Cervical Cancer Screening Coverage Research Articles

Self-reported participation in cervical cancer screening among Polish women in 2004-2019.

We aimed to assess self-reported participation in cervical cancer screening among Polish women between 2004 and 2019 and to identify the groups with the lowest participation rate. Data on declared participation in cervical cancer screening were obtained from the European Health Interview Survey from 2004 to 2019. In 2019, 86.7% of Polish women aged ≥ 15 years declared that they had ever undergone a Pap test. Compared to 2004, the coverage of ever-screened women improved by 16.6 percentage points. The proxy population coverage was 72.9%. The highest proportion of women who underwent a Pap smear in the last three years was observed among those aged 35-44 years and 25-34 years (84.0% and 83.2%, respectively), and the lowest among women aged ≥ 75 years (20.5%). The proportion screened within the last three years also varied by education (up to lower secondary education 26.4%, up to post-secondary non-tertiary education 62.8%, and the highest level of education 83.7%), urbanization (large cities 66.7%, suburbs, and smaller cities 62.8%, and rural areas 59.0%), income (poorest households 42.5%, wealthiest households 70.6%), and declared health status (best 68.9%, worst 41.4%). The lowest participation in screening was observed in the southeastern regions and the highest in the northwestern regions of Poland. In Poland, in 2019, the approximate coverage of cervical cancer screening was high compared to other European countries and has improved over the last 15 years. A complete screening registry is required to confirm questionnaire-based self-reported data. Targeted interventions should be implemented to address low participation in the identified regions and socioeconomic groups.

Cervical Cancer Screening Coverage at Tertiary Care Institutes Across India.

The 70% screening coverage target proposed in the global cervical cancer elimination strategy is not achieved even at tertiary centres in India. A situational analysis was done to assess the currently existing facilities and barriers in tertiary care institutes. This cross sectional multicentric study was conducted from August to September 2021 in six tertiary care institutes across India. Women aged 30-49 years attending outpatient services (OPD) were invited for cervical screening. Women and health care professionals (HCPs) were administered structured questionnaires to assess knowledge, attitude and practices regarding cervical cancer screening services. Out of 6709 eligible women who attended OPD, 1666 (24.8%; range:19-57%) received screening. Availability of screening kits was limited to 10-25 Pap/HPV tests per day. Visual inspection with acetic acid (VIA) and HPV testing were offered only at certain centres. Colposcopy and treatment facilities were optimal at all centres. Knowledge, attitude and practices were analysed for 1800 women: 45.7% had heard of cervical cancer, 78.0% did not know that it is preventable, 75.8% never heard about screening. Common symptoms correctly identified included postmenopausal bleeding (4.8%), postcoital bleeding (5.7%), intermenstrual bleeding (5.8%) and vaginal discharge (12.4%). Risk factors were identified by minority: poor menstrual hygiene (6.6%), oral contraceptive pill use (6.4%), multiparity (4.4%), and HPV infection (3.0%). Out of 21, mean total knowledge score (MTKS) was 2.07± 2.67. Out of 317 HCPs, 96.5% knew that cervical cancer is caused by HPV infection, is preceded by premalignant stage, and that it is preventable by screening and treatment (80.1%). Knowledge about screening modalities was present in 87.4% for cytology, 75.1% for VIA, 68.8% for HPV test. MTKS of HCPs was 20.88±6.61 out of 32. Even at tertiary centres, limited availability of HPV tests, reluctance to implement VIA and lack of awareness among women remain the major barriers.

The Role of Social Obstetrics and Gynecology in the Coverage of Cervical Cancer Screening in the Era of Health Transformation in Indonesia

The Role of Social Obstetrics and Gynecology in the Coverage of Cervical Cancer Screening in the Era of Health Transformation in Indonesia

Coverage and associated factors with cervical cancer screening in Spain

Abstract Background Cervical cancer is a preventable cancer due to vaccination and screening. In Spain 80% of new cases of cervical cancer are women that haven't ever participated in screening programmes. It is outlined if this participation is properly done and if cervical cancer screening is still a challenge for public health in Spain. Our aims are to estimate cervical cancer screening coverage, distinguishing female participation ever and participation every three years according to current recommendations, and to identify the associated factors with participation in the screening. Methods An analysis from a subpopulation of the European Health Survey in Spain in 2020 was conducted. Women between 25 and 65 years old that answered the Adult and Home questionnaires were included. Our main variables were “not participating ever in cervical cancer screening”, and “incorrect participation”. A descriptive analysis of the variables and logistic regression models were developed to identify the determinants for the participation in cervical cancer screening. Results 6924 women fulfilled the selection criteria. The percentage of not participating ever in cervical cancer screening was 11.7%. The percentage of incorrect regularity of participation was 18.0%. Young and elderly women, low socio-economic educational level, sedentary lifestyle, absence of private health insurance, good self-perceived health and working as informal carer were associated with deficient women's participation in screening. Conclusions Despite high percentage of participation in cervical cancer screening, the frequency of women that participate correctly can be improved. Socio-economic factors, health perception and assurance, lifestyle, and informal care, have an influence in producing disparities in women's participation and regularity in cervical cancer screening. Future studies are needed to analyse the association among lifestyles, role of carer women and coverage of cervical cancer screening. Key messages • Impact of social determinants of health have been recognised in cervical cancer screening. • Specific programs for vulnerable women are needed to improve their participation in cervical cancer screening.

Papanicolaou test in Brazil: analysis of the National Health Survey of 2013 and 2019.

To compare the coverage of cervical cancer screening in Brazil in 2013 and 2019, investigating the factors associated with having the test performed and the reasons given for not doing it. Additionally, a comparison is made concerning the time taken to receive the test result in SUS (Sistema Único de Saúde) and in the private health services. Using data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), prevalence rates and corresponding confidence intervals were calculated to determine the frequency of recent cervical cancer screenings among women aged between 25 and 64 years old in Brazil, for both 2013 and 2019. Poisson regression models were employed to compare the prevalence of the outcome according to sociodemographic characteristics. The reasons for not having the test and the time between performing and receiving the result were also analyzed. The findings revealed an increase in the coverage of preventive cervical cancer exams in Brazil from 78.7% in 2013 to 81.3% in 2019. Additionally, there was a decline in the proportion of women who had never undergone the exam, from 9.7% to 6.1%. Prevalence of test uptake was higher among white women, those with higher levels of education and income, and those residing in the South and Southeast regions of the country. The most commonly cited reasons for not taking the test were the impression it was unnecessary (45% in both 2013 and 2019) and never having been asked to undergo the test (20.6% in 2013 and 14.8% in 2019). Despite the high coverage of screening achieved in the country, there is great inequality in access to the test, and a non-negligible number of women are at greater risk of dying from a preventable disease. Efforts must be made to structure an organized screening program that identifies and captures the most vulnerable women.

The association of cervical cancer screening and quality of care: A systematic analysis of the Global Burden of Disease Study 2019.

Improving the quality of care is vital to enhance outcomes for cervical cancer patients. However, the inequality of cervical cancer care was seldomly assessed. We collected the data of cervical cancer burden from the Global Burden of Disease 2019 database, and constructed the Quality of Care Index (QCI) using principle component analysis. Then the disparity of QCI across regions and populations were evaluated. The association between cervical cancer screening coverage and QCI weas also explored. Quality of cervical cancer care was of disparity across regions with different development levels, with a widening gap between low-income regions and others. Cervical cancer QCI dropped rapidly after the age of 35. Cervical cancer screening coverage was positively associated with QCI, and this association was stronger in countries with low- and middle-development levels. Regions with a low development level and the middle-aged women were vulnerable in QCI improvement. Higher screening coverage was associated with better cervical cancer QCI, implying that expanding cervical cancer screening coverage may be an effective strategy to improve the quality of cervical cancer care.

Toward 70% cervical cancer screening coverage: Technical challenges and opportunities to increase access to human papillomavirus (HPV) testing.

The World Health Organization (WHO) has called for the elimination of cervical cancer as a public health problem. Cervical cancer screening through human papillomavirus (HPV) testing is a core component of the strategy for elimination, with a set target of screening 70% of women twice in their lifetimes. In this review, we discuss technical barriers and opportunities to increase HPV screening globally.

A Comprehensive Assessment of Interventions in Women Cervical Cancer Screening in South Sudan

Introduction: The substantial impact of cervical cancer, particularly in low-resource environments like South Sudan, underscores the urgent need for preventive solutions, as access remains sparse. Contemporary treatment options while accessible, bring about severe side effects without greatly extending disease-free survival, emphasizing the importance of preventive screening, especially for adult women. The glaring absence of screening leads to women potentially suffering from progressed cervical cancer, a grim reality in South Sudan that contributes to around 12% of the female disease burden. Consequently, it is vital to examine the reach, associated elements, and health system initiatives aimed at cervical cancer screening in this region. This study intended to conduct an in-depth analysis of South Sudan's health system with a focus on understanding and evaluating the current interventions in place for cervical cancer screening among women.
 Methods: The research was based on a community-oriented cross-sectional survey aimed at evaluating cervical cancer screening habits among women of childbearing age in five South Sudanese counties. The participants were women aged 26-65 years, with 575 samples in total. A four-stage random sampling procedure was followed in each stratum, focusing on half the Payams per county. Structured interviews were utilized for primary data collection, supplemented by key informant discussions for qualitative data. Descriptive statistics and log-binomial regression models were used for data analysis. The study was conducted in Torit, Magwi, Terekeka, Raja, and Aweil North, targeting women of reproductive age due to their HPV infection risk.
 Results: The study found that only 11.5% of women in South Sudan had been screened for cervical cancer. Factors associated with cervical cancer screening rates included women who reported shorter waiting times for medical services (aPR=3.47 [CI=1.69-7.14]), received HPV vaccination (aPR=4.71 [CI=3.04-7.31]), kind and caring health workers (aPR=3.35 [CI=1.47-7.63]), and integrated cervical screening facilities (aPR=2.28 [CI=1.45-3.60]) had higher screening rates. However, the study found little evidence of community or institutional interventions aimed at increasing cervical cancer screening rates.
 Conclusion: Based on the findings, cervical cancer screening coverage for women in South Sudan is very low, at only 11.5%. However, certain factors were found to be associated with higher screening prevalence, including shorter wait times, caring and kind health workers, and integrated screening facilities were also associated with higher screening prevalence. It is concerning that there were virtually no interventions at the institutional level to increase screening rates. These findings suggest the need for targeted interventions to improve access to screening services and strengthen health systems to increase cervical cancer screening coverage in South Sudan.

Integrated Acetic Acid Visual Inspection with Installation or Examination of Intrauterine Contraception Devices: Literature Review

Cervical cancer is one of the post-translational modification where the incidence has continued to increase in the past 10 years. Cervical cancer screening using a single visit approach (SVA) model for prevention of cervical cancer through an isovaleric acidemia (IVA) examination followed by cryotherapy treatment or referral to a higher service. The SVA approach model is still not effective for increasing cervical cancer screening coverage. The one shot method is an IVA model development design that is integrated with IUD insertion. Based on experience, an IVA examination can be carried out simultaneously with pre-insertion, installation, and post-insertion IUD services. The one shot method for IUD acceptors can provide two benefits in one service and can be done at first-level health facilities.

Assessing Cervical Cancer Screening Coverage and Associated Factors in South Sudan: A Community - Based Cross - Sectional Survey

Assessing Cervical Cancer Screening Coverage and Associated Factors in South Sudan: A Community - Based Cross - Sectional Survey

Cervical cancer screening aided by artificial intelligence, China.

To implement and evaluate a large-scale online cervical cancer screening programme in Hubei Province, China, supported by artificial intelligence and delivered by trained health workers. The screening programme, which started in 2017, used four types of health worker: sampling health workers, slide preparation technicians, diagnostic health workers and cytopathologists. Sampling health workers took samples from the women on site; slide preparation technicians prepared slides for liquid-based cytology; diagnostic health workers identified negative samples and classified positive samples based on the Bethesda System after cytological assessment using online artificial intelligence; and cytopathologists reviewed positive samples and signed reports of the results online. The programme used fully automated scanners, online artificial intelligence, an online screening management platform, and mobile telephone devices to provide screening services. We evaluated the sustainability, performance and cost of the programme. From 2017 to 2021, 1 518 972 women in 16 cities in Hubei Province participated in the programme, of whom 1 474 788 (97.09%) had valid samples for the screening. Of the 86 648 women whose samples were positive, 30 486 required a biopsy but only 19 495 had one. The biopsy showed that 2785 women had precancerous lesions and 191 had invasive cancers. The cost of screening was 6.31 United States dollars (US$) per woman for the public payer: US$1.03 administrative costs and US$ 5.28 online screening costs. Cervical cancer screening using artificial intelligence in Hubei Province provided a low-cost, accessible and effective service, which will contribute to achieving universal cervical cancer screening coverage in China.

Experience and acceptability for HPV self-sampling among women in Jiangsu province, China: a cross-sectional survey

This aim of this study was to investigate women’s knowledge about HPV along with their experience and acceptability of self-sampling in Jiangsu province, China. A total of 862 women aged 25–63 years old from Jiangsu province who purchased an HPV self-sampling test kit were invited to complete a questionnaire designed by the authors. Participants had high acceptability for HPV self-sampling with a mean score of 4.2 (95% [CI], 4.1–4.22) out of 5 points. 27% of participants preferred clinician-sampling, 33% preferred self-sampling, other 40% expressed no preference. Women with good knowledge about HPV and with a good experience with HPV self-sampling were more acceptable for self-sampling (P < 0.05). The biggest concern about HPV self-sampling of the participants includes ‘specimens’ spoilage’, ‘incorrect sampling’, ‘can’t get results in time’, and so on. HPV self-sampling can be used to improve cervical cancer screening coverage and participation rates in China.

Survey of current policies towards widening cervical screening coverage among vulnerable women in 22 European countries.

This study aimed to investigate the status of cervical cancer screening (CCS) implementation in Europe by investigating national or regional policies towards broadening coverage of CCS amongst vulnerable subgroups of the population at high risk for CC. A web-based survey was conducted between September 2021 and February 2022 with CCS programme managers and experts to identify and rank six population subgroups at high risk considered most vulnerable to CC and to map existing policies that addressed the coverage of CCS towards population sub-groups at risk. A total of 31 responses were received from experts covering 22 European countries. The results of this survey suggest that whilst many countries identify lower coverage of CCS amongst population subgroups at high risk of CC as a public health problem, few countries have developed dedicated policies towards broadening coverage among these subgroups. The six countries who reported having done so were concentrated in the Northern or Western European regions, suggesting the existence of geographical disparities within the continent. A key challenge in this respect is the difficulty to categorize subgroups of the target population; many individuals are burdened by intersectionality thereby resting in multiple categories, which may hinder the effectiveness of interventions targeted to reach specific subgroups. A greater clarity on the conceptualization of vulnerability can help countries to develop and subsequently implement strategies to increase coverage to subgroups of the target population currently underserved with regards to CCS.

Associations between the signing status of family doctor contract services and cervical cancer screening behaviors: a cross-sectional study in Shenzhen, China

BackgroundAs a core part of the primary healthcare system, family doctor contract services (FDCS) may help healthcare providers promote cervical cancer screening to the female population. However, evidence from population-based studies remains scant. This study aimed to investigate the potential associations between the signing status of FDCS and cervical cancer screening practices in Shenzhen, China.MethodsA cross-sectional survey among female residents was conducted between July to December 2020 in Shenzhen, China. A multistage sampling method was applied to recruit women seeking health services in community health service centers. Binary logistic regression models were established to assess the associations between the signing status of FDCS and cervical cancer screening behaviors.ResultsOverall, 4389 women were recruited (mean age: 34.28, standard deviation: 7.61). More than half (54.3%) of the participants had signed up with family doctors. Women who had signed up for FDCS performed better in HPV-related knowledge (high-level rate: 49.0% vs. 35.6%, P<0.001), past screening participation (48.4% vs. 38.8%, P<0.001), and future screening willingness (95.9% vs. 90.8%, P<0.001) than non-signing women. Signing up with family doctors was marginally associated with past screening participation (OR: 1.13, 95%CI: 0.99–1.28), which tended to be robust among women with health insurance, being older than 25 years old at sexual debut, using condom consistently during sexual intercourse, and with a low level of HPV related knowledge. Similarly, signing up with family doctors was positively associated with future screening willingness (OR: 1.68, 95%CI: 1.29–2.20), which was more pronounced among women who got married and had health insurance.ConclusionsThis study suggests that signing up with family doctors has positive associations with cervical cancer screening behaviors among Chinese women. Expanding public awareness of cervical cancer prevention and FDCS may be a feasible way to achieve the goal of cervical cancer screening coverage.

Leveraging COVID-era innovation for cervical cancer screening: Clinician awareness and attitudes toward self-sampling and rapid testing for HPV detection.

Cervical cancer screening rates are declining in the US, with persistent disparities among vulnerable populations. Strategies to better reach under-screened communities are needed. The COVID pandemic sparked major shifts in healthcare delivery, including the accelerated development and adoption of rapid diagnostic testing, broadened access to remote care, and growing consumer demand for self-testing, which could be leveraged for cervical cancer. Rapid tests for the detection of Human Papillomavirus (HPV) have the potential to improve cervical cancer screening coverage, and if coupled with patient-collected cervicovaginal samples, create an opportunity for self-testing. The objectives of this study were: 1) to examine whether COVID influenced clinician perspectives of rapid testing as a screening modality; and 2) to assess clinician awareness, perceived benefits and limitations, and willingness to adopt point-of-care HPV testing, patient self-sampling, and rapid HPV self-testing with self-collected samples. The methodology adopted consisted of an online cross-sectional survey (n = 224) and in-depth interviews (n = 20) were conducted with clinicians who perform cervical cancer screening in Indiana, ranked in the top ten states for cervical cancer mortality and with marked disparities across socio-demographic groups. The main findings show that about half the clinicians reported that the COVID pandemic had influenced their views on rapid testing as a screening modality both positively (greater public acceptability of rapid testing and impact on patient care) and negatively (concerns regarding accuracy of rapid tests). The majority of clinicians (82%) were willing to adopt rapid HPV testing at the point-of-care, while only 48% were willing to adopt rapid HPV self-testing with self-collected samples. In-depth interviews revealed provider concerns around patients' ability to collect their own sample, report results correctly, and return to the clinic for follow-up and other preventive care. Addressing clinician concerns about self-sampling and rapid HPV testing, such as ensuring that rapid tests include sample adequacy controls, is necessary to mitigate barriers to adoption for cervical cancer screening.

Acceptability and Preference for Human Papilloma Virus Self-Sampling among Thai Women Attending National Cancer Institute.

Cervical cancer screening is an important public health strategy to reduce cervical cancer incidence and mortality. Human papillomavirus (HPV) self-sampling is the alternative method that can potentially increase participation in cervical cancer screening. This study aimed to evaluate the acceptability of HPV self-sampling as a primary cervical cancer screening among Thai women. A cross-sectional study was conducted at National Cancer Institute, Thailand, between March and September 2021. Eligible women were invited to collect their own samples with a vaginal cotton swab for cervical screening. The data on demographics, acceptability, and preference for HPV self-sampling were collected via a self-administered questionnaire. A Likert scale was used to assess the response of self-sampling acceptability. The multivariable logistic regression determined factors that influence preference for HPV self-sampling. A total of 265 participants were recruited. Over 70% agreed that self-sampling was easy, less embarrassing, and not painful. They also felt confident in their ability to self-sample correctly and would recommend this method to a friend or relative. For their next screening round, 66.4% preferred self-sampling whereas 33.6% preferred clinician-collected samples as routine screening. The factors that influence preference for self-sampling were age, marital status, feeling less embarrassed, and confidence in performing the tests. Most of the study participants accepted HPV self-sampling. This suggests that the self-sampling method will be an additional option to increase cervical cancer screening coverage which leads to improving the effectiveness of the national program.

Regional and country-level trends in cervical cancer screening coverage in sub-Saharan Africa: A systematic analysis of population-based surveys (2000-2020).

Sub-Saharan Africa (SSA) has the highest cervical cancer (CC) burden globally-worsened by its HIV epidemics. In 2020, the World Health Organization (WHO) introduced a CC elimination strategy with goals for vaccination, screening, and treatment. To benchmark progress, we examined temporal trends in screening coverage, percent screened at least twice by the age of 45, screening coverage among women living with HIV (WLHIV), and pre-cancer treatment coverage in SSA. We conducted a systematic analysis of cross-sectional population-based surveys. It included 52 surveys from 28 countries (2000 to 2020) with information on CC screening among women aged 25 to 49 years (N = 151,338 women). We estimated lifetime and past 3-year screening coverage by age, year, country, and HIV serostatus using a Bayesian multilevel model. Post-stratification and imputations were done to obtain aggregate national, regional, and SSA-level estimates. To measure re-screening by age 45, a life table model was developed. Finally, self-reported pre-cancer treatment coverage was pooled across surveys using a Bayesian meta-analysis. Overall, an estimated 14% (95% credible intervals [95% CrI]: 11% to 21%) of women aged 30 to 49 years had ever been screened for CC in 2020, with important regional and country-level differences. In Eastern and Western/Central Africa, regional screening coverages remained constant from 2000 to 2020 and WLHIV had greater odds of being screened compared to women without HIV. In Southern Africa, however, screening coverages increased and WLHIV had equal odds of screening. Notably this region was found to have higher screening coverage in comparison to other African regions. Rescreening rates were high among women who have already been screened; however, it was estimated that only 12% (95% CrI: 10% to 18%) of women had been screened twice or more by age 45 in 2020. Finally, treatment coverage among 4 countries with data was 84% (95% CrI: 70% to 95%). Limitations of our analyses include the paucity of data on screening modality and the few countries that had multiple surveys. Overall, CC screening coverage remains sub-optimal and did not improve much over the last 2 decades, outside of Southern Africa. Action is needed to increase screening coverage if CC elimination is to be achieved.

Medicaid expansions and differences in guideline-adherent cervical cancer screening between American Indian and White women.

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. 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. The Medicaid expansions were not associated with guideline-adherent cervical cancer screening (AIAN: -1percentage point [ppt] [95% confidence interval, CI: -4, 2 ppts]; White: 3 ppts [95% CI: -0, 6 ppts]), but were associated with a 2ppt increase (95% CI: 0, 4ppt) 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]). 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.

Screening practices for breast and cervical cancer and associated factors, among rural women in Vellore, Tamil Nadu.

Population-based screening coverage for breast and cervical cancer screening in the community is inadequately reported in India. This study assessed screening rates, awareness, and other factors affecting screening, among rural women aged 25-60 years in Vellore, Tamil Nadu. Women aged 25-60 years, from five randomly selected villages of a rural block were included in this cross-sectional study in Vellore, Tamil Nadu. Households were selected by systematic random sampling, followed by simple random sampling of eligible women in the house. A semi-structured questionnaire was used to assess screening practices, awareness, and other factors related to cervical and breast cancer. Although 43.8% and 57.9% were aware of the availability of screening for cervical and breast cancer respectively, screening rates were only 23.4% (95% confidence interval [CI]: 18.4-28.4%) and 16.2% (95% CI: 11.9-20.5%), respectively. Adequate knowledge (score of ≥50%) on breast cancer was only 5.9%, with 27.2% for cervical cancer. Only 16.6% of women had ever attended any health education program on cancer. Exposure to health education (breast screening odds ratio [OR]: 6.89, 95% CI: 3.34-14.21; cervical screening OR: 6.92, 95% CI: 3.42-14.00); and adequate knowledge (breast OR: 4.69, 95% CI: 1.55-14.22; cervix OR: 3.01, 95% CI: 1.59-5.68) were independently associated with cancer screening. Awareness and screening rates for breast and cervical cancer are low among rural women in Tamil Nadu, a south Indian state with comparatively good health indices, with health education being an important factor associated with screening practices.

Multiple Center Research on Relationship Between Screening Quality and Detection of Cervical Cancer - Six Provinces, China, June-December 2021.

The effective implementation of cervical cancer examination programs requires improved cervical cancer screening coverage and quality. The detection rate of ≥high-grade squamous intraepithelial lesions (HSIL) in 6 hospitals was 19.6%. Not having undergone screening in the last 5 years and abnormal screening results had a negative association with detection of ≥HSIL, and abnormal screening results would increase the risk of detection by 75% compared with normal screening results. Additionally, low-grade, high-grade, and cancer of colposcopic impression were associated with a higher risk for detecting ≥HSIL. It is essential to disseminate health knowledge about cervical cancer control to women in order to increase their awareness and screening rates. Additionally, it is necessary to further strengthen the training of professional staff to improve the quality of cervical cancer prevention, including screening, colposcopic examination, and follow-up for target female populations.