdissection-polymerase chain reaction method despite the presence of binucleated cells and parakeratotic cells. Thus, the presence of binucleated cells, parakeratotic cells, and giant cells in Pap smears may not be predictive of cervical lesions above low-grade squamous intraepithelial lesions or infection with highly carcinogenic HPV genotypes.
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Affiliation(s)
- Kaori Okayama
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, 1-7-1 Tonyamachi, Takasaki-shi 370-0006, Gunma, Japan
| | - Mao Kakinuma
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, 1-7-1 Tonyamachi, Takasaki-shi 370-0006, Gunma, Japan
| | - Koji Teruya
- Department of Health and Welfare, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi 181-8621, Tokyo, Japan
| | - Mizue Oda
- Genki Plaza Medical Center for Health Care, 3-6-5 Iidabashi, Chiyoda-ku 102-0072, Tokyo, Japan
| | - Masahiko Fujii
- Genki Plaza Medical Center for Health Care, 3-6-5 Iidabashi, Chiyoda-ku 102-0072, Tokyo, Japan
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi 181-8621, Tokyo, Japan
| | - Hirokazu Kimura
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, 1-7-1 Tonyamachi, Takasaki-shi 370-0006, Gunma, Japan
| | - Toshiyuki Sasagawa
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Uchinadadaigaku, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Mitsuaki Okodo
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi 181-8621, Tokyo, Japan
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M Al Kindi R, H Al Sumri H, M Al Muhdhoori T, Al Mamari K, A Al Kalbani M, H Al-Azri M. Knowledge of cervical cancer screening among Omani women attending a university teaching hospital: a cross-sectional study. BMC Womens Health 2024; 24:40. [PMID: 38218830 PMCID: PMC10787955 DOI: 10.1186/s12905-023-02870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/26/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVES To assess knowledge, attitudes, and practices regarding cervical cancer and Pap smear screening among Omani women attending a tertiary clinic in Muscat, Oman, and to establish correlations with selected sociodemographic factors. METHODS An observational, cross-sectional study was carried out among Omani women aged 18-50 years old attending the outpatient clinic of the Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, from October 2019 to February 2020. A validated Arabic-language questionnaire was utilized to collect data regarding the participants' sociodemographic characteristics, their knowledge of cervical cancer and related risk factors, and their knowledge, attitudes, and practices related to cervical cancer screening and Pap smear testing. RESULTS Of the 380 respondents, 86 and 55% had previously heard of cervical cancer and Pap smear testing, respectively; however, only 26% were knowledgeable concerning these topics. Knowledge scores were significantly associated with various sociodemographic factors, including marital status and a previous awareness of cervical cancer (odds ratio: > 1, p < 0.05). Only 21% had themselves previously undergone Pap smear testing; however, 75% reported being willing to undergo such screening in future. CONCLUSIONS Knowledge regarding cervical cancer-related risk factors and Pap smear screening was poor among a cohort of Omani women attending a tertiary clinic in Muscat, Oman. This may play a role in the increased frequency of cervical cancer cases observed in Oman over recent years. As such, a well-structured public education program is recommended to raise awareness of this issue.
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Affiliation(s)
- Rahma M Al Kindi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
| | - Hana H Al Sumri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Khoula Al Mamari
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mouza A Al Kalbani
- Department of Gynecology, Sultan Qaboos Comprehensive Cancer Care and Research Center (SQCCCRC), Muscat, Oman
| | - Mohammed H Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Effah K, Tekpor E, Wormenor CM, Essel NOM, Kemawor S, Sesenu E, Danyo S, Kitcher YT, Klutsey GB, Tay G, Tibu F, Abankroh KA, Atuguba BH, Akakpo PK. Tritesting in Battor, Ghana: an integrated cervical precancer screening strategy to mitigate the challenges of multiple screening visits and loss to follow-up. Ecancermedicalscience 2023; 17:1645. [PMID: 38414966 PMCID: PMC10898900 DOI: 10.3332/ecancer.2023.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Indexed: 02/29/2024] Open
Abstract
Background Human papillomavirus (HPV) DNA testing is more sensitive than cytology for detecting cervical precancer; however, increasing reports of high-risk HPV (hr-HPV)-negative cases of cervical intraepithelial neoplasia (CIN) and even malignancy motivate the use of combined testing. We present our experience with 'tritesting', defined as the performance of HPV DNA testing, cytology and visual inspection in a single session at the Cervical Cancer Prevention and Training Centre, Ghana. We further determined the prevalence rates of hr-HPV infection, abnormal cytology and cervical lesions among women screened using tritesting. Methods This descriptive retrospective cross-sectional study assessed all women screened via tritesting between April 2019 to April 2023. HPV DNA testing was performed using the Sansure MA-6000, GeneXpert or AmpFire platforms. Visual inspection was performed using enhanced visual assessment mobile colposcopy or visual inspection with acetic acid. Liquid-based cytology was performed using cervical samples taken with a Cervex-Brush® and fixed in PreservCyt, while samples for conventional cytology were taken using an Ayre spatula and cytobrush. Results Among 236 women screened (mean age, 39.1 years (standard deviation, 10.9)), the overall prevalence rates of hr-HPV infection and cervical lesions were 17.8% (95% confidence interval (CI), 13.1-23.3) and 11.9% (95% CI, 8.0-16.7), respectively. Cytology yielded findings of atypical squamous cells of undetermined significance or worse in 2.5% (95% CI, 0.9-5.5) of women. Histopathology following loop electrosurgical excision procedure revealed CIN I (tritest positive) and CIN III (hr-HPV-positive, visual inspection 'positive', cytology-negative) in one woman each. Factors independently associated with hr-HPV infection among 'tritested' women were age ≥ 39 years, tertiary level of education and current contraceptive use. Twenty-seven out of 39 hr-HPV-positive women (69.2%; 95% CI, 52.4-83.0) showed a type 3 transformation zone and would have needed to be recalled for a cytologic sample to be taken in a 'see and triage' approach with HPV DNA testing and a visual inspection method. Conclusion This study brings tritesting into the spotlight, as an alternative to other methods, particularly for women who prefer this due to the advantage of a single visit to a health facility and being more cost-effective, if they have to travel long distances to access cervical screening services.
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Affiliation(s)
- Kofi Effah
- Catholic Hospital, PO Box 2, via Sogakope, Battor, Volta Region, Ghana
- https://orcid.org/0000-0003-1216-2296
| | - Ethel Tekpor
- Catholic Hospital, PO Box 2, via Sogakope, Battor, Volta Region, Ghana
| | | | - Nana Owusu Mensah Essel
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 730 University Terrace, Edmonton T6G 2T4, Canada
- https://orcid.org/0000-0001-5494-5411
| | - Seyram Kemawor
- Catholic Hospital, PO Box 2, via Sogakope, Battor, Volta Region, Ghana
| | - Edna Sesenu
- Catholic Hospital, PO Box 2, via Sogakope, Battor, Volta Region, Ghana
| | - Stephen Danyo
- Catholic Hospital, PO Box 2, via Sogakope, Battor, Volta Region, Ghana
| | | | | | - Georgina Tay
- Catholic Hospital, PO Box 2, via Sogakope, Battor, Volta Region, Ghana
| | - Faustina Tibu
- Catholic Hospital, PO Box 2, via Sogakope, Battor, Volta Region, Ghana
| | | | | | - Patrick Kafui Akakpo
- Department of Pathology, Clinical Teaching Center, School of Medical Sciences, University of Cape Coast, PMB, Cape Coast, Ghana
- https://orcid.org/0000-0003-0356-0663
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Benjamin KA, Lamberti N, Cooke M. Predictors of non-adherence to cervical cancer screening among immigrant women in Ontario, Canada. Prev Med Rep 2023; 36:102524. [PMID: 38116269 PMCID: PMC10728462 DOI: 10.1016/j.pmedr.2023.102524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Cervical cancer is one of the most common types of cancer among women and is largely preventable with regular screening using Papanicolau (Pap) tests. In Canada, all provinces have regular screening programs, although with slightly differing recommendations. Previous research has found that immigrant women, who are a large proportion of the Canadian population, are at higher risk of being under-screened, or non-adherent to the recommended screening frequency. Using data from the 2017 Canadian Community Health Survey, this study examined: (1) the extent to which immigration status and time since immigration are associated with Pap test adherence in Ontario, and (2) predictors of Pap test adherence for immigrants and Canadian born populations in Ontario, Canada's most populous province, with a focus on the role of racial or ethnic identity among immigrants. Estimates of 3-year test adherence were 71.3 % (95 %CI: 66.9-75.7) among immigrant women and 75.4 % (95 %CI: 73.1-77.1) among non-immigrant women. Recent immigrants (6-10 years in Canada) had lower adherence (63.5 %, 95 %CI: 48.0-80.0). Logistic regression models found that immigrant women had lower adherence than Canadian-born women, controlling for age, household income, education, and having a primary care physician. Subgroup analysis found that South Asian immigrant women were least likely to be adherent. These results support targeted programming to increase screening adherence among recent immigrants and raise concerns regarding potential barriers to screening. Data that allow better disaggregation of racial and ethnic identities are important for better understanding the potential implications of these patterns for racial inequities in health.
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Affiliation(s)
- Kayla A. Benjamin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nina Lamberti
- Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON M5T 3M6, Canada
| | - Martin Cooke
- School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G5, Canada
- Department of Sociology and Legal Studies, Faculty of Arts, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G5, Canada
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Zago RA, Camilo-Júnior DJ, Pires D'Ávilla SCG, Xavier-Júnior JCC. The impact of transformation zone representation on the frequency of abnormal cervical cytological results. Eur J Obstet Gynecol Reprod Biol 2023; 289:173-176. [PMID: 37688813 DOI: 10.1016/j.ejogrb.2023.08.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To compare the frequency of abnormal cervical cytological results with and without representation of the transformation zone (TZ) in a medium-sized city in Brazil according to the Bethesda categorization. METHODS We performed an analytical observational study evaluating cytological results over 15 years from conventional smears collected within the Public Brazilian Health System in Araçatuba, Brazil. Tests were stratified by age and cytological result according to Brazilian guidelines and the Bethesda System. RESULTS There were 261,881 examinations, 159,251 with and 102,630 without TZ representation. The global frequency of abnormal results was higher in smears with TZ representation (crude odds ratio [OR] 4.03; 95% confidence interval [CI] [3.71-4.38]). Considering only women between 25 and 64 years (the target of the national guidelines), there were higher results for high-grade squamous intraepithelial lesions (OR 11.54; 95% CI 6.74-19.78), low-grade squamous intraepithelial lesions (OR 2.82; 95% CI 2.17-3.67) atypical squamous cell in which high-grade intraepithelial lesion cannot be excluded (OR 6.90; 95% CI 4.91-9.66) and atypical squamous cell of undetermined significance (OR 3.53; 95% CI 3.11-4.01) among cases with TZ representation. CONCLUSION Samples with TZ representation were associated with higher rates of abnormal results. Health professionals should be regularly trained to understand the weakness of cytological examinations when the TZ is not represented, especially in developing countries.
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Affiliation(s)
- Renata Alfena Zago
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil, Guatemala Street no. 414, Araçatuba, São Paulo 16071-045, Brazil
| | - Deolino João Camilo-Júnior
- Pathology Institute of Araçatuba, São Paulo, Brazil, Floriano Peixoto Street no. 808, Araçatuba, São Paulo 16015-000, Brazil
| | - Solange Correa Garcia Pires D'Ávilla
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil, Guatemala Street no. 414, Araçatuba, São Paulo 16071-045, Brazil; São José do Rio Preto Medical School (FAMERP), São Paulo, Brazil, Floriano Peixoto Street no. 808, Araçatuba, São Paulo 16015-000, Brazil
| | - José Cândido Caldeira Xavier-Júnior
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil, Guatemala Street no. 414, Araçatuba, São Paulo 16071-045, Brazil; Pathology Institute of Araçatuba, São Paulo, Brazil, Floriano Peixoto Street no. 808, Araçatuba, São Paulo 16015-000, Brazil; Botucatu Medical School. Paulista State University, Botucatu, São Paulo, Brazil, Floriano Peixoto Street no. 808, Araçatuba, São Paulo 16015-000, Brazil.
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Salazar Moya J, Rojas-Zumaran V, Vegas C, Salafia A, Contreras-Pulache H. Use of grape-based stain (Vinatela) on cervical cytology: A Peruvian validation study. Cytojournal 2023; 20:30. [PMID: 37810437 PMCID: PMC10559590 DOI: 10.25259/cytojournal_19_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/10/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives The Papanicolaou's (Pap's) stain is used for cervical cancer screening. It employs toxic-carcinogenic expensive reagents, which may not be easily accessible to many communities worldwide. The objective of this study was to validate the grape-based alcohol-extracted dye (Vinatela) on normal cervical samples for the Pap test. Material and Methods Samples of the two grape species were collected from two vineyards through the Agroindustrial Research Institute of Universidad Privada San Juan Bautista. The dye extraction from the grape species and the dye performance to stain cells were conducted in three phases: (a) direct staining with pre-fermentation wine products, (b) direct fragmentation of grapes and direct staining with shells of the grapes, and (c) alcoholic extraction of the dye. Vinatela obtained from two species (Vitis vinifera "Tempranillo" and "Malbec") and posterior staining of cervical samples. We conducted a double-blind validation on 30 cervical samples. Results The basophilic components of the cervical cells were stained. Alcoholic extraction staining protocol had a low yield. The nuclear and cytoplasmic borders, the nuclear details, and the polymorphonuclear nuclei were stained with Vinatela and could be differentiated during nuclear coloration. The initial staining protocol was 10- 20 min × (mean ~12 min) staining time. We noted a slightly better staining with V. v. Tempranillo as compared to V. v. Malbec (P = 0.045). Conclusion Cervical cells stained with Vinatela stain from two grape species cultivated in the Southern of Peru, showed basophilic nuclear details.
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Affiliation(s)
- Jeel Salazar Moya
- Graduate School, Universidad Privada San Juan Bautista, Peru
- Department of Biomedical Engineering, Faculty of Engineering, Universidad Tecnológica del Perú, Lima, Peru
| | - Victor Rojas-Zumaran
- Department of Pathology, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, Peru
- School of Engineering in Enology and Viticulture, Universidad Privada San Juan Bautista, Ica, Perú
| | - Carlos Vegas
- School of Engineering in Enology and Viticulture, Universidad Privada San Juan Bautista, Ica, Perú
| | - Amalia Salafia
- School of Engineering in Enology and Viticulture, Universidad Privada San Juan Bautista, Ica, Perú
- Faculty of Oenology and Agroindustries, Universidad Maza, Mendoza, Argentina, Peru
| | - Hans Contreras-Pulache
- South America Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru
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Lee RY, Koo JY, Kim NI, Kim SS, Nam JH, Choi YD. Usefulness of the human papillomavirus DNA chip test as a complementary method for cervical cytology. Cytojournal 2023; 20:34. [PMID: 37810438 PMCID: PMC10559486 DOI: 10.25259/cytojournal_40_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 05/08/2022] [Indexed: 10/10/2023] Open
Abstract
Objectives As a convenient and economical method of screening cervical cancer and precancerous pathologies, the Papanicolaou smear (Pap smear) has been most widely used. Nevertheless, it requires cytological changes for making diagnoses and reportedly has a high false-negative rate. In this study, the usefulness of the human papillomavirus (HPV) DNA chip test as a complementary method that can compensate for the defect of the Pap smear was investigated. Material and Methods Of the 6516 patients who simultaneously underwent a Pap smear and an HPV DNA chip test at Chonnam National University Hospital between January 2015 and December 2016, 1897, an initial PAP smear-negative patients who had undergone an additional Pap smear during their 2-year follow-up period were selected for this study. Of the subject patients, 281 underwent a cervical biopsy. Results The Pap smear follow-up of an initial Pap smear-negative subjects showed 53 (75.7%) HPV high-risk positive cases in the cytology low-grade lesion group (70 cases) and 46 (97.8%) HPV high-risk positive cases in the cytology high-grade lesion group (47 cases). The 281 biopsy cases included 67 biopsy low-grade lesion cases and 74 biopsy high-grade lesion cases, of which there were 45 (67.2%) and 67 (90.5%) HPV high-risk positive cases, respectively. The follow-up cytology on the high-risk HPV-positive subjects showed that the ratio of their high-grade lesions was 260.8 times greater than that of the high-risk HPV-negative subjects (OR = 260.8 and 95% CI: 36.1 and 1886.1); and their biopsy showed that the ratio of their high-grade lesions was 102.7 times greater than that of the HPV-negative subjects (OR = 102.7 and 95% CI: 14.0 and 753.3). Conclusion The complementary use of the HPV DNA chip test may be useful in increasing the accuracy of screening examinations for the early diagnosis of uterine cervix cancer when combined with the Pap smear.
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Affiliation(s)
- Rae-Young Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Joo-Yeon Koo
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Nah-Ihm Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung-Sun Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong-Hee Nam
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
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13
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Pelegrina B, Paytubi S, Marin F, Martínez JM, Carmona Á, Frias-Gomez J, Peremiquel-Trillas P, Dorca E, Zanca A, López-Querol M, Onieva I, Benavente Y, Barahona M, Fernandez-Gonzalez S, De Francisco J, Caño V, Vidal A, Pijuan L, Canet-Hermida J, Dueñas N, Brunet J, Pineda M, Matias-Guiu X, Ponce J, Bosch FX, De Sanjosé S, Alemany L, Costas L. Evaluation of somatic mutations in cervicovaginal samples as a non-invasive method for the detection and molecular classification of endometrial cancer. EBioMedicine 2023; 94:104716. [PMID: 37480623 PMCID: PMC10393602 DOI: 10.1016/j.ebiom.2023.104716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND The incidence of endometrial cancer is increasing worldwide. While delays in diagnosis reduce survival, case molecular misclassification might be associated with under- and over-treatment. The objective of this study was to evaluate genetic alterations to detect and molecularly classify cases of endometrial cancer using non-invasive samples. METHODS Consecutive patients with incident endometrial cancer (N = 139) and controls (N = 107) from a recent Spanish case-control study were included in this analysis. Overall, 339 cervicovaginal samples (out of which 228 were clinician-collected and 111 were self-collected) were analysed using a test based on next-generation sequencing (NGS), which targets 47 genes. Immunohistochemical markers were evaluated in 133 tumour samples. A total of 159 samples were used to train the detection algorithm and 180 samples were used for validation. FINDINGS Overall, 73% (N = 94 out of 129 clinician-collected samples, and N = 66 out of 90 self-collected samples) of endometrial cancer cases had detectable mutations in clinician-collected and self-collected samples, while the specificity was 80% (79/99) for clinician-collected samples and 90% (19/21) for self-collected samples. The molecular classifications obtained using tumour samples and non-invasive gynaecologic samples in our study showed moderate-to-good agreement. The molecular classification of cases of endometrial cancer into four groups using NGS of both clinician-collected and self-collected cervicovaginal samples yielded significant differences in disease-free survival. The cases with mutations in POLE had an excellent prognosis, whereas the cases with TP53 mutations had the poorest clinical outcome, which is consistent with the data on tumour samples. INTERPRETATION This study classified endometrial cancer cases into four molecular groups based on the analysis of cervicovaginal samples that showed significant differences in disease-free survival. The molecular classification of endometrial cancer in non-invasive samples may improve patient care and survival by indicating the early need for aggressive surgery, as well as reducing referrals to highly specialized hospitals in cancers with good prognosis. Validation in independent sets will confirm the potential for molecular classification in non-invasive samples. FUNDING This study was funded by a competitive grant from Instituto de Salud Carlos III through the projects PI19/01835, PI23/00790, and FI20/00031, CIBERESP CB06/02/0073 and CIBERONC CB16/12/00231, CB16/12/00234 (Co-funded by European Regional Development Fund. ERDF: A way to build Europe). Samples and data were provided by Biobank HUB-ICO-IDIBELL, integrated into the Spanish Biobank Network, and funded by the Instituto de Salud Carlos III (PT20/00171) and by Xarxa de Bancs de Tumors de Catalunya (XBTC) sponsored by Pla Director d'Oncologia de Catalunya. This work was supported in part by the AECC, Grupos estables (GCTRA18014MATI). It also counts with the support of the Secretariat for Universities and Research of the Department of Business and Knowledge of the Generalitat de Catalunya, and grants to support the activities of research groups 2021SGR01354 and 2021SGR1112.
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Affiliation(s)
- Beatriz Pelegrina
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Fátima Marin
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain
| | - José Manuel Martínez
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Faculty of Medicine, University of Barcelona, Spain
| | | | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Faculty of Medicine, University of Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Faculty of Medicine, University of Barcelona, Spain
| | - Eduard Dorca
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Alba Zanca
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Marta López-Querol
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Irene Onieva
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of Medicine, University of Barcelona, Spain
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Marc Barahona
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Fernandez-Gonzalez
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Javier De Francisco
- Department of Anesthesiology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Caño
- Department of Anesthesiology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - August Vidal
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Lara Pijuan
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Júlia Canet-Hermida
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain
| | - Núria Dueñas
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain
| | - Joan Brunet
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain; Hereditary Cancer Program, Catalan Institute of Oncology, IDIBGI, Girona, Spain; Medical Oncology Department, Catalan Institute of Oncology, Doctor Josep Trueta Girona University Hospital, Girona, Spain
| | - Marta Pineda
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL Program, L'Hospitalet, Barcelona, Spain
| | - Xavier Matias-Guiu
- Consortium for Biomedical Research in Cancer - CIBERONC, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Universitat Oberta de Catalunya, Barcelona, Spain
| | - Silvia De Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Consultant, National Cancer Institute, Bethesda, MD, 20814, USA; ISGlobal, Barcelona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Faculty of Medicine, University of Barcelona, Spain
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, Av Gran Vía 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health - CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029, Madrid, Spain; Faculty of Medicine, University of Barcelona, Spain.
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Barakzai S, Koltun-Baker E, Melville SJ, Rangel E, Dahl M, Dancz CE. Rates of unanticipated premalignant and malignant lesions at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population. AJOG Glob Rep 2023; 3:100217. [PMID: 37275440 PMCID: PMC10232886 DOI: 10.1016/j.xagr.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The rate of unanticipated premalignant or malignant pathology at the time of hysterectomy performed for pelvic organ prolapse has been previously reported to be 0.2%. It is not known whether this rate is similar in patients with limited access to regular medical care. OBJECTIVE This study aimed to describe the rates of unanticipated premalignancy and malignancy at the time of hysterectomy performed for pelvic organ prolapse in an underscreened population and to determine the risk factors for unanticipated pathology. STUDY DESIGN Hysterectomies performed for pelvic organ prolapse at a large public hospital between July 2007 and July 2019 were reviewed. Patients undergoing surgery for malignancy or premalignancy were excluded. Medical records were reviewed for demographic information, medical history, preoperative workup, and final pathology. Frequencies of abnormal pathologies were calculated. Demographic and screening factors were correlated with pathologic findings using the Fisher exact test or Mann-Whitney U test, as appropriate. This study was approved by the institutional review board. RESULTS Between 2007 and 2019, 759 cases of pelvic organ prolapse were identified. Of 759 patients, 667 (87.9%) self-identified as Hispanic. The median age was 57 years old, and 505 of 759 patients (66.5%) were in the postmenopausal stage. Abnormal uterine bleeding history was present in 217 of 759 patients (28.6%). Of 759 patients, 493 (65.4%) underwent preoperative ultrasonography, and 290 (38.3%) underwent preoperative endometrial biopsy. Of the 744 uterine specimens that had available histology results, there were 2 cases of endometrial hyperplasia and 1 case of endometrial cancer. Of the 729 cervical specimens that were available for review, there was 1 case of intraepithelial neoplasia and 2 cases of cervical cancer. In the 246 patients who underwent oophorectomy, no ovarian malignancy was found. CONCLUSION For patients undergoing hysterectomy for pelvic organ prolapse in an underscreened population, the rates of endometrial dysplasia or cancer were 0.40% (3/744), and the rates of cervical dysplasia or cancer were 0.42% (3/729). Our results underscore the importance of considering screening history when interpreting preoperative cervical and endometrial cancer screening. Consideration of higher negative predictive value tests, such as cytology with human papillomavirus cotesting and preoperative counseling on the risks and management strategies of unanticipated premalignancy or malignancy within this population may be reasonable.
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Affiliation(s)
- Syem Barakzai
- Departments of Obstetrics and Gynecology (Dr Barakzai, Ms Koltun-Baker, Mr Melville, and Drs Rangel and Dancz)
| | - Emma Koltun-Baker
- Departments of Obstetrics and Gynecology (Dr Barakzai, Ms Koltun-Baker, Mr Melville, and Drs Rangel and Dancz)
| | - Samuel J.F. Melville
- Departments of Obstetrics and Gynecology (Dr Barakzai, Ms Koltun-Baker, Mr Melville, and Drs Rangel and Dancz)
| | - Enanyeli Rangel
- Departments of Obstetrics and Gynecology (Dr Barakzai, Ms Koltun-Baker, Mr Melville, and Drs Rangel and Dancz)
| | - Molly Dahl
- Urology (Dr Dahl), University of Southern California, Los Angeles, CA
| | - Christina E. Dancz
- Departments of Obstetrics and Gynecology (Dr Barakzai, Ms Koltun-Baker, Mr Melville, and Drs Rangel and Dancz)
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Gartner DR, Islam JY, Margerison CE. Medicaid expansions and differences in guideline-adherent cervical cancer screening between American Indian and White women. Cancer Med 2023; 12:8700-8709. [PMID: 36629351 PMCID: PMC10134301 DOI: 10.1002/cam4.5593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although preventable through screening, cervical cancer incidence and mortality are higher among American Indian and Alaska Native women (AIAN) than White women. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansions may uniquely impact access and use of cervical cancer screening among AIAN women and ultimately alleviate this disparity. METHODS Using Medicaid eligible AIAN (N = 4681) and White (N = 57,661) women aged 18-64 years from the 2010-2020 Behavioral Risk Factor Surveillance System, we implemented difference-in-differences regression to estimate the association between the Medicaid expansions and guideline-adherent cervical cancer screening and health care coverage. RESULTS The Medicaid expansions were not associated with guideline-adherent cervical cancer screening (AIAN: -1 percentage point [ppt] [95% confidence interval, CI: -4, 2 ppts]; White: 3 ppts [95% CI: -0, 6 ppts]), but were associated with a 2 ppt increase (95% CI: 0, 4 ppt) in having had a pap test in the last 5 years among White women. The Medicaid expansions were also associated with increases in having a health plan (AIAN: 5 ppts [95% CI: 1, 9]; White: 11 ppts [95% CI: 7, 15]) and decreases in avoiding medical care due to costs (AIAN: -8 ppts [95% CI: -13, -2]; White: -6 ppts [95% CI: -9, -4]). CONCLUSIONS While we observed improvements in health care coverage, we did not observe changes to guideline-adherent cervical cancer screening following the ACA's Medicaid expansions. Given the disproportionate burden of cervical cancer among AIAN women, identifying ways to improve cervical cancer screening uptake and delivery should be prioritized to reduce preventable deaths.
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Affiliation(s)
- Danielle R. Gartner
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Jessica Y. Islam
- Cancer Epidemiology ProgramH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Oncologic SciencesUniversity of South FloridaTampaFloridaUSA
| | - Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human MedicineMichigan State UniversityEast LansingMichiganUSA
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Duong HT, Hopfer S. Exploring Intergenerational Communication on Social Media Group Chats as a Cancer Prevention Intervention Opportunity Among Vietnamese American Families: Qualitative Study. JMIR Form Res 2023; 7:e35601. [PMID: 36790844 PMCID: PMC10013128 DOI: 10.2196/35601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Families use social media group chats to connect with each other about daily life and to share information. Although cancer is not a frequent topic of conversation in family settings, the adoption of mobile technology in the family context presents a novel opportunity to promote cancer prevention information. To the best of our knowledge, few studies have used private social media group chats to promote cancer prevention information to family members. OBJECTIVE In this formative study, we investigated how family group chat platforms can be leveraged to encourage colorectal cancer screening, human papillomavirus vaccination, and cervical cancer screening among intergenerational Vietnamese American families. This study aimed to cocreate a family-based communication intervention for introducing cancer screening information in family group chats. We sought to understand family members' motivations for using group chats, family dynamics and conversation patterns, and group chat experiences and cultural norms for interacting with family members. METHODS Overall, 20 audio-recorded and semistructured interviews were conducted with young Vietnamese adults. The study was conducted between August and October 2018. Participants were Vietnamese Americans; aged between 18 and 44 years; living in Orange County, California; had an existing family group chat; and expressed an interest in becoming family health advocates. Data were analyzed using a framework analysis. RESULTS In total, 13 (65%) of the 20 young adults reported having >1 group chat with their immediate and extended family. Preventive health was not a typical topic of family conversations, but food, family announcements, personal updates, humorous videos or photos, and current events were. Young adults expressed openness to initiating conversations with family members about cancer prevention; however, they also raised concerns that may influence family members' receptivity to the messages. Themes that could potentially impact family members' willingness to accept cancer prevention messages included family status and hierarchy, gender dynamics, relational closeness in the family, and source trust and credibility. These considerations may impact whether families will be open to receiving cancer screening information and acting on it. The participants also mentioned practical considerations for intervention and message design, which included the Vietnamese cultural conversation etiquette of hỏi thăm, respect for a physician's recommendation, prevention versus symptom orientation, the family health advocate's bilingual capacity, and the busy lives of family members. In response to exemplar messages, participants mentioned that they preferred to personalize template messages to accommodate conversational norms in their family group chats. CONCLUSIONS The findings of this study inform the development of a social media intervention for increasing preventive cancer screening in Vietnamese American families.
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Affiliation(s)
- Huong Thien Duong
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, Irvine, CA, United States
| | - Suellen Hopfer
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, Irvine, CA, United States
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O'Laughlin DJ, Strelow BA, Fellows NA, Stevens JN, Kelsey EA, Fink SR, Peters SM, Johnson JA, Houghton JP, Stolp AM, Fischer KM, Tweedy JM, DeJesus RS. Papanicolaou test collection with the Papette brush or the spatula with cytobrush: A pragmatic study. Womens Health (Lond) 2023; 19:17455057231170975. [PMID: 37119034 PMCID: PMC10154996 DOI: 10.1177/17455057231170975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Cotesting with the Papanicolaou (Pap) and human papillomavirus tests detects most precancerous and cancerous lesions and increases the sensitivity for detecting high-grade precancerous and invasive cervical cancers compared with human papillomavirus testing alone. OBJECTIVE To compare the use of the Papette brush (hereafter Papette) to the traditional spatula with endocervical brush (cytobrush) for cervical cancer screening. DESIGN Pragmatic observational study. METHODS Adult women aged 21-64 years who were eligible for a Papanicolaou test at a Midwest Community Internal Medicine practice underwent cervical cancer screening using the Papette or spatula with cytobrush from 18 August 2021 through 1 February 2022. Cluster sampling was used across the practice. Pathology reports were then analyzed to compare the number of satisfactory versus unsatisfactory results between the two collection techniques. RESULTS We collected results for 756 Pap tests. The test results were satisfactory with the Papette 93.8% of the time compared with 93.0% for the spatula with cytobrush. CONCLUSION The Papette is not inferior to a spatula with cytobrush as a collection method for Pap tests.
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Affiliation(s)
| | - Brittany A Strelow
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicole A Fellows
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joy N Stevens
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Kelsey
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephanie R Fink
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sonya M Peters
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jennifer A Johnson
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jaclyn P Houghton
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anne M Stolp
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen M Fischer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Johanna M Tweedy
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ramona S DeJesus
- Division of Community Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Bruegl AS, Emerson J, Tirumala K. Persistent disparities of cervical cancer among American Indians/Alaska natives: Are we maximizing prevention tools? Gynecol Oncol 2023; 168:56-61. [PMID: 36399813 PMCID: PMC9797436 DOI: 10.1016/j.ygyno.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cervical cancer incidence and mortality disparities experienced by American Indian/Alaska Native (AI/AN) women have persisted for decades. Pap smear screening and HPV vaccination are powerful tools to prevent cervical cancer. We evaluated the utilization of these tools among AI/ANs living in the Pacific Northwest (PNW). METHODS The Indian Health Service (IHS) National Data Warehouse's Epi Data Mart was analyzed using all healthcare visits from 2010 to 2020 from IHS, Tribal, and Urban Indian clinics in the PNW. Women ages 21-64 were included and considered up-to-date on pap smears if they had either cytology within 3 years or cytology with HPV testing within 5 years of the most recent clinical encounter. HPV vaccination rates for both sexes were calculated for individuals ages 9-26. HPV vaccination was considered complete if: two vaccines were received prior to age 15 or after three vaccinations if initiated after age 15. FINDINGS Cervical cancer screening rates are below the national average of 73.5% ranging between 57.1% - 65.0%. Sub-analysis of age groups shows substantially lower rates of up-to-date pap smear screening in the 50-64 age group. HPV vaccination rates have increased over time for both sexes across all age groups. However, the current vaccination rate of 58.6% is well below the Healthy People 2030 goal of 84.3%. INTERPRETATION Cervical cancer screening and HPV vaccination are the cornerstones of cervical cancer prevention and early detection. These tools are underutilized and public health efforts can be strengthened to improve cervical cancer disparities in AI/AN women. FUNDING Author ASB: Funding for this project has been provided through the Robert Wood Johnson Foundation Harold Amos Minority Faculty Development Grant and the National Cancer Institute K08 Mentored Clinical Scientist Development Award.
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Affiliation(s)
- A S Bruegl
- Division of Gynecologic Oncology, Department of OB/Gyn, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - J Emerson
- Division of Gynecologic Oncology, Department of OB/Gyn, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America
| | - K Tirumala
- Northwest Portland Area Indian Health Board, Tribal Epidemiology Center, 2121 SW Broadway Street, Suite 300, Portland, OR 97201, United States of America
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Bortolli APR, Treco IC, Vieira VK, Pascotto CR, Ferreto LED, Wendt GW, Lucio LC. Prevalence of HPV and associated factors in a population of women living in southern Brazil. Braz J Microbiol 2022; 53:1979-1986. [PMID: 36261773 PMCID: PMC9679043 DOI: 10.1007/s42770-022-00849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/12/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To determine the prevalence of HPV and investigate factors associated with the infection in women in the city of Francisco Beltrão, southwest Paraná, attending the public health system. METHODS This cross-sectional study included 324 women, aged between 18 and 65 years, who were attending public health services for routine gynecological consultation. Interviews were conducted to obtain information about socioeconomic, sexual, gynecological, and life habits. After performing the Papanicolaou test, endocervical brush was employed to detect HPV by polymerase chain reaction with the primers MY09-MY11. RESULTS The prevalence of HPV was 6.8%, out of which 58.3% presented with cytopathologic alterations. And the presence of current cervical alterations can increase the chances of having HPV by almost 33 times (ORadj: 32.688; p < 0.001), recent vaginal infection increased the chances of HPV infection by 2.7 times (ORadj: 2.773; p = 0.04). The non-white ethnicity increased HPV infection chances threefold (ORadj: 3.058; p = 0.039). CONCLUSION The main finding was low prevalence of HPV infection. Factors that may be linked to HPV infection were cervical alterations, recent vaginal infection, and women's ethnicity.
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Affiliation(s)
- Ana Paula Reolon Bortolli
- Universidade Estadual Do Oeste Do Paraná, Programa de Pós-Graduação Em Ciências Aplicadas À Saúde, Francisco Beltrão, Paraná, Brazil
| | - Indianara Carlotto Treco
- Universidade Estadual Do Oeste Do Paraná, Programa de Pós-Graduação Em Ciências Aplicadas À Saúde, Francisco Beltrão, Paraná, Brazil
| | - Valquíria Kulig Vieira
- Universidade Estadual Do Oeste Do Paraná, Programa de Pós-Graduação Em Ciências Aplicadas À Saúde, Francisco Beltrão, Paraná, Brazil
| | - Claudicéia Risso Pascotto
- Universidade Estadual Do Oeste Do Paraná, Programa de Pós-Graduação Em Ciências Aplicadas À Saúde, Francisco Beltrão, Paraná, Brazil
| | - Lirane Elize Defante Ferreto
- Universidade Estadual Do Oeste Do Paraná, Programa de Pós-Graduação Em Ciências Aplicadas À Saúde, Francisco Beltrão, Paraná, Brazil
| | - Guilherme Welter Wendt
- Universidade Estadual Do Oeste Do Paraná, Centro de Ciências da Saúde, Francisco Beltrão, Paraná, Brazil
| | - Léia Carolina Lucio
- Universidade Estadual Do Oeste Do Paraná, Programa de Pós-Graduação Em Ciências Aplicadas À Saúde, Francisco Beltrão, Paraná, Brazil.
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Chincha Lino OJ, Chinchihualpa Paredes NO, Samalvides Cuba F. Factors associated with normal or abnormal Papanicolaou smear among HIV-infected women at a national hospital in Lima, Peru, 2012-2015. AIDS Care 2022; 34:1264-1267. [PMID: 34793251 DOI: 10.1080/09540121.2021.2002254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
HIV-infected women are at a risk of developing abnormal lesions of the uterine cervix. The objective of this study was to determine factors associated with normal or abnormal Papanicolaou (Pap) smear among HIV-infected women. A case-control study was conducted; case and control were defined as HIV-infected women ≥18 years with an abnormal and normal Pap smear, respectively. A logistic regression analysis was performed, and the Odds Ratio (OR) was calculated with its 95% Confidence Interval (CI). We included 368 patients, and the mean age was 36.83 years (SD ± 9.81), similar between cases and controls. Regarding cases, 30.50% (n = 43) had an alcohol consumption (AC), 75.18% (n = 106) were on antiretroviral therapy (ART) and 37.74% (n = 40) were in virologic failure (VF). About controls, 18.02% (n = 41) had AC, 85.02% (n = 193) were on ART, and 23.12% (n = 40) were in VF. In multivariate analysis, AC [OR: 1.77 (1.06-2.95)], VF [OR: 2.41 (1.55-3.74)], and ART [OR: 0.07 (0.02-0.23)] were significant factors. The risk factors associated with an abnormal Pap smear were AC and VF. ART was a protective factor. Therefore, besides scheduled Pap smear, human papillomavirus screening/immunization, VF, and ART should be strictly reinforced, and AC should be mitigated.
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Affiliation(s)
- Omayra Jannet Chincha Lino
- Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Perú
| | - Nathaly Olga Chinchihualpa Paredes
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú.,Sociedad Científica de Estudiantes de Medicina Cayetano Heredia (SOCEMCH), Lima, Perú
| | - Frine Samalvides Cuba
- Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Perú.,Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
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Luu XQ, Lee K, Jun JK, Suh M, Jung KW, Lim MC, Choi KS. Effect of Pap smears on the long-term survival of cervical cancer patients: a nationwide population-based cohort study in Korea. Epidemiol Health 2022; 44:e2022072. [PMID: 36108672 PMCID: PMC9943631 DOI: 10.4178/epih.e2022072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/07/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the effect of cervical cancer screening by Papanicolaou (Pap) smears on the long-term survival of cervical cancer patients. METHODS We constructed a retrospective cohort of 14,903 women diagnosed with invasive cancer or carcinoma in situ in 2008 and 2009 and followed up until December 31, 2019, by using individual-level data from 3 national databases of the Korean National Cancer Screening Program, the Korean Central Cancer Registry, and death certificates. Cox proportional-hazards regression was used to investigate the effect of cervical cancer screening on mortality. RESULTS In total, 12,987 out of 14,867 patients (87.4%) were alive at the end of the follow-up period (median: 10.5 years). Screened patients had a 38% lower risk of cervical cancer death than never-screened patients (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.54 to 0.70). Screening was associated with 59% and 35% lower risks of death, respectively, in screened patients with localized and regional stages. Furthermore, lower HRs among women who received screening were observed in all age groups, especially women aged 50-59 years (HR, 0.54; 95% CI, 0.42 to 0.69). The lowest HR for cervical cancer death was reported among patients screened within the past 2 years (HR, 0.54; 95% CI, 0.47 to 0.63), and the HRs increased with increasing time intervals. CONCLUSIONS Pap smear screening significantly reduced the risk of cervical cancer-specific death in Korean women across all cancer stages.
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Affiliation(s)
- Xuan Quy Luu
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Kyeongmin Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - kyu-won Jung
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Division of Tumor Immunology, Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea,Correspondence: Kui Son Choi Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea E-mail:
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Dorji N, Tshering S, Choden S, Chhetri M, Bhujel D, Wangden T, Pradhan B, Bhutia PC, Tshomo U. Evaluation of the diagnostic performance of colposcopy in the diagnosis of histologic cervical intraepithelial neoplasia 2+ (CIN2+). BMC Cancer 2022; 22:930. [PMID: 36038826 PMCID: PMC9422165 DOI: 10.1186/s12885-022-10030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Colposcopy is a tool for triaging screen positive women regardless of method used for cervical cancer screening. The objective of this study was to evaluate the diagnostic performance of colposcopy in the diagnosis of histologic cervical intraepithelial neoplasia 2+ (CIN 2+) at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu, Bhutan. Methods This cross-sectional study was conducted from March 2021 to August 2021 among 299 women who availed colposcopy services at the colposcopy clinic of JDWNRH, Bhutan. Women included in this study were either screen positive (Pap smear) or were suspected to have invasive cancer; they underwent colposcopy and a cervical biopsy irrespective of colposcopy impression. This histopathologic assessment was considered as the gold standard test for the diagnosis of cervical intraepithelial neoplasia (CIN) or invasive cancer. Results The mean age of the study participants was 43 years (ranges, 25–76 years). The sensitivity, specificity and accuracy of senior colposcopists to diagnose histologic CIN 2+ were 80.0% (95% CI 59.30, 93.17), 71.07% (95% CI 62.13, 78.95), and 72.60% (95% CI 64.61, 79.65), and for junior colposcopists were 59.46% (95% CI 42.10, 75.25), 76.72% (95% CI 67.97, 84.04), and 72.55% (95% CI 64.76, 79.45) respectively. The overall sensitivity, specificity, and accuracy of colposcopy to diagnose histologic CIN 2+ were 66.67% (95% CI 53.66, 78.05), 73.73% (95% CI 67.63, 79.23), and 72.24% (95% CI 66.79, 77.24) respectively. Conclusions In this study, the senior and junior colposcopists had a comparable colposcopic accuracy to diagnose histologic CIN 2+, whereas senior had a higher sensitivity but a lower specificity than junior colposcopists.
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Affiliation(s)
- Namkha Dorji
- Department of Obstetrics and Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
| | - Sangay Tshering
- Department of Obstetrics and Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sonam Choden
- Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Meera Chhetri
- Colposcopy Clinic, Gyeltsuen Jetsun Pema Mother and Child Hospital, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Damanti Bhujel
- Colposcopy Clinic, Gyeltsuen Jetsun Pema Mother and Child Hospital, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Tshering Wangden
- Department of Obstetrics and Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Birendra Pradhan
- Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Pema Choden Bhutia
- Department of Obstetrics and Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Ugyen Tshomo
- Department of Obstetrics and Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Cerqueira RS, Dos Santos HLPC, Prado NMDBL, Bittencourt RG, Biscarde DGDS, Dos Santos AM. [Control of cervical cancer in the primary care setting in South American countries: systematic reviewControl del cáncer cervicouterino en los servicios de atención primaria de salud en los países de América del Sur: revisión sistemática]. Rev Panam Salud Publica 2022; 46:e107. [PMID: 36016837 PMCID: PMC9395576 DOI: 10.26633/rpsp.2022.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Descrever as estratégias para prevenção e controle do câncer do colo do útero (CCU) na atenção primária à saúde (APS) na América do Sul. Métodos. Revisão de literatura em duas etapas: revisão documental em sites governamentais de Argentina, Bolívia, Brasil, Chile, Colômbia, Equador, Paraguai, Peru, Uruguai e Venezuela; e revisão sistemática da literatura nas bases LILACS, MEDLINE, Scopus, SciELO e Science Direct. Resultados. Foram incluídos 21 documentos institucionais (planos, guias de prática e diretrizes nacionais) e 25 artigos. Todos os países tinham taxas elevadas de morbimortalidade por CCU. Predominou o rastreamento oportunístico na APS, embora os documentos disponíveis sinalizassem intenções e estratégias para diagnóstico precoce e acompanhamento longitudinal dos casos suspeitos e confirmados, preferencialmente na rede pública. Todos os países adotavam uma concepção abrangente de APS, embora o processo de implementação estivesse em estágios heterogêneos e predominassem a focalização e a seletividade. Destaca-se pior acesso ao rastreamento para mulheres de regiões rurais ou remotas e para povos originários. A indisponibilidade de serviços de APS próximos às residências/comunidade foi uma importante barreira para o rastreamento do CCU. Conclusões. A fragmentação dos sistemas de saúde e a segmentação na oferta de serviços são obstáculos para a prevenção e o controle do CCU na América do Sul. São necessários programas organizados de rastreamento do CCU e a incorporação de busca ativa para realização do Papanicolaou via APS. A interculturalidade nas práticas e a formulação de políticas numa perspectiva interseccional são fundamentais para superar as iniquidades no controle do CCU nos países sul-americanos.
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Affiliation(s)
- Raisa Santos Cerqueira
- Universidade Federal da Bahia Programa de Pós-Graduação em Saúde Coletiva Vitória da Conquista (BA) Brasil Universidade Federal da Bahia, Programa de Pós-Graduação em Saúde Coletiva, Vitória da Conquista (BA), Brasil
| | - Hebert Luan Pereira Campos Dos Santos
- Universidade Federal da Bahia Programa de Pós-Graduação em Saúde Coletiva Vitória da Conquista (BA) Brasil Universidade Federal da Bahia, Programa de Pós-Graduação em Saúde Coletiva, Vitória da Conquista (BA), Brasil
| | - Nilia Maria de Brito Lima Prado
- Universidade Federal da Bahia Programa de Pós-Graduação em Saúde Coletiva Vitória da Conquista (BA) Brasil Universidade Federal da Bahia, Programa de Pós-Graduação em Saúde Coletiva, Vitória da Conquista (BA), Brasil
| | - Rebecca Gusmão Bittencourt
- Universidade Federal da Bahia Programa de Pós-Graduação em Saúde Coletiva Vitória da Conquista (BA) Brasil Universidade Federal da Bahia, Programa de Pós-Graduação em Saúde Coletiva, Vitória da Conquista (BA), Brasil
| | - Daniela Gomes Dos Santos Biscarde
- Universidade Federal da Bahia Escola de Enfermagem Salvador (BA) Brasil Universidade Federal da Bahia, Escola de Enfermagem, Salvador (BA), Brasil
| | - Adriano Maia Dos Santos
- Universidade Federal da Bahia Programa de Pós-Graduação em Saúde Coletiva Vitória da Conquista (BA) Brasil Universidade Federal da Bahia, Programa de Pós-Graduação em Saúde Coletiva, Vitória da Conquista (BA), Brasil
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Honarvar Z, Zarisfi Z, Salari Sedigh S, Masoumi Shahrbabak M. Comparison of conventional and liquid-based Pap smear methods in the diagnosis of precancerous cervical lesions. J OBSTET GYNAECOL 2022; 42:2320-2324. [PMID: 35579303 DOI: 10.1080/01443615.2022.2049721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cervical cancer is one of the five most common cancers among women. The present study aimed to compare conventional and liquid-based Pap smear methods in 2018 in Kerman, Iran. This was a cross-sectional study. Pap smear samples (conventional Pap smear (CN) and liquid-based cytology (LBC)) were collected from five health centres in Kerman. Samples were classified into two groups of liquid and CNs, and each group was classified into normal, abnormal (including, atypical squamous cells of undetermined significance (ASCUS+), atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H+), low-grade squamous intraepithelial lesion (LSIL+), high-grade squamous intraepithelial lesion (HSIL+) and cancer+) and unsatisfactory. Descriptive data analysis and chi-square/Fisher's exact test were performed in SPSS 20 (SPSS Inc., Chicago, IL). Totally, 31,513 women were screened by two CN and LBC. The mean age of subjects was 39.73 ± 9.58 years. The unsatisfactory smears (1.4% versus 0.02%; p=.001) and ASCUS+ (45.1% versus 39.4%; p=.007) were more reported by conventional tests, while LSIL+ (33.1% versus 38.9%; p=.005) was reported by the LBC test. Among women who were younger than 40 years, the CIN2+ that was found by LBC was significantly more than the CN method (37.4% versus 31.7, p=.04) and among older women (older than 40 years) the CIN1+ was significantly more as well (18% versus 13.6%, p=.05). The present study showed that, although LBC had many advantages, CN is still useful. Further studies are to be suggested as a clinical trial in another population with a large number of participants to compare the diagnosing methods of cervical cancers. Impact StatementWhat is already known on this subject? The conventional Pap smear (CN) and liquid-based cytology (LBC) methods are the most common methods for screening cervical cancers. Previously, in some studies, LBC was reported as a better method and in some studies, traditional method was preferred. Conflicting results were found in previous articles.What do the results of this study add? LBC compared to CN could find truer abnormal cases. The superiority of the LBC method is seen in cases such as reducing unsatisfactory cases, etc. LBC compared to CN could find more CIN+. Also, LBC could find more CIN1+ among women older than 40 years and more CIN+ ≥2 among younger women.What are the implications of these findings for clinical practice and/or further research? Although LBC has many advantages and it is easier, CN is still useful and both methods are suitable for cervical abnormality and cancer detection. CN cannot be declared an outdated method.
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Affiliation(s)
- Zahra Honarvar
- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Zarisfi
- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Saideh Salari Sedigh
- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Masoumi Shahrbabak
- Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Alqabbani R, Chan J, Goldberg A. Adequacy in Endocervical Curettage. Am J Clin Pathol 2022; 158:378-382. [PMID: 35568991 DOI: 10.1093/ajcp/aqac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 04/14/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Specimen adequacy is an important quality assurance component of a cervical Papanicolaou test. Although consensus exists on minimal acceptable cellularity for cervical Papanicolaou tests, no such criteria exist for endocervical curettage (ECC) specimens. We sought to identify minimum acceptable cellularity for accurate diagnosis of high-grade dysplasia (HGD) on ECC. METHODS All patients with HGD diagnosed in a loop electrosurgical excision procedure (LEEP) from May 8, 2018, to December 18, 2019, and an ECC in the preceding 6 months at our institution were included (n = 51). All ECCs performed before the LEEP were evaluated for cellularity of squamous cells using Aperio eSlide Manager (Leica Biosystems). Biopsy results concurrent with the ECC were noted. We compared the number of squamous cells in positive and negative ECC specimens using a t-test. The proportion of ECC specimens and concurrent biopsies undergoing immunohistochemical (IHC) staining for p16 were compared using the χ2 test. P < .05 was considered significant. RESULTS Endocervical curettage specimens positive for HGD have increased cellularity compared with negative ECC specimens (mean cellularity, 10,165 vs 1,055; P < .05). Further, IHC staining for p16 was more likely to be performed on an ECC specimen positive for HGD than on a negative ECC specimen (50% vs 3%; P < .05). Biopsies performed concurrently with a negative ECC finding were more likely to undergo p16 IHC than biopsies performed concurrently with a positive ECC finding (51% vs 7%; P < .05). Finally, we observed no difference in the proportion of biopsies undergoing IHC staining for p16 when comparing biopsies positive for HGD with negative biopsies (37% vs 46%; P = .33). CONCLUSIONS We find cellularity of approximately 10,000 cells adequate to diagnose HGD in an ECC specimen and cellularity of approximately 1,000 cells to be inadequate. Further, we find p16 IHC commonly used as a "rule-in" test on ECC specimens at our institution. Biopsies accompanying an ECC specimen negative for HGD are more likely to undergo p16 IHC than those accompanying an ECC specimen positive for HGD, but there is no difference in the proportion of biopsies undergoing p16 IHC when comparing positive and negative results in the biopsies themselves. These findings further support the need for adequate cellularity for diagnosis in ECC, especially when a biopsy is technically difficult. Further areas for exploration include investigating laboratory procedures to maximize the cellularity of ECC specimens.
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Affiliation(s)
- Roa Alqabbani
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Joanna Chan
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Allison Goldberg
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Paboriboune P, Phongsavan K, Arounlangsy P, Flaissier B, Aphayarath O, Phimmasone P, Banchongphanith K, Xayaovong M, Jourdain G, Schott A, Saadatian‐Elahi M, Magaud L, Klich A, Ngo‐Giang‐Huong N, Heard I, Rabilloud M, Picot VS, Longuet C. Efficacy of careHPV™ human papillomavirus screening versus conventional cytology tests for the detection of precancerous and cancerous cervical lesions among women living with HIV-1 in Lao People's Democratic Republic. Cancer Med 2022; 11:1984-1994. [PMID: 35257506 PMCID: PMC9089224 DOI: 10.1002/cam4.4502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/12/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In the Lao People's Democratic Republic (Lao PDR), cervical cancer is the third leading cause of women cancer. AIMS The objective of this cross-sectional study was to compare the efficacy of careHPV™ test versus conventional Pap smear or Siriraj liquid-based cytology in the detection of cervical cancer in women living with human immunodeficiency virus type 1 (HIV-1). MATERIALS & METHODS Overall, 631 women consented to participate. Four cervical specimens were taken for the purpose of conventional Pap smear, Siriraj liquid-based cytology, careHPV™ test, and HPV-16 genotyping. The exact McNemar test was used to compare the efficacy and diagnostic performance of the tests. RESULTS Of the 631 women with follow-up, 331 were human papillomavirus (HPV) negative. High-grade squamous intraepithelial lesions were found in 37 women, biopsy-proven high-grade cervical intraepithelial neoplasia in 50 women, and invasive carcinoma in seven women. The proportion of women with high-grade cervical lesion or carcinoma detected after abnormal careHPV™ test was higher (6.02%; 95% confidence interval [CI]: 4.4-8.1) than that detected by conventional Pap smear (4.59%; 95% CI: 3.2-6.5). careHPV™ and HPV-16 genotyping had, respectively, the highest sensitivity (80.8%; 95% CI: 67.4-89.5) and specificity (92.2%; 95% CI: 89.8-94.2). HPV-16 was the most frequently detected genotype. CONCLUSIONS careHPV™ test represents a screening option in Lao PDR, particularly in women living with HIV-1 because of higher prevalence of chronic HPV in this population.
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Affiliation(s)
| | | | | | - Bruno Flaissier
- Fondation MérieuxPhu Phanang National Bio‐DiversityVientianeLao‐PDR
| | | | | | | | - Mixi Xayaovong
- Centre d'Infectiologie Christophe Mérieux (CICML)VientianeLao‐PDR
| | - Gonzague Jourdain
- French National Research Institute for Sustainable Development (IRD)MarseilleFrance
| | | | - Mitra Saadatian‐Elahi
- Service HygièneEpidémiologieInfectiovigilance et PréventionCentre Hospitalier Edouard HerriotHospices Civils de LyonLyonFrance
- Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID) – Inserm – U1111 – UCBL Lyon 1 – CNRS – UMR5308 – ENS de LyonLyonFrance
| | | | - Amna Klich
- Université de LyonLyonFrance
- Université Lyon 1VilleurbanneFrance
- Service de Biostatistique‐BioinformatiquePôle Santé PubliqueHospices Civils de LyonLyonFrance
- Équipe Biostatistique‐SantéLaboratoire de Biométrie et Biologie ÉvolutiveCNRS UMR 5558VilleurbanneFrance
| | | | - Isabelle Heard
- French National Human papillomavirus Reference LaboratoryInstitut PasteurParisFrance
| | - Muriel Rabilloud
- Université de LyonLyonFrance
- Université Lyon 1VilleurbanneFrance
- Service de Biostatistique‐BioinformatiquePôle Santé PubliqueHospices Civils de LyonLyonFrance
- Équipe Biostatistique‐SantéLaboratoire de Biométrie et Biologie ÉvolutiveCNRS UMR 5558VilleurbanneFrance
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Miller DL, Graham A, Davis KE, Kaur H, White M, Maleki Z, Rodriguez EF. Risk Assessment of Human Papillomavirus-Positive Cytology-Negative Cervical Cancer Screening in Black and White Women. Am J Clin Pathol 2022; 157:399-405. [PMID: 34508551 DOI: 10.1093/ajcp/aqab129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES As we move toward human papillomavirus (HPV) only as the preferred cervical cancer screening method, we performed a retrospective analysis of Black and White women with negative cytology (Papanicolaou negative [PAPneg]) and positive high-risk HPV (hrHPV) (HPVpos) results and determined follow-up. METHODS We searched our pathology data system for patients with PAPneg/HPVpos results (2017-2019). Follow-up data were reviewed (39 months), and a comparison among race was performed. RESULTS In total, 1,728 patients were identified (Black, 53%; White, 47%). Twenty-nine percent of the patients had no follow-up with no difference among the races. HPV 16 was more common among Whites (P < .01), while non-16/18 hrHPV was more common among Black patients (P = .01). A total of 30 (3.3%) Black and 26 (3.2%) White patients were diagnosed with cervical intraepithelial neoplasia grade 2/3 (CIN 2/3). More White women were diagnosed on biopsy alone (negative endocervical curettage) compared with Black women (20 vs 9, P < .01). Meanwhile, there were 21 Black and 6 White women with CIN 2/3 on endocervical curettage (P = .01). CONCLUSIONS Follow-up of women with PAPneg/HPVpos remains a challenge. There was no disparity in follow-up when cohorts were compared. However, Black women had higher numbers of high-grade intraepithelial lesions on endocervical curettage.
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Affiliation(s)
- Daniel L Miller
- Department of Pathology, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Ashleigh Graham
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katelynn E Davis
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harsimar Kaur
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marissa White
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erika F Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kasraei S, Ghahghaei-Nezamabadi A, Seifollahi A, Aghajani F, Nakhostin-Ansari A, Zarei N, Tehranian A. Comparison of cytopathologic findings in patients with negative Pap test and positive high-risk HPV infection among three groups. Arch Gynecol Obstet 2022; 306:857-863. [PMID: 35233666 DOI: 10.1007/s00404-022-06444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/09/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Comparison of colposcopy-guided biopsy and endocervical cytologic (ECC) results in patients with negative Papanicolaou (Pap) and positive high-risk (HR) HPV tests in the three groups of HPV 16/18, non-16/18 HR-HPV (other HR-HPV), and concurrent infection of either HPV 16/18 and at least one subtype of other HR-HPVs. METHODS This cross-sectional study was conducted among women aged 30-65 who had negative Pap and positive HR-HPV DNA tests. Pap test was performed using liquid cytology. For HPV DNA testing, the polymerase chain reaction (PCR) method was used. RESULTS Among 394 participants, 111 (28.2%) were in the HPV 16/18, 226 (57.4%) in the Other HR-HPV, and 57 (14.4%) in the concurrent group. The mean age of participants was 35.71 ± 7.1 years. Cervical intraepithelial neoplasia (CIN) grade 2/3 were seen in 29 (26.1%) patients of HPV 16/18, 60 (26.5%) of other HR-HPV, and 18 (31.6%) of concurrent infection group (P = 0.593). HPV 52 was the most common subtype in the other HR-HPV group (15%). CONCLUSIONS The risk of high-grade CIN lesions in patients with negative Pap test and positive other HR-HPV was not significantly less than patients with positive HPV 16/18. Besides, the risk of losing the patients to 1-year follow-up seems high.
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Affiliation(s)
- Sara Kasraei
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Rashid Ave, Resalat Highway, Tehranpars, P.O Box: 1653915981, Tehran, Iran
| | - Akram Ghahghaei-Nezamabadi
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Rashid Ave, Resalat Highway, Tehranpars, P.O Box: 1653915981, Tehran, Iran
| | - Akram Seifollahi
- Pathology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Aghajani
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sport Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Zarei
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Rashid Ave, Resalat Highway, Tehranpars, P.O Box: 1653915981, Tehran, Iran
| | - Afsaneh Tehranian
- Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Rashid Ave, Resalat Highway, Tehranpars, P.O Box: 1653915981, Tehran, Iran. .,Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Lin M, Narkcham S, Jones A, Armylagos D, DiPietro B, Okafor O, Tracey P, Vercher T, Vasquez S, Haley S, Crumley S, Gorman B, Jacobi E, Amrikachi M, Coffey D, Mody D, Okoye E. False-negative Papanicolaou tests in women with biopsy-proven invasive endocervical adenocarcinoma/adenocarcinoma in situ: a retrospective analysis with assessment of interobserver agreement. J Am Soc Cytopathol 2022; 11:3-12. [PMID: 34583894 DOI: 10.1016/j.jasc.2021.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The objectives of our study were to identify factors contributing to false-negative Papanicolaou (Pap) tests in patients with endocervical adenocarcinoma (EA) or adenocarcinoma in situ (AIS), and to analyze the impact of educational instruction on interobserver agreement in these cases. MATERIALS AND METHODS False-negative Pap tests from patients with EA/AIS were reviewed by a consensus group and by 12 individual reviewers in 2 rounds, with an educational session on glandular neoplasia in Pap tests conducted between the 2 rounds. RESULTS Of 79 Pap tests from patients with EA/AIS, 57 (72.2%) were diagnosed as abnormal and 22 (27.8%) as negative. Of the 22 false-negative cases, 10 remained negative on consensus review, with false-negative diagnoses attributed to sampling variance. The other 12 cases were upgraded to epithelial abnormalities (including 8 to glandular lesions). The false-negative diagnoses were attributed to screening variance in 2 cases and interpretive variance in 10 cases. On individual review, abnormal cells were misinterpreted as reactive glandular cells or endometrial cells in 7 of 8 and 5 of 8 cases upgraded to glandular abnormalities, respectively. With education, the proportion of individual reviewers demonstrating at least moderate agreement with the consensus diagnosis (Cohen's kappa >0.4) increased from 33% (4 of 12) to 75% (9 of 12). CONCLUSIONS Sampling and interpretive variance each accounted for nearly one-half of the false-negative Pap tests, with underclassification as reactive glandular or endometrial cells the main source of the interpretive variances. Educational instruction significantly decreased the interpretive variance and interobserver variability in the diagnosis of glandular abnormalities.
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Affiliation(s)
- Michelle Lin
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Siroratt Narkcham
- Department of Pathology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Donna Armylagos
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Brittany DiPietro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | | | | | | | | | - Susan Haley
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Suzanne Crumley
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Blythe Gorman
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Elizabeth Jacobi
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Mojgan Amrikachi
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Donna Coffey
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Dina Mody
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Ekene Okoye
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
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de Souza HD, Waissman AL, Diório GRM, Peres SV, Francisco RPV, Galletta MAK. Prevalence of oncogenic human papillomavirus in pregnant adolescents, association with colpocytological changes, risk factors and obstetric outcomes. Clinics (Sao Paulo) 2022; 77:100127. [PMID: 36327641 PMCID: PMC9636540 DOI: 10.1016/j.clinsp.2022.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/29/2022] [Accepted: 10/03/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The authors aim to carry out an investigation on the impact of cervical oncogenic Human Papillomavirus (HPV) detection in pregnant adolescents, to clarify the prevalence and risk factors, considering the importance and lack of data on this topic in Brazil. METHODS A cross-sectional study was conducted with adolescents receiving prenatal care in a tertiary hospital in São Paulo, Brazil, with routine Pap smear and oncogenic HPV detection test in the uterine cervix. The authors sought to associate the results of these tests with demographic and obstetric variables. RESULTS A total of 303 pregnant adolescents whose mean age was 15.30 ± 1.22 years comprised the study subjects. The frequency of high-risk HPV cervical detection was 50.50%. Multivariate analysis revealed that a large number of partners in their lifetime (OR = 1.27) and having a religion (OR = 2.05) were risk factors for cervical detection of oncogenic HPV, while schooling appeared as a protective factor (OR = 0.85). There was an association between this detection and colpocytological alterations, reaching almost 30% of patients, but without association with obstetric and neonatal outcomes. CONCLUSION The prevalence found is one of the highest in Brazil and worldwide. A greater number of partners during their lifetime and having religion were detected as possible factors associated with cervical HPV detection. Detection of cervical HPV-DNA did not influence obstetric and neonatal outcomes. The findings of this study reinforce the need to implement educational measures capable of modifying the incidence of sexually transmitted infections in this population and capable of promoting adherence to HPV vaccination programs.
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Affiliation(s)
- Henrique Diório de Souza
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Departamento Materno Infantil, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, MG, Brazil
| | - Adriana Lippi Waissman
- Divisão de Clínica Obstétrica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Giselle Rodrigues Mota Diório
- Departamento de Internato, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, MG, Brazil
| | - Stela Verzinhasse Peres
- Divisão de Clínica Obstétrica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Divisão de Clínica Obstétrica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Marco Aurélio Knippel Galletta
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
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Hosier H, Sheth SS, Oliveira CR, Perley LE, Vash-Margita A. Unindicated cervical cancer screening in adolescent females within a large healthcare system in the United States. Am J Obstet Gynecol 2021; 225:649.e1-649.e9. [PMID: 34256029 DOI: 10.1016/j.ajog.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/25/2021] [Accepted: 07/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Current consensus recommendations are to not initiate cervical cancer screening for immunocompetent adolescent females before 21 years of age. This is in part because of the very low rate of 0.8 per 100,000 new cervical cancer cases diagnosed among women aged between 20 to 24 years. Timely human papillomavirus vaccination further decreases the incidence of cervical cancer to 4 cases per 100,000 persons by the age of 28 years. Screening before 21 years of age has demonstrated no clear benefit in cancer risk reduction or outcomes. In addition, unindicated screening among adolescents can lead to patient harm and increasing costs to the healthcare system. OBJECTIVE It is important to assess the rates of overutilization of cervical cancer screening and to identify areas where improvements have occurred and where further opportunities exist. This study aimed to assess the trends over time and the practice and provider factors associated with unindicated cervical cancer screening tests in adolescent females within the largest healthcare system in the state. STUDY DESIGN Cross-sectional data from patients aged 13 to 20 years who underwent cervical cancer screening between January 1, 2012, and December 31, 2018, across a large multihospital health system were reviewed. All cervical cancer screening results were included. The incidence rate of unindicated screening was analyzed over 6-month intervals using the Poisson regression analysis. RESULTS The study included data from 118 providers and 794 women. Among the 900 screening results, most (90%) were unindicated: 87% with unindicated cytology testing alone and 14% with unindicated human papillomavirus testing. Screening tests were collected from patients aged 13 to 20 years, many of whom had multiple unindicated cytology tests, with 25 patients having ≥3 tests before the age of 21 years. Most results of cytology testing were negative for intraepithelial lesion or malignancy (77%). Moreover, 52 invasive diagnostic or therapeutic procedures (49 colposcopies and 3 conizations) were performed, of which 45 (87%) followed an unindicated screening test. Between 2012 and 2018, the incidence rate of unindicated cytology decreased by 33% (12.6 to 8.5 unindicated cytology per 1000 encounters). The incidence rate of unindicated screening was lower in the academic setting than in the community setting (incidence rate ratio, 0.43; P<.01). Even with decreases in the overall rates of unindicated screening throughout the study period, there were still 58 unindicated screening tests performed in the final year of this study. CONCLUSION Despite substantial reductions in unindicated screening for women aged <21 years, there remained areas for improvement. Our data reflected practices of guideline nonadherence up to 7 years after the 2012 guideline. Now, with a new series of changes to the guidelines, which may be even more challenging for patients and providers, it is more important than ever to utilize evidence-based strategies to improve guideline dissemination and adherence.
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A Pachani P, Godbole RR, Kshersagar J, Jagdale R, Gosavi A, SomshekharPatil, Sharma RK, Joshi MG. A comparative study of smica in various body fluids of diagnosed cervical cancer patients and healthy women. Obstet Gynecol Sci 2021. [PMID: 34743476 DOI: 10.5468/ogs.21121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/13/2021] [Indexed: 11/08/2022] Open
Abstract
Objective Cervical cancer (CC) is a major public health problem in women, and its early detection can help reduce morbidity and mortality. The objective of this study was to compare serum levels of soluble MHC class I-related chain A (sMICA) levels in various body fluids between women diagnosed with CC and healthy women. Methods A case-control study was conducted at a tertiary care hospital and a cancer center in Kolhapur, India. Overall, 150 individuals (100 CC patients and 50 healthy women) participated after providing informed written consent. Demographic data, histopathology history, parity, and tumor, node, and metastasis (TNM) staging data were collected. Pap smears, saliva, blood, and urine samples were collected. Pap smears were examined microscopically, and sMICA levels in all samples were determined by enzyme-linked immunoassay (ELISA). Results The mean age of women with cervical cancer was 49.86±8.18 years. Squamous cell carcinoma (70%) was the most common histological variant in CC patients. Serum soluble sMICA levels differed significantly with parity and TNM staging (P<0.05). Mean levels of sMICA were significantly different in samples (CC cases vs. healthy patients; saliva: 166.721±108.718 vs. 0.039±0.005 pg/mL; urine: 82.921±45.580 vs. 0.010±0.005 pg/mL; serum: 35.756±10.799 vs. 0.039±0.005 pg/mL, P<0.001). Conclusion Levels of sMICA in body fluids can be considered as a diagnostic or prognostic tool to determine disease progression or tumor regression.
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Bispo Pereira EH, Camilo-Júnior DJ, D'ávilla SCGP, Mattar NJ, Xavier-Júnior JCC. Comparison of cervical cancer screening results among public and private services in Brazil. Int J Gynaecol Obstet 2021; 158:289-294. [PMID: 34655231 DOI: 10.1002/ijgo.13985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/19/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the frequency of cervical smear test results between women seen in private and public health services in a medium-sized city in Brazil. METHODS This was an observational analytical study analyzing cervical cytologic results over 16 years. Public data were collected from the Brazilian National Health System, and private refers to those collected at private clinics. RESULTS The overall frequency of unsatisfactory/rejected results was higher in public service examinations (odds ratio [OR] 0.05; 95% confidence interval [CI] 0.04-0.06). The same occurred for atypical squamous cells of undetermined significance (ASC-US) (OR 0.90; 95% CI 0.85-0.95) and atypical squamous cells cannot exclude high grade intraepithelial lesions (ASC-H) (OR 0.55; 95% CI 0.47-0.64) categories. For low-grade squamous intraepithelial lesions, the frequency was higher among women from private services (OR 1.39; 95% CI 1.24-1.55). Among women aged 25-64 years, the frequency of high-grade squamous intraepithelial lesions was higher among women seen in the public service (OR 0.81; 95% CI 0.66-0.99). CONCLUSION Brazilian public services showed higher frequencies of unsatisfactory/rejected results and higher rates of ASC-US and ASC-H. Focusing on pre-analytical phases and establishing an internal quality control program can help improve these rates even though national protocols guide them.
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Affiliation(s)
| | | | - Solange Correa Garcia Pires D'ávilla
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil.,São José do Rio Preto Medical School (FAMERP), São Paulo, Brazil
| | | | - José Cândido Caldeira Xavier-Júnior
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil.,Pathology Institute of Araçatuba, São Paulo, Brazil
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Massad LS, Xie X, Minkoff HL, Michel KG, D’Souza G, Wang CC, Konkle-Parker D, Ofotokun I, Fischl MA, Rahangdale L, Strickler HD. Frequency of high-grade squamous cervical lesions among women over age 65 years living with HIV. Am J Obstet Gynecol 2021; 225:411.e1-411.e7. [PMID: 33957115 DOI: 10.1016/j.ajog.2021.04.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Current US cervical cancer screening guidelines recommend screening cessation at the age of 65 years provided women have adequate previous screening and no history of precancer. Women living with HIV are at higher risk of cervical cancer than women living without HIV. Furthermore, limited data exists to quantify the risk of cervical cancer among women who otherwise would qualify for screening cessation. OBJECTIVE This study aimed to determine whether guidelines recommending women to discontinue cervical cancer screening at the age of 65 years are appropriate for women living with HIV. STUDY DESIGN Semiannual Papanicolaou testing was performed as part of surveillance visits in the Women's Interagency HIV Study. Launched in October 1994, the Women's Interagency HIV Study is a federally funded US multisite cohort study that has enrolled 3678 women living with HIV and 1304 women living without HIV; we included data throughout September 2019 onward. Conventional Papanicolaou tests were collected at scheduled 6-month visits and read centrally according to the 1991 Bethesda System criteria. Results were analyzed among women at least 65 years of age. The primary endpoint was high-grade cytology, including high-grade squamous intraepithelial lesions; atypical glandular cells; atypical squamous cells, cannot exclude high-grade lesions; and malignant cytology. Wilcoxon rank-sum tests were used to compare the continuous variables, and Chi-square tests or the Fisher exact tests were used to compare the categorical variables. The Kaplan-Meier method was used to calculate the cumulative incidence. Poisson regression was used to compare 2 incidence rates. RESULTS Of 169 eligible women (121 women living with HIV and 48 women living without HIV) who contributed 678.4 person-years of observation after reaching the age of 65 years, 2.2% had high-grade cytologic abnormalities. However, no cancer was found. Furthermore, 20 women had previous precancer results, and 74 women had abnormal Papanicolaou test results in the previous decade. Among 50 women (38 women living with HIV and 12 women living without HIV) with a previous hysterectomy and no history of cervical precancer, the cumulative incidence rates of high-grade squamous intraepithelial lesions were 0.6 (95% confidence interval, 0.0-3.2) per 100 person-years for women living with HIV and 0.0 (95% confidence interval, 0.0-8.1) per 100 person-years for women living without HIV (P=.61). Only 48 women (27 women living with HIV and 21 women living without HIV) had cervices and met the current guidelines to discontinue screening; their risk of experiencing high-grade squamous intraepithelial lesions was 2.2 (95% confidence interval, 0.6-5.5) per 100 person-years overall and did not vary by HIV status (2.3 [95% confidence interval, 0.5-6.8] per 100 person-years for women living with HIV and 1.8 [95% confidence interval, 0.0-9.8] per 100 person-years for women living without HIV; P=.81). CONCLUSION Most women living with HIV do not meet the criteria for cervical cancer screening cessation and will need to continue screening over the age of 65 years; however, women who meet the criteria for screening cessation have risks of high-grade squamous lesions similar to women living without HIV and may choose to discontinue.
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Kasting ML, Haggstrom DA, Lee JL, Dickinson SL, Shields CG, Rawl SM. Financial hardship is associated with lower uptake of colorectal, breast, and cervical cancer screenings. Cancer Causes Control 2021; 32:1173-1183. [PMID: 34283327 PMCID: PMC9878578 DOI: 10.1007/s10552-021-01465-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/14/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE Cancer screening uptake differs between groups in ways that cannot be explained by socioeconomic status alone. This study examined associations between material, psychosocial, and behavioral aspects of financial hardship and cancer screening behaviors. METHODS Surveys were mailed to 7,979 people ages 18-75 who were seen in the statewide health system in Indiana. Participants reported SES, feelings about finances, and whether they had to forgo medical care due to cost. This was compared to uptake of mammogram, colonoscopy/sigmoidoscopy, and Pap testing in best-fit multivariable logistic regression analyses controlling for demographic and healthcare characteristics. RESULTS A total of 970 surveys were returned; the majority of respondents were female (54%), non-Hispanic White (75%), and over 50 years old (76%). 15% reported forgoing medical care due to cost; this barrier was higher among Black than White participants (24% vs. 13%; p = 0.001). In a best fit regression model for colonoscopy/sigmoidoscopy, those who reported they had to forgo medical care due to cost had lower odds of screening (aOR 0.41; 95% CI 0.22-0.74). Forgoing medical care due to cost was not significantly associated with Pap testing in bivariate analyses. For mammogram, forgoing medical care due to cost was significant in bivariate analyses (OR 0.44; 95% CI 0.22-0.88), but was not significant in the multivariable model. CONCLUSION Associations between financial hardship and cancer screening suggest the need to reduce barriers to cancer screening even among patients who have access to healthcare. Future research should explore barriers related to both healthcare and personal costs.
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Affiliation(s)
- Monica L Kasting
- Department of Public Health, Purdue University, 812 W. State Street, Matthews Hall, Room 216, West Lafayette, IN, 47907, USA.
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA.
| | - David A Haggstrom
- Health Services Research and Development Service, Center for Health Information and Communication, Department of Veterans Affairs, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Joy L Lee
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Stephanie L Dickinson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Cleveland G Shields
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
- Center for Cancer Research, Purdue University, West Lafayette, IN, USA
| | - Susan M Rawl
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- School of Nursing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Bell SG, Rowe M, Kobernik EK, McKee K, LeBar W, Bell JD. Using ThinPrep Papanicolaou test samples to evaluate sexually transmitted infection screening practices. J Am Soc Cytopathol 2021; 10:571-576. [PMID: 34548251 DOI: 10.1016/j.jasc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/22/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We sought to evaluate the use of Papanicolaou samples as a screening tool for sexually transmitted infections (STIs). METHODS Retrospective chart review analyzing Papanicolaou samples for STI. Samples were processed and results compared to clinical data to assess this technique's viability. Cases and controls were matched by sample date. Characteristics of women with STI testing were compared in bivariate analyses. RESULTS We analyzed 50 STI-positive and 50 date-matched samples. Thirteen (26.0%) of the STI-positive patients were not screened at their visit. Women without STI screening were older (39.5 vs. 30.0 years, P = 0.001); non-Hispanic White (65.9% vs. 46.4%, P = 0.05); and married (60.0% vs. 26.9%, P = 0.005) than women with STI screening. Fifty-eight were offered and accepted STI testing at their visit; 37 samples were STI-positive: 17 (29.3%) Mycoplasma genitalium (Mgen), 10 (17.2%) chlamydia, 6 (10.3%) trichomoniasis, 1 (1.7%) gonorrhea, and 3 (5.2%) had two STIs. Among the 42 patients without STI testing, 12 (28.6%) had positive samples: 6 (14.3%) chlamydia, 5 (12.0%) Mgen, and 1 (2.4%) trichomoniasis. CONCLUSIONS Over one-quarter of STI-positive patients were not screened; though low-risk by current screening criteria, a significant number may harbor untreated STIs; using Papanicolaou samples may allow for increased screening in this population.
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Affiliation(s)
- Sarah G Bell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
| | - Meghan Rowe
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Emily K Kobernik
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Kimberly McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - William LeBar
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jason D Bell
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Okayama K, Sasagawa T, Teruya K, Oda M, Fujii M, Kimura H, Okodo M. Profiles of Human Papillomavirus Detection of the Multinucleated Cells in Cervical Smears. Microorganisms 2021; 9:microorganisms9081575. [PMID: 34442654 PMCID: PMC8401768 DOI: 10.3390/microorganisms9081575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
Many genotypes of human papillomaviruses (HPVs) may lead to morphological changes in cells, resulting in various atypical cells, such as multinucleated cells (MNCs) and koilocytes, in the cervix. However, the relationships between the profiles of HPV genotypes and MNCs are not exactly known. Thus, this study comprehensively profiles the HPV genotypes in MNCs using a microdissection method. HPV genotypes and MNCs were detected in 651 cases with an abnormal Pap smear by liquid-based cytology. Specific HPV genotypes were also detected, including HPV16, 34, and 56, which might be associated with MNCs. This result suggests that the high-risk HPV genotypes, such as HPV16 and 56, are associated with the atypical changes in MNC morphology from normal cervical cells. The results also show that MNCs may be a predictor of squamous intraepithelial lesion.
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Affiliation(s)
- Kaori Okayama
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, 1-7-1 Tonyamachi, Takasaki-shi, Gunma 370-0006, Japan
| | - Toshiyuki Sasagawa
- Department of Obstetrics and Gynecology, Kanazawa Medical University, 1-1 Uchinadadaigaku, Kahoku-gun, Ishikawa 920-0293, Japan
| | - Koji Teruya
- Department of Health and Welfare, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi, Tokyo 181-8621, Japan
| | - Mizue Oda
- Genki Plaza Medical Center for Health Care, 3-6-5 Iidabashi, Chiyoda-ku, Tokyo 102-0072, Japan
| | - Masahiko Fujii
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi, Tokyo 181-8621, Japan
| | - Hirokazu Kimura
- Department of Health Science, Gunma Paz University Graduate School of Health Sciences, 1-7-1 Tonyamachi, Takasaki-shi, Gunma 370-0006, Japan
| | - Mitsuaki Okodo
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi, Tokyo 181-8621, Japan
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Horback K, Sundling KE, Schmidt RJ, Cibas ES. Developing dashboards for performance improvement in cytopathology. J Am Soc Cytopathol 2021; 10:535-542. [PMID: 34362716 DOI: 10.1016/j.jasc.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/13/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cytopathology has well-defined and objective quality metrics for monitoring the performance of cytopathologists (CPs) and cytotechnologists (CTs). We transformed these metrics into dashboards for real-time visualization and on-demand feedback. METHODS Dashboards were constructed with data from the previous 10 calendar years using the software Tableau. The dashboards for CPs were designed to display 2 gynecologic metrics and 1 nongynecologic metric: the ASCUS:SIL ratio, the percentage of high-risk human papillomavirus (HPV)-positive ASCUS interpretations (HPV+ ASCUS rate), and the proportion of AUS/FLUS thyroid interpretations. CT dashboards were designed to include these plus 2 others: the percentage of Papanicolaou tests referred for CP review and the percentage of Papanicolaou tests interpreted as unsatisfactory. Established professional benchmarks or standard deviations were used to set color-coded "goal," "borderline," and "attention" zones. RESULTS Personal dashboards were successfully developed and implemented for CPs and CTs in the laboratory, with results that are automatically updated every week, requiring minimal curation. Each CP and CT has a unique link that allows them access to their results at any time. Color-coded displays show the individual their quality metrics over the past 10 years, with a snapshot of data from the past 3 months. The laboratory director has a unique link that allows the director access to results for each individual and the laboratory in aggregate. CONCLUSIONS Personalized dashboards enable individuals to access their performance metrics on demand and examine recent performance as well as patterns over time. This facilitates self-motivation to improve performance and adhere to professional benchmarks.
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Affiliation(s)
- Katharine Horback
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kaitlin E Sundling
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan J Schmidt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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Narkcham S, Mody DR, Jones A, Thrall MJ. Rescreening of high-risk HPV positive Papanicolaou tests initially screened as negative is a low yield procedure in the era of HPV genotyping. J Am Soc Cytopathol 2021; 10:558-564. [PMID: 34103275 DOI: 10.1016/j.jasc.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/20/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Many laboratories rescreen Papanicolaou test slides initially interpreted as negative, but positive for human papillomavirus (HPV) high-risk types, as a quality control measure. We have evaluated the utility of this practice in the era of HPV genotyping as a laboratory improvement project. MATERIAL AND METHODS Between August 2016 and October 2019, we identified 3618 rescreened Papanicolaou tests with follow-up biopsies. The biopsy results were put into 3 groups: 1) Negative; 2) LSIL: HPV changes or low-grade squamous intraepithelial lesion; and 3) HSIL: high-grade squamous intraepithelial lesion or carcinoma. HPV molecular testing results with subtyping for types 16 and 18 were available for 3117 of these cases. RESULTS A total of 530 of 2812 Papanicolaou tests (18.8%) with positive HPV results were reinterpreted as cytologically abnormal after rescreening; 75 (14.2%) had a biopsy result of HSIL. The subset positive for HPV types 16/18 had 38 of 133 cytology positive cases diagnosed as HSIL on biopsy vs. 107 of 935 cytology negative cases diagnosed as HSIL on biopsy (28.6% vs. 11.4%, P < 0.0001). The subset positive for "other" (non-16/18) high-risk HPV types had 37 of 397 cytology positive follow-up HSIL vs. 84 of 1288 cytology negative follow-up HSIL (9.3% vs. 6.5%, P = 0.075). CONCLUSIONS Rescreening has the highest yield in specimens positive for types 16/18. However, for this group colposcopy is recommended regardless of cytology findings, reducing the patient benefit. Routine rescreening of cytology negative/HPV positive Papanicolaou tests has reduced utility when HPV subtyping is performed and should be reconsidered.
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Affiliation(s)
| | - Dina R Mody
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | | | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas.
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Kiff JM, Cotter M, Munro EG, Leonard ME, Morgan TK, Bruegl AS. Cervical Cancer Screening in Postmenopausal Women: Is It Time to Move Toward Primary High-Risk Human Papillomavirus Screening? J Womens Health (Larchmt) 2021; 30:972-978. [PMID: 33826419 PMCID: PMC8299692 DOI: 10.1089/jwh.2020.8849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Cervical cytology in postmenopausal women is challenging due to physiologic changes of the hypoestrogenic state. Misinterpretation of an atrophic smear as atypical squamous cells of uncertain significance (ASCUS) is one of the most common errors. We hypothesize that high-risk human papillomavirus (hrHPV) testing may be more accurate with fewer false positive results than co-testing of hrHPV and cervical cytology for predicting clinically significant cervical dysplasia in postmenopausal women. Materials and Methods: We conducted a retrospective analysis of 924 postmenopausal and 543 premenopausal women with cervical Pap smears and hrHPV testing. Index Pap smear diagnoses (ASCUS or greater vs. negative for intraepithelial lesion) and hrHPV testing results were compared with documented 5-year clinical outcomes to evaluate sensitivity and specificity of hrHPV compared with co-testing. Proportions of demographic factors were compared between postmenopausal women who demonstrated hrHPV clearance versus persistence. Results: The prevalence of hrHPV in premenopausal and postmenopausal women was 41.6% and 11.5%, respectively. The specificity of hrHPV testing (89.6% [87.4-91.5]) was significantly greater compared with co-testing (67.4% [64.2-70.4]) (p < 0.05). A greater proportion of women with persistent hrHPV developed cervical intraepithelial lesion 2 or greater (CIN2+) compared with women who cleared hrHPV (p = 0.012). No risk factors for hrHPV persistence in postmenopausal women were identified. Conclusion: Our data suggest that hrHPV testing may be more accurate than co-testing in postmenopausal women and that cytology does not add clinical value in this population. CIN2+ was more common among women with persistent hrHPV than those who cleared hrHPV, but no risk factors for persistence were identified in this study.
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Affiliation(s)
- Jaime M Kiff
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Elizabeth G Munro
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Terry K Morgan
- Department of Pathology, Oregon Health and Science University, Portland, Oregon, USA
| | - Amanda S Bruegl
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
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Kuroki LM, Massad LS, Woolfolk C, Thompson T, McQueen A, Kreuter MW. Cervical cancer risk and screening among women seeking assistance with basic needs. Am J Obstet Gynecol 2021; 224:368.e1-8. [PMID: 33316278 DOI: 10.1016/j.ajog.2020.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the United States, more than half of cervical cancers occur in women who are inadequately screened. Interventions to improve access to cervical cancer preventive care is critical to reduce health inequities. OBJECTIVE This study aimed to evaluate the need for cervical cancer screening among women seeking assistance with basic needs and to assess best approaches to facilitate Papanicolaou test referral. STUDY DESIGN This study is a secondary analysis of a randomized controlled trial of low-income female callers to 2-1-1 Missouri, a helpline for local health and social services. The need for cervical cancer screening was assessed. Callers were randomized to 1 of 3 arms, each providing a Papanicolaou test referral: verbal referral only, verbal referral and tailored print reminder, or verbal referral and navigator. The primary outcome was contacting a Papanicolaou test referral 1 month following intervention. Student t tests or Mann-Whitney U tests were used to analyze significant differences in continuous variables, whereas Fisher exact or χ2 tests were used for categorical variables. We stratified by number of unmet basic needs (0-1 vs ≥2) and compared success of contacting a Papanicolaou test referral among study groups (verbal referral vs tailored reminder vs navigator) using the Fisher exact test and χ2 test, respectively. Multivariate logistic regression was used to assess risk factors for nonadherence for Papanicolaou test at baseline and at 1 month follow-up, adjusting for race and ethnicity, age, insurance status, self-rated health, smoking, and study group. RESULTS Among 932 female callers, 250 (26.8%) needed cervical cancer screening. The frequency of unmet basic needs was high, the most common being lack of money for unexpected expenses (91.2%) and necessities, such as food, shelter, and clothing (73.2%). Among those needing a Papanicolaou test, 211 women received screening referrals. Women in the navigator group (21 of 71, 29.6%) reported higher rates of contacting a Papanicolaou test referral than those exposed to verbal referral only (11/73, 15.1%) or verbal referral and tailored print reminder (9/67, 13.4%) (P=.03). Among 176 women with ≥2 unmet needs who received a Papanicolaou test referral, the provision of a navigator remained associated with contacting the referral (navigator [33.9%] vs verbal referral [17.2%] vs tailored reminder [10.2%]; P=.005). Assignment to the navigator group (adjusted odds ratio, 3.4; 95% confidence interval, 1.4-8.5) and nonwhite race (adjusted odds ratio, 2.0; 95% confidence interval, 1.5-2.8) were independent predictors of contacting a Papanicolaou test referral. CONCLUSION Low-income women seeking assistance with basic needs often lack cervical cancer screening. Health navigators triple the likelihood that women will make contact with Papanicolaou test services, but most 2-1-1 callers still fail to schedule Papanicolaou testing despite assistance from navigators. Interventions beyond health navigators are needed to reduce cervical cancer disparities.
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Tisler A, Ojavee SE, Veerus P, Soodla P, Uusküla A. Cervical cancer screening patterns among HIV-positive women in Estonia: a population-based retrospective cohort study. BMC Cancer 2021; 21:350. [PMID: 33794821 PMCID: PMC8017631 DOI: 10.1186/s12885-021-08076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/22/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The World Health Organisation (WHO) calls for the elimination of cervical cancer (CC) as a public health issue. To achieve elimination, efforts must be aligned and accelerated. Women living with HIV (WLWH) have excess risk for developing, and dying from, CC over the general population. Estimates of cervical cancer screening programme coverage in Eastern European countries that have experienced HIV epidemics since the early 2000's are scarce. METHOD This population-based retrospective study uses a healthcare administrative database and follows cohorts of all WLWH in a ratio of 1:3 randomly matched (age, region) HIV negative women from 2009 to 2018. Annual and longitudinal (over the whole study period) coverage for cervical cancer screening (opportunistic, organised, HIV specific) and adjusted odds ratios (AORs) for longitudinal screening coverage predictors were estimated from 2009 to 2018. RESULTS Among WLWH and HIV-negative women, the mean annual coverage with opportunistic screening was 61.45 and 65.59%; and organised screening was 20.4 and 28.7%, respectively (both: p < 0.00001). 19.01% (95% CI 18.05-19.97) HIV-negative and 13.9% (95% CI 12.35-15.45) WLWH were longitudinally covered with organised cervical cancer screening. Among WLWH, the mean annual HIV-specific cervical cancer screening coverage was 49.4, and 24.3% were longitudinally covered. Longitudinal coverage with HIV-specific cervical cancer screening was inversely associated with age, hepatitis C virus (HCV) co-infection (AOR 0.754, 95% CI 0.619, 0.916), not having insurance (AOR 0.331, 95% CI 0.264, 0.412), drug abuse (AOR 0.459, 95% CI 0.336, 0.618) and higher among those retained in HIV care (AOR 1.972, 95% CI 1.615, 2.410). Among HIV-negative women, longitudinal coverage with organised cervical cancer screening was inversely associated with residence in the region and higher among older women. CONCLUSIONS Our results highlight unacceptably low coverage of cervical cancer screening of WLWH in Estonia. There is need for dedicated cervical cancer screening efforts for WLWH considering the high cancer risk and rate in the study population.
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Affiliation(s)
- Anna Tisler
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
| | - Sven Erik Ojavee
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
| | - Piret Veerus
- National Institute for Health Development, Tallinn, Estonia
| | - Pilleriin Soodla
- Department of Internal Medicine, Tartu University Hospital, Tartu, Estonia
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Noji N, Okayama K, Oda M, Shimada A, Okodo M. Human papillomavirus infection status of single cells isolated from cervical cytology specimens by simple manual microdissection. J Med Virol 2021; 93:5084-5094. [PMID: 33599297 DOI: 10.1002/jmv.26888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
Human papillomavirus (HPV) testing with cytology triage for cervical cancer screening has proven to be useful. It is considered that a significant percentage of HPV-positive women followed by reflex cytology have had multiple-type HPV infections rather than single-type infections. However, the effects of multiple-type infections on changes in the cytomorphology of exfoliated cervical cells have not been investigated. The aim of this study was to validate simple manual microdissection (MMD) maneuver and investigate the HPV infection status of single cells isolated from Papanicolaou (Pap) smears prepared from women with multiple-type infections. Using cytology samples from 90 patients with abnormal Pap smear results, we evaluated the efficiency of the MMD procedure and determined the HPV infection status of single squamous intraepithelial lesion (SIL) cells microdissected from patients with multiple-type infection. When validating the MMD procedure, the HPV-positive rate was 81.5% using 119 MMD samples from the Pap smear in 61 cases with single-type infection. This MMD procedure was able to efficiently collect single cells. Of 119 MMD samples from 29 cases with multiple-type infection, the HPV-positive rate was 42.9%, and most (96.1%) MMD samples exhibited only one genotype. Our MMD maneuver successfully identified HPV genotypes using single cells isolated from cytology specimens. A majority of single SIL cells prepared from multiple-type infection cases turned out to contain only one genotype. In the future, the MMD method could be applied while studying the relationship between the morphological changes exhibited by SIL cells on Pap smear and the infected HPV genotype.
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Affiliation(s)
- Natsumi Noji
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, Mitaka-shi, Tokyo, Japan
| | - Kaori Okayama
- Department of Medical Technology, Faculty of Health Science, Gunma Paz University, Takasaki-shi, Gunma, Japan
| | - Mizue Oda
- Department of Gynecology, Genki Plaza Medical Center for Health Care, Chiyoda-ku, Tokyo, Japan
| | - Atsuyoshi Shimada
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, Mitaka-shi, Tokyo, Japan
| | - Mitsuaki Okodo
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, Mitaka-shi, Tokyo, Japan
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Ghalavandi S, Heidarnia A, Zarei F, Beiranvand R. Knowledge, attitude, practice, and self-efficacy of women regarding cervical cancer screening. Obstet Gynecol Sci 2021; 64:216-25. [PMID: 33355856 DOI: 10.5468/ogs.20236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Iran has a low incidence of cervical cancer (CC). The country is introducing an organized screening system, including human papillomavirus screening. Studies show a high dropout rate among eligible women in continuing testing. Methods This descriptive-analytic study was part of the first phase of a clinical trial conducted on a random sample of 400 women aged 18–49 in Andimeshk City, Khuzestan Province, in 2020. The data collection tool consisted of a man-made questionnaire that included domains of demographic characteristics, knowledge, attitude, practice, and self-efficacy in the Pap smear test. The data were analyzed with Stata-16 using linear and logistic regression models. Results The mean knowledge, attitude, and self-efficacy scores were 6.80±2.33, 34.99±4.32, and 28.67±7.34, respectively. In the multiple models, every unit increase in the knowledge or attitude scores raised the mean self-efficacy score by 1.04 and 0.48, respectively (P<0.001). Every unit increase in the knowledge and self-efficacy scores increased the chance of performing Pap smear 1.61 and 1.41 times, respectively (P<0.001). Conclusion Given the association of women’s knowledge and self-efficacy with practice in performing the Pap smear, it seems that an effective program promoting women’s health behavior regarding CC screening would include applied education to raise community awareness and improve women’s attitudes, self-efficacy, and practice.
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Yang CM, Sung FC, Hsue CS, Muo CH, Wang SW, Shieh SH. Comparisons of Papanicolaou Utilization and Cervical Cancer Detection between Rural and Urban Women in Taiwan. Int J Environ Res Public Health 2020; 18:E149. [PMID: 33379209 DOI: 10.3390/ijerph18010149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 01/11/2023]
Abstract
Using the claims data of one million insured residents in Taiwan from 1996–2013, this study identified 12,126 women in an urban city (Taichung) and 7229 women in a rural county (Yunlin), aged 20 and above. We compared Papanicolaou (Pap) test uses and cervical cancer detection rates between urban and rural women. Results showed that the Pap screening rate was slightly higher in rural women than in urban women (86.1 vs. 81.3 percent). The cervical cancer incidence was much greater for women without Pap test than women with the test (35.8 vs. 9.00 per 1000 in rural women and 20.3 vs. 7.00 per 1000 in urban women). Nested case-control analysis showed that Pap test receivers had an adjusted odds ratio (OR) of 0.35 (95% CI = 0.25–0.51) to be diagnosed with cervical cancer as compared to those who did not receive the test. The rural women had an adjusted OR of 1.46 (95% CI = 1.03–2.06) to be diagnosed with cervical cancer as compared to urban women. In conclusion, women in rural area are at higher cancer risk than city women. Women who do not undergo Pap tests deserve timely intervention of Pap test to prevent the onset of cancer, particularly in rural women with low income.
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Kim M, Kim H, Suh DH, Kim YB. Cervical Cancer in Women with Normal Papanicolaou Tests: A Korean Nationwide Cohort Study. Cancer Res Treat 2020; 53:813-818. [PMID: 33321565 PMCID: PMC8291189 DOI: 10.4143/crt.2020.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose This study aimed to evaluate the risk of cervical cancer diagnosed within 1 year after the last of multiple consecutive normal Papanicolau (Pap) tests. Materials and Methods The database of the National Health Insurance Service was used. We obtained Pap test data for 11,052,116 women aged 30–79 between 2007–2012. The cumulative incidence rates and 5-year overall survival rates of cervical cancer diagnosed within 1 year after the last normal Pap test were compared between women with one (N1), two (N2), and three consecutive normal Pap tests (N3). Women who did not receive a Pap test during the study period were assigned in the N0 group. Results The 1-year cumulative incidence rates of cervical cancer were 58.9, 24.6, 20.3, and 14.2 per 105 in the N0, N1, N2, and N3 groups, respectively. Compared to the N1 group, the risk of cervical cancer diagnosed within 1 year of the last normal Pap test decreased by 17% (relative risk [RR], 0.825; 95% confidence interval [CI], 0.716 to 0.951) in the N2 group and 42% (RR, 0.578; 95% CI, 0.480 to 0.695) in the N3 group. However, the 5-year survival rate in women diagnosed with cervical cancer within 1 year of the last normal Pap test in the N3 group was not higher than that of the N1 group (79.6% vs. 81.3%, p=0.706). Conclusion As normal Pap tests are consecutively repeated, cervical cancer risk significantly decreases. However, previous consecutive normal Pap tests are not associated with improving survival outcomes in women shortly diagnosed with cervical cancer after the last normal Pap test.
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Affiliation(s)
- Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Hyeongsu Kim
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Okodo M, Okayama K, Teruya K, Kimura H, Noji N, Ishii Y, Fujii M, Oda M, Sasagawa T. Koilocytic changes are not elicited by human papillomavirus genotypes with higher oncogenic potential. J Med Virol 2020; 92:3766-3773. [PMID: 32190903 DOI: 10.1002/jmv.25775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/17/2020] [Indexed: 12/23/2022]
Abstract
Koilocytes are considered a common cytopathological effect in patients with human papillomavirus (HPV) infection. Thus, we aimed to elucidate whether koilocytes are common to all HPV infections. Liquid-based cytology samples from 651 patients with abnormal Papanicolaou (Pap) test results were used to analyze the presence of koilocytes and HPV genotype. HPV genotype was determined in complete liquid cytology samples and microdissected cell samples from Pap smear slides using the uniplex E6/E7 polymerase chain reaction method, which can detect 39 mucosal HPV genotypes. Koilocytes were found in 29.3% (191) of all patients. Logistical regression analysis of diverse HPV genotypes revealed that infections with low-risk HPV types (HPV-6b, HPV-40, HPV-42, HPV-61, HPV-74, HPV-89, and HPV-90), probably high-risk HPV types (HPV-53 and HPV-66), and high-risk types (HPV-39 and HPV-56) were significantly associated with the presence of koilocytes. However, HPV-16, HPV-18, and HPV-52, which have higher oncogenic potential, were not found to be associated with koilocytes. These results were confirmed by HPV genotyping using microdissected koilocytes in 27 patients.Most common high-risk types belonging to α-9 and α-7 genotypes appear to rarely induce koilocytic changes. Therefore, koilocytes may provide additional useful information for predicting the risk of progression to high-grade lesions.
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Affiliation(s)
- Mitsuaki Okodo
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - Kaori Okayama
- Department of Medical Technology, Faculty of Health Sciences, Gunma Paz University, Gunma, Japan
| | - Koji Teruya
- Department of Health and Welfare, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - Hirokazu Kimura
- Department of Medical Technology, Faculty of Health Sciences, Gunma Paz University, Gunma, Japan
| | - Natsumi Noji
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - Yasuyoshi Ishii
- Department of Clinical Laboratory, Genki Plaza Medical Center for Health Care, Tokyo, Japan
| | - Masahiko Fujii
- Department of Medical Technology, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - Mizue Oda
- Department of Gynecology, Genki Plaza Medical Center for Health Care, Tokyo, Japan
| | - Toshiyuki Sasagawa
- Department of Obstetrics and Gynecology, Kanazawa Medical University, Ishikawa, Japan
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Schwock J, Starova B, Khan ZF, Mirkovic J, Parra-Herran C, Ko HM, Rouzbahman M, Ghorab Z. Cytomorphologic Features of Gastric-Type Endocervical Adenocarcinoma in Liquid-Based Preparations. Acta Cytol 2020; 65:56-66. [PMID: 33152741 DOI: 10.1159/000511003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Gastric-type endocervical adenocarcinoma (GAS) is a recently described, uncommon, and aggressive tumor with distinct morphologic features and HPV-independent etiology. Data on GAS in liquid-based cytology (LBC) Papanicolaou (Pap) test preparations from a North American patient population are scant. We systematically assessed the cytomorphologic characteristics of GAS in LBC from patients in Ontario and examined if glandular cell nuclear area could represent a readily assessable feature which may aid in GAS detection. STUDY DESIGN Pap test slides preceding the diagnosis of GAS were retrieved locally or requested from outside laboratories. A structured review of 15 cytomorphologic features was performed using the available LBC Pap test slides of GAS and a set of usual-type endocervical adenocarcinomas (UEA). Morphometry of the glandular cell nuclear area was performed, and normalized values were compared to UEA and benign endocervical cells. RESULTS At least 1 Pap test (5 ThinPrep®, 11 SurePath®, and 1 direct smear) was available for 14 patients. Original LBC Pap test diagnoses were negative for intraepithelial lesion or malignancy (NILM) (7), adenocarcinoma/carcinoma (6), atypical glandular cells (2), and adenocarcinoma in situ (1). Review detected abnormal glandular cells in 6/7 NILM cases. Honeycomb-like sheets, nuclear enlargement, and microvesicular cytoplasm were the single most common architectural, nuclear, and cytoplasmic features, respectively. Microvesicular cytoplasm (100 vs. 17%), honeycomb-like sheets (87 vs. 8%), prominent nucleoli (93 vs. 25%), and anisonucleosis (93 vs. 50%) were most discriminatory for GAS versus UEA, respectively. Yellow mucin, intranuclear cytoplasmic pseudoinclusions, and goblet/Paneth-like cells were uncommon, but unique for GAS. Glandular cell nuclear area normalized to neutrophils was found to be significantly increased in GAS compared to benign endocervical cells. CONCLUSIONS GAS is under-recognized and may mimic reactive endocervical cells. Awareness of the tumor type and its cytomorphology is critical for early detection. Identification of glandular cells with uniform nuclear enlargement in conjunction with any of the other cytologic features may help avoid false-negative Pap results. Neutrophils may serve as convenient size reference and visual aid.
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Affiliation(s)
- Joerg Schwock
- Division of Pathology, University Health Network, Toronto, Ontario, Canada,
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada,
| | - Blerta Starova
- Department of Laboratory Medicine, William Osler Health System, Brampton, Ontario, Canada
| | - Zanobia F Khan
- Department of Pathology, Lakeridge Health, Oshawa, Ontario, Canada
| | - Jelena Mirkovic
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hyang Mi Ko
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Marjan Rouzbahman
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Abstract
Background β-Catenin mediates cellular adhesion and the Wnt/β-catenin signaling mechanism, thereby controlling cell proliferation and differentiation. Studies of endometrial tissue suggest that there are differences in β-catenin expression during the course of regular menstrual cycles. However, differences in expression in squamous epithelial cells between the proliferative and secretory phases have hitherto remained unknown. Objectives To localize β-catenin in squamous epithelial cells in cervicovaginal smears during the course of regular menstrual cycles. Methods In this observational study, smears were taken from women (n = 102) with various gynecological complaints. Squamous epithelial cells were stained using a Papanicolaou method to evaluate their cytology and any infection. An anti-β-catenin antibody was used to localize immunoreactivity in the cell membrane, cytoplasm, and/or nucleus. Results Women with a regular menstrual cycle (n = 62) were divided into 2 groups: those in a proliferative phase (26/62, 42%) and those in a secretory phase (36/62, 58%). Cytoplasmic and nuclear β-catenin immunoreactivity was observed prominently in the proliferative phase (19/26, 73%), whereas low-level β-catenin immunoreactivity was seen in the secretory phase (9/36, 25%). Compared with the secretory phase, the mean H-scores for β-catenin immunoreactivity in the proliferative phase were significantly increased in the membrane (P = 0.039), the cytoplasm (P < 0.001), and the nucleus (P = 0.033). By contrast, β-catenin immunoreactivity was reduced from parabasal to superficial cells in both the proliferative and secretory phases. Conclusions Cytoplasmic and/or nuclear β-catenin immunoreactivity may indicate that the activity of the Wnt/β-catenin signaling pathway is cycle dependent.
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Affiliation(s)
- Hanife Guler Donmez
- Department of Biology, Faculty of Science, Hacettepe University, Beytepe Campus, 06800Ankara, Turkey
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Pearson J, Payne D, Yoshida K, Garrett N. Access to and engagement with cervical and breast screening services for women with disabilities in Aotearoa New Zealand. Disabil Rehabil 2020; 44:1984-1995. [PMID: 32931340 DOI: 10.1080/09638288.2020.1817158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To describe access to and engagement with cervical and breast screening services for women who are Deaf or live with a physical or sensory disability in Aotearoa New Zealand (NZ). METHOD We carried out an online survey on a convenience sample of 84 women. Tests of association were undertaken between socio-demographics and cervical and breast screening; and between disability type, and health outcomes and barriers to screening respectively. Participants also reported specific barriers to screening. RESULTS Living without family/partner and unemployment were associated with never having a cervical smear. Non-English preferred language, and urban residence were related to lower levels of breast self-examination; having insufficient income was related to never having a mammogram. Disability type was not related to either smear or mammogram on eligibility, uptake ever, or uptake timeframe. A higher proportion of those with multiple disability types experienced service environment barriers to having a cervical smear. Specific barriers to screening covered accessibility, service environment, and information. CONCLUSIONS This study, unique in Aotearoa, provides insights into disabled women's access to and engagement with screening services and suggests factors that may inhibit or facilitate participation. Women with multiple disabilities may be disadvantaged in the seeking and delivery of screening.Implications for rehabilitationRehabilitation and other practitioners need to be attuned to how women living with multiple disabilities may be disadvantaged in the seeking of, and, more importantly, the delivery of breast or cancer screening.Practitioners need to discuss with disabled women what supports or resources they need to have screening procedures, and to advocate for these supports for their clients.Practitioners need to ensure accessibility that encompasses the whole screening journey from the initial invitation to the obtaining of results.For practitioners to be able to provide equitable service delivery, the government and institutional policies and procedures that are developed must take into consideration the multiple needs of women living with disabilities.
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Affiliation(s)
- Janet Pearson
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Deborah Payne
- Department of Nursing, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Karen Yoshida
- Department of Physical Therapy, Social & Behavioural Health Sciences Division, Rehabilitation Sciences Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nicholas Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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