Cervical Cancer Screening Methods Research Articles

Breaking Barriers: Empowering Cervical Cancer Screening with HPV Self-Sampling for Sex Workers and Formerly Incarcerated Women in Toronto

Background: Although cervical cancer (CC) is highly preventable through appropriate screening methods like the Papanicolaou (Pap) test, which enables early detection of malignant and precancerous lesions, access to such screening has not been equitable across social groups. Sex workers and people with records of incarceration are among the most under-screened populations in Ontario. Little is known about the acceptability and feasibility of HPV self-sampling (HPV-SS) as an alternative cervical cancer screening method for these groups. This online, community-based mixed-methods pilot study aimed to address this knowledge gap. Methods: Eighty-four under- and never-screened sex workers and ex-prisoners aged 25–69 years and residing in the Greater Toronto Area, were recruited by community peer associates. Participants completed an online survey and viewed short videos about CC and screening with Pap and HPV-SS. Those who opted for HPV-SS conducted the test at one of two collaborating organizations. Results: The median age of participants was 36.5 years. Most had limited knowledge about CC and screening. Approximately 13% identified as non-binary, and 5% as two-spirit or trans men, with the majority having completed secondary education. Of the participants, 88% chose HPV-SS, and one-third tested positive for high-risk HPV types. The ability to self-sample without judgment from healthcare providers was noted as a key advantage. However, there was a need for training on proper HPV-SS techniques. Conclusions: To improve cervical cancer screening among sex workers, increasing awareness through participatory community co-creation of sexual health education is essential. Additionally, offering HPV-SS as a screening option is crucial, given its demonstrated acceptability and feasibility within this population, many of whom lack a primary care provider and face discriminatory attitudes in healthcare settings.

Cervical Cancer Screening Uptake Among Women with Disabilities: Findings from a Cross-Sectional Study in Chile

The Papanicolaou (Pap) test is one of the most effective methods for cervical cancer screening. However, women with disabilities are less likely to be screened. The objective of this study is to determine whether there is a difference in Pap test utilisation between women with and without disabilities and to analyse the demographic, socioeconomic, and health-related characteristics associated with Pap test uptake among women with disabilities in Chile. Data from the 2022 National Socioeconomic Characterization Survey were analysed, and 71,989 women between 18 and 75 years of age were included. The dependent variable was Pap test utilisation, and the exposure variable was disability. We used logistic regressions to control for demographic, socioeconomic, and health-related covariates. The results showed that women with disabilities were less likely to undergo a Pap test compared to those without disabilities. Characteristics such as being married, being aged between 25 and 64 years, and having secondary or tertiary education increased the likelihood of Pap test utilisation. Conversely, being single, having received special education, and being inactive decreased these odds. Effective public health policies are needed that will increase Pap test utilisation for all population subgroups, including women with disabilities and, therefore, promote health equity.

HPV E6/E7 mRNA screening alone can be used as a screening method for cervical cancer in premenopausal women in China: A retrospective study.

This study aimed to assess the value of a HPV E6/E7 mRNA assay (Aptima® HPV [AHPV]) for primary cervical cancer screening combined with menopausal status. A total of 16 917 women underwent AHPV testing and had complete histopathological results at the Affiliated Hospital of Jining Medical University China between January 1, 2017 and March 31, 2022. We evaluated the performance of different screening strategies and combined strategies, as well as evaluations of different menopausal states. When identifying LSIL+ (includes low- and high-grade squamous intraepithelial lesions and invasive cervical cancer [ICC]), the sensitivity (91.2%) and negative predictive value (NPV; 96.6%) were significantly higher for AHPV than for liquid-based cytology assay (LBC; 33.2% and 84.7% for sensitivity and NPV, respectively). Furthermore, the co-testing strategy (cytology combined with AHPV), when compared with AHPV, achieved a slightly higher sensitivity (93.6% vs. 91.2%, respectively, P < 0.001), a similar specificity (61.3% vs. 62.7%, respectively, P = 0.014), a similar positive predictive value (PPV; 37.5% vs. 37.8%, respectively, P = 0.709) and a similar NPV (97.5% vs. 96.6%, respectively, P = 0.001). Moreover, AHPV (when compared with menopausal women) achieved a higher sensitivity (93.5% vs. 77.7%, respectively, P < 0.001), a higher NPV (97.3% vs. 93.9%, respectively, P < 0.001), a similar PPV (37.8% vs. 37.0%, respectively, P = 0.618) and a slightly lower specificity (60.7% vs. 72.1%, respectively, P < 0.001) in premenopausal women. These results were similar when identifying HSIL+ (includes high-grade squamous intraepithelial lesion and ICC). The present study suggests that initial screening with HPV E6/E7 mRNA testing rather than combined screening is a suitable candidate for cervical cancer screening in China (especially for premenopausal women) based on economic reasons.

Knowledge and awareness regarding pap test and HPV typing for cervical cancer screening in Edo North, Nigeria

BackgroundCervical cancer remains a significant global health concern, with some types of human papillomavirus (HPV) infection playing a pivotal role in its etiology. This research was conducted to explore the awareness and knowledge regarding Pap tests and HPV typing as screening tools for Cervical Cancer in Edo North, Nigeria.MethodsData was collected with the use of a pretested structured questionnaire that includes open ended and close ended response format to assess knowledge. Data was analyzed using the IBM SPSS version 29.ResultsThis study utilized a descriptive cross-sectional study design with 113 participants aged 25–65 years. A significant knowledge gap regarding the purpose of Pap tests and HPV testing was observed, with only 32.7% of participants aware of their purpose. Only 20.4% of participants had undergone cervical screening, with inconsistencies in screening frequency. HPV vaccination rates were low, with only one vaccinated individual.ConclusionThis study reveals a concerning low level of awareness and knowledge among participants regarding Pap tests and HPV testing in cervical cancer screening. These findings emphasize the need for improved education and communication about cervical cancer screening methods to empower individuals to make informed decisions about their healthcare.

Study on artificial intelligence recognition pre-processing algorithm for cervical cancer

INTRODUCTION: Cervical cancer is the most common malignant tumor in the female reproductive system, with the number of deaths due to cervical cancer in developing countries accounting for 80% of the global total. In China, the incidence rate of cervical cancer is increasing year by year. At present, the commonly used methods for cervical cancer screening include TCT, HPV testing, TCT+HPV combined testing, FRD, and VIA/VILI. Among them, although TCT+HPV combined testing has high sensitivity and specificity, it is costly and time-consuming. VIA/VILI screening is cost-effective, easy to operate, and suitable for promotion in economically underdeveloped areas.However, VIA/VILI screening relies on the subjective judgment of doctors, so its accuracy is relatively low in rural areas of China with a large population and a lack of well-trained doctors. To address this issue, computer-aided diagnosis (CAD) technology is needed to improve the accuracy and reliability of VIA/VILI screening. OBJECTIVES: The implementation of artificial intelligence (AI)-based Visual Inspection with Acetic acid (VIA) screening and computer-aided diagnosis has the potential to significantly reduce the cost of cervical cancer screenings and increase the coverage rate of cervical cancer screenings, thus reducing the incidence rate of the disease. To this end, we have developed an AI preprocessing algorithm aimed at improving the accuracy of AI in detecting cervical cancer. METHODS: Initially, the algorithm maps images to the YCrCb and Lab color spaces. Unlike traditional enhancement methods that mainly focus on the luminance channel, our method primarily enhances the Cr channel in the YCrCb color space and a channel in the Lab color space. This paper innovatively proposes the LT_CLAHE algorithm to enhance the Cr channel, obtaining an enhanced image with a bias towards blue-green colors, and uses the WLS algorithm to enhance the a channel, obtaining an enhanced image with a bias towards red colors. Subsequently, the enhanced images from both color spaces are fused to eliminate color distortion. RESULTS: Experimental results show that our method significantly enhances the texture of lesions and outperforms traditional methods across various objective indicators. When the enhanced images from this paper are used as input for neural networks, there is also a significant increase in the accuracy of neural network detection.

Pre-clinical study of IR808 dye for cervical cancer in vitro and in vivo imaging.

There is an urgent need for improved methods for early screening and rapid diagnosis of cervical cancer since current conventional screening methods are plagued by operator subjectivity and unnecessary biopsies. IR808 is a tumour-targeting near-infrared (NIR) fluorescent dye that permits NIR imaging without the requirement of chemical conjugation. Our study investigates an IR808-based strategy for real-time monitoring of the cervix in vivo and rapid assessment of cervical specimens in vitro. We investigated the uptake of IR808 in vitro using normal cervical epithelial cells and three cervical cancer cell lines. The biodistribution of IR808 was examined in vivo via intravenous injection into tumour-bearing mice. Additionally, in vitro tissues were stained with IR808 to simulate the identification of cervical tumors in the clinical setting. Biocompatibility of the dye in both cellular and animal models was also examined. IR808 exhibited significant tumour-to-background ratios in fluorescence molecular imaging of in vivo tumors in nude mice. The application of NIR fluorescent dye IR808 in specific imaging screening, safe and non-invasive real-time monitoring, and rapid identification of cervical tumors from tissue specimens is expected to improve current screening methods for cervical cancer.

The Future of Cervical Cancer Screening.

Cervical cancer remains a significant health concern, particularly in developing countries, where it is a leading cause of cancer-related deaths among women. Innovative technologies have emerged to improve the efficiency, cost-effectiveness, and sensitivity of cervical cancer screening and treatment methods. This study aims to explore the various approaches for the detection and treatment of human papillomavirus (HPV), cervical dysplasia (CD), and cervical cancer, highlighting new technologies and updated screening strategies in developing areas. A comprehensive literature search was conducted using PubMed to identify relevant publications on the subject of cervical cancer screening and HPV detection. HPV infection and cervical cancer continue to pose significant global health challenges. Emerging technologies such as rapid, low-cost HPV testing combined with high-resolution digital colposcopy and artificial intelligence interpretation hold promise for efficient and sensitive screening. Advancements in HPV vaccine distribution, high-risk HPV screening, DNA methylation assays, dual-stain cytology, lab-on-chip assays, and deep learning technologies offer new avenues for improved detection and risk stratification.Research and innovations in detection and treatment methods are crucial for reducing the burden of these diseases worldwide. Screening for HPV and CD plays a pivotal role in reducing the risk of cervical cancer-related mortality. The development of novel technologies, along with efforts to enhance global health equity and integrate cervical cancer prevention with HIV screening and treatment programs, represent critical steps toward achieving comprehensive cervical cancer screening on a global scale.

Abstract A144: Insight into cervical cancer screening and HPV self-sampling among Vietnamese immigrants in Southern California

Abstract Background: Screening can effectively identify precancerous lesions for early treatment to prevent cervical cancer. However, only 69% of Vietnamese immigrants in the U.S. reported screening in the past 3 years compared to 84% of non-Hispanic White women. Human papillomavirus (HPV) self-sampling is a novel cervical cancer screening approach that does not require women to visit healthcare providers and has been shown to increase screening uptake in several minority populations. Understanding the attitudes towards cervical cancer screening, including HPV self-sampling, among Vietnamese immigrants could inform strategies to improve their screening rates. Methods: We conducted two online semi-structured focus groups with a total of nine Vietnam-born women aged 50-65 living in Southern California, which has the largest Vietnamese community outside of Vietnam, to understand their awareness of, attitudes towards, and experiences with cervical cancer screening. Participants also watched two short videos on two cervical cancer screening methods (Papanicolaou "Pap" test and HPV self-sampling) and shared their thoughts on each method. Each focus group was recorded, transcribed, translated into English, and coded and analyzed using NVivo 14. Results: Three main themes emerged from the focus groups. First, participants showed a strong acceptance of cervical cancer screening despite poor knowledge of the disease and its prevention as well as logistic and psychosocial barriers associated with visiting healthcare providers for screening. Second, participants found HPV self-sampling to be highly acceptable, mentioning advantages like its convenience and the lack of embarrassment compared to visiting healthcare providers. However, there were some concerns regarding the mailing of the self-collected samples and the cost of the test. Third, participants described circumstances that may be immigrant-specific, such as a shift from making gynecologic appointments themselves in Vietnam to relying on family doctors as gatekeepers for such appointments in the U.S., a strong preference for Vietnamese- speaking providers, and the use of English as a Second Language (ESL) centers, community organizations, radio stations, and newspapers targeting Vietnamese communities to obtain healthcare information. Conclusions: HPV self-sampling has the potential to improve cervical cancer screening uptake in Vietnamese immigrants since it can overcome barriers associated with visiting healthcare providers for a Pap test. Education campaigns are needed to increase awareness of cervical cancer screening and address concerns related to HPV self-sampling. Engagement with healthcare providers, organizations, and media channels that serve Vietnamese communities may be effective since Vietnamese immigrants often receive health-related information from these sources. It is necessary to explore the perceptions of younger immigrants and U.S.-born Vietnamese women to inform efforts that can improve screening uptake in all Vietnamese women; focus groups and interviews of these women are underway. Citation Format: Minh T. Phung, Ivy Nguyen, Bethany Nguyen, Hailey Nguyen, Becky Nguyen, Dung Hua, Celeste L. Pearce, Alice W. Lee. Insight into cervical cancer screening and HPV self-sampling among Vietnamese immigrants in Southern California [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A144.

A systematic review of healthcare professionals and women's experiences and perceptions of colposcopy method of cervical cancer screening in Nigeria

Background: Cervical cancer continues to pose a significant public health issue in Nigeria, characterized by high rates of incidence and mortality. Colposcopy is integral to the cervical cancer screening process and its early detection. However, the uptake of colposcopy screening in Nigeria remains suboptimal, with various factors contributing to this phenomenon. Comprehending the experiences and perceptions of healthcare professionals and patients concerning colposcopy for cervical cancer screening is vital to enhance screening initiatives and alleviate the impact of cervical cancer in Nigeria. This systematic review aims to identify the gap in knowledge and synthesize the existing literature on the experiences and perceptions of healthcare professionals and patients regarding colposcopy for cervical cancer screening in Nigeria. Methods: A comprehensive search of the literature was conducted in Academic search elite, African journals online (AJOL), CINAHL, MBASE, psycho info, Cochrane, Medline (via PubMed) and Scopus databases from 2010 until March 2023. The quality of the included studies was assessed using Joanna Briggs Institute (JBI) critical appraisal tool. Thematic analysis was deployed to synthesize the extracted data. Results: Fourteen (14) studies satisfied the inclusion criteria. Most studies were conducted in developed countries and urban settings. The review revealed key themes that were categorized into four: insufficient knowledge/awareness, emotional factors, cultural/religious factors, and organizational/systemic factors. Conclusion: The review identified barriers to colposcopy screening in Nigeria, highlighting the need for targeted interventions to improve cervical cancer screening rates. Hence, the need for a qualitative study in rural parts of Nigeria to explore the in-depth understanding of patients' and healthcare professionals’ regarding colposcopy screening utilization.

Economic Evaluation of Cervical Cancer Screening by HPV DNA, VIA, and Pap smear Methods in Indonesia.

Cervical cancer occurs 80% in developing country including Indonesia and take place in the first rank of incidence rate and third rank in mortality rate in Asian Pacific. Natural history of cervical cancer gives a potential to get accurate screening method. Cervical cancer screening m in Indonesia use VIA and Pap smear method for women in age range 30 to 50 years old. Recently, HPV DNA test has been recommended in international and national policy as primary screening method for cervical cancer. This research aims to asses cost-effectiveness and economic implications of specific cervical cancer screening modalities. Cost-effectiveness analysis was conducted from societal perspective. Cost data was collected from four hospitals in Indonesia. Direct medical costs were derived from discussions with an expert panel and hospital billing data, aligning with current practice guidelines. Direct and indirect non-medical costs were estimated from patient interviews. Effectiveness data for the screening methods were extracted from a systematic review of existing literature. Markov model design was used for cost-effectiveness analysis. Budget impact analysis used healthcare perspective method from its billing for cervical cancer patients. Cervical cancer screening costs are calculated using direct medical, non-medical, and indirect expenses. Regarding to cost-effective analysis by incremental cost-effective ratio (ICER), pap smear for every 3 and 5 years is more cost-effective than VIA. HPV DNA also has the potential to be cost-effective. The budget impact analysis investigates scenarios, with a focus on negotiation-based cost reductions for HPV DNA testing. Controlling HPV DNA tariffs at USD 8.76 proves cost-effective. In conclusion, pap smear is the most cost-effective modality, while HPV DNA has the potential to be cost-effective by reducing the unit cost. Despite favorable outcomes, challenges in implementation suggest a phased approach for resource equalization before full deployment.

Comparison of cervical cancer screening models based on Pap and HPV tests in Tbilisi, Georgia.

The objective of this study was to evaluate the effectiveness of human papillomavirus HPV test with HPV16/18 genotyping and liquid-based cytology (LBC) triage as a primary screening method for cervical cancer compared to conventional Pap test in women undergoing routine cervical cancer screening in Tbilisi. Cross-sectional, prospective study was conducted, where 1,000 enrolled women aged 30-60 years during one visit underwent conventional Pap smear and Hr-HPV testing (Roche Cobas system). Women with any positive screening results were referred for further evaluation and remaining cells from the Cell Collection Medium vial were used for LBC. The study calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each screening method and receiver-operating characteristic (ROC) curve to evaluate the accuracy of each diagnostic method in identifying people with CIN2+ diseases. The HPV test with HPV16/18 genotyping and LBC triage demonstrated higher sensitivity (76.9%), specificity (71.6%), and PPV (34.5%) compared to conventional Pap tests (p < 0.05). NPV was also high with the HPV test (94.1%). The HPV test alone had the highest sensitivity (92.3%) and NPV (96.7%), but lower specificity (41.4%) and PPV (22.6%) than the HPV test with HPV16/18 genotyping and LBC triage (p < 0.05). Comparing the areas under the curve (AUCs), only the HPV with HPV16/18 genotyping and LBC triage showed a statistically significant difference when compared to conventional Pap (0.71 vs. 0.55, p = 0.03) and high figures of AUC 0.71 (95% CI: 0.58-0.85) suggesting that HPV test with HPV16/18 genotyping and LBC triage is a more reliable screening method for detecting CIN2+ disease and preventing cervical cancer, than other screening modality. The results suggest that the HPV test with HPV16/18 genotyping and LBC triage is a more effective primary screening method compared to conventional Pap tests. This information should be the basis for transition from cytological screening to HPV testing in Georgia.

HPV self-sampling implementation strategies to engage under screened communities in cervical cancer screening: a scoping review to inform screening programs.

Human papillomavirus (HPV) testing as a method of cervical cancer screening can be performed by healthcare providers or by patients through self-sampling directly in the community, removing several barriers experienced by under screened populations. The objective of this scoping review was to determine which HPV self-sampling implementation and engagement strategies have been used to engage under screened populations (i.e., Indigenous, newcomer, and rural and remote communities) in cervical cancer screening. A scoping review was conducted searching MEDLINE, CINAHL, EMBASE, Cochrane Library, and SocINDEX from inception to August 2023. The inclusion criteria were: (1) Indigenous, newcomer, and rural and remote communities; (2) countries identified as members of the Organization for Economic Co-operation and Development; and (3) intervention included HPV self-sampling. The review was registered prior to conducting the search (https://osf.io/zfvp9). A total of 26 studies out of 2,741 studies met the inclusion criteria. In-person engagement with trusted community leaders was the most widely used and accepted recruitment and engagement strategy across all three populations. Six out of seven studies with Indigenous communities distributed HPV self-sampling kits to eligible participants in person in a clinical setting for collection on site or at home. Similarly, nine of the identified studies that engaged newcomers recruited participants in person through the community, where eligible participants were either given a kit (n = 7) or received one in the mail (n = 2). Lastly, of the 10 identified studies engaging rural and remote participants in HPV self-sampling, six recruited eligible participants in person at various community locations and four used electronic medical records or registries to identify and mail kits to participants. HPV self-sampling through in person kit distribution and mail out of HPV self-sampling kits is an effective way to increase participation rates amongst under screened populations.

AICyte-alone capabilities as an independent screener for triaging cervical cytology using a 50% negative cutoff value.

AICyte has previously demonstrated a potential role in cervical cytology screening for reducing the workload by using a 50% negative cutoff value. The aim of the current study is to evaluate this hypothesis. The authors used the Ruiqian WSI-2400 (with the registered trademark AICyte) to evaluate a collection of 163,848 original cervical cytology cases from 2018 to 2023 that were collected from four different hospital systems in China. A breakdown of cases included 46,060 from Shenzhen, 67,472 from Zhengzhou, 25,667 from Shijiazhuang, and 24,649 from Jinan. These collected cases were evaluated using the AICyte system, and the data collected were statistically compared with the original interpretative results. In 98.80% of all artificial intelligence cases that were designated as not needing further review, the corresponding original diagnosis was also determined to be negative. For any cases that were designated atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion or higher, the sensitivity and negative predictive value were 90.77% and 98.80%, respectively. The sensitivity and negative predictive value were greater in cases designated as low-grade squamous intraepithelial lesion or higher at 98.92% and 99.94%, respectively. Of the 49 low-grade squamous intraepithelial lesion or higher that were designed by AICyte as not needing further review, the cytohistologic correlation revealed eight cases of cervical intraepithelial neoplasia 1 and 18 negative cases; and the remaining cases were without histologic follow-up. In practice, AICyte used at a 50% negative cutoff value could reduce the anticipated workload if a protocol were implemented to label cases that qualified within the negative cutoff value as not needing further review, thereby finalizing the case as negative for intraepithelial lesions and malignancy. For pathologic practices that do not have cytotechnologists or in which the workflow is sought to be optimized, the artificial intelligence system AICyte alone to be an independent screening tool by using a 50% negative cutoff value, which is a potential assistive method for cervical cancer screening.

If I Have the Courage…I Prefer to See a Doctor: A Qualitative Exploration of Ethiopian Women’s Hesitancy to Screen for Cervical Cancer Using HPV Self-Sampling

PURPOSE In Ethiopia, cervical cancer screening uptake remains low (14%), despite efforts to increase access to preventive services. While Ethiopia’s national screening program currently uses a “screen-and-treat” approach with visual inspection with acetic acid (VIA), human papillomavirus (HPV) self-sampling may be a screening option available in the future, which has been found to be a safe and easy approach for sample collection in many global contexts. Some concerns exist among age-eligible women for HPV self-sampling, therefore understanding the nuanced perceptions towards HPV self-sampling from an Ethiopian perspective is important. This qualitative study explores perceived pros and cons to cervical cancer screening with HPV self-sampling so that this approach can be tailored to the cultural and social context of Ethiopia to increase screening uptake. METHODS In 2022, four focus groups were conducted with 50 Ethiopian women to discuss their perceptions towards cervical cancer and cervical cancer screening methods. Participants were shown educational videos on VIA and HPV self-sampling. They were prompted to compare the two screening modalities and discuss why they liked or disliked each. Audio recordings were translated and transcribed, transcripts were coded with Dedoose software, and content analysis was conducted to identify major themes contributing to hesitancy to screen using HPV self-sampling. RESULTS A lack of awareness, coupled with a lack of confidence in collecting their own specimen, influenced many women to have notable negative views of the HPV self-sampling process. Many women thought the self-sampling would be “difficult,” as it “might hurt sensitive places.” A participant shared: “I might not use the device properly. If I have the courage and the desire, I prefer to see a doctor.” Interestingly, participants often stated that they would be more willing to try HPV self-sampling if they had increased understanding, education, and “awareness” of cervical cancer and the procedure. CONCLUSION To promote cancer screening services in underserved communities such as in Ethiopia, it is imperative to understand the major factors that influence screening. Focus groups revealed reasons that women may be hesitant to screen for cervical cancer using HPV self-sampling. Education and screening interventions should address these concerns and self-described knowledge gaps to empower patients to make informed decisions about screening.

Screening Methods for Cervical Cancer.

Cervical cancer seriously affects the health of women worldwide. Persistent infection of high-risk HPV (Human Papilloma Virus) can lead to cervical cancer. There is a great need for timely and efficient screening methods for cervical cancer. The current screening methods for cervical cancer are mainly based on cervical cytology and HPV testing. Cervical cytology is made of Pap smear and liquid-based cytology, while HPV testing is based on immunological and nucleic acid level detection methods. This review introduces cervical cancer screening methods based on cytology and human papillomavirus testing in detail. The advantages and limitations of the screening methods are also summarized and compared.

Acceptability of self-collected vaginal samples for human papillomavirus testing for primary cervical cancer screening: comparison of face-to-face and online recruitment modes

BackgroundThis study aimed to assess the acceptability and attitudes of women towards human papillomavirus (HPV) self-sampling and compare the effectiveness of two delivery modes utilising face-to-face and online website for cervical cancer screening in Hong Kong.MethodsWomen aged 30–65 years were invited to participate by distributing the study information pamphlets at the specialist clinics of a regional acute hospital. Those who were interested in participating were given the option to join directly face-to-face or through an online website. All participants provided informed consent and received self-sampling kits and acceptability questionnaires either immediately (face-to-face) or through the post after registering at the website (online). All participants were requested to collect their own vaginal samples using a swab which was then brushed on a DNA sample storage card and returned to the hospital either in person or by post. The self-collected samples were tested for high-risk HPV using the Sentis™ HPV assay, a validated isothermal nucleic acid amplification real-time fluorescent detection assay. The primary outcome was the uptake rate of HPV self-sampling.ResultsOf the 1998 women recruited (1200 face-to-face, 798 online), 1377 returned their samples, giving an overall uptake rate of 68.9%. The uptake rate was significantly greater in the face-to-face mode than in the online mode (74.6% vs. 60.4%, p < 0.001). The median age of the participants was 49 years, 43.7% were never or under-screened, and 7.1% had high-risk HPV detected. Overall, 82.1% of the participants reported self-sampling convenient, and 79.3% were not embarrassed when collecting self-samples. However, only 49.8% were confident that they had collected the self-samples correctly. Most (91.1%) of the participants expressed willingness to perform self-sampling again, mostly because it was simple (79.2%) and quick (56.3%).ConclusionsHPV self-sampling can serve as an alternative primary screening method for cervical cancer in Hong Kong, especially for individuals who have not been adequately screened in the past. Both face-to-face and online website recruitment were associated with high acceptability, emphasising the potential benefits of utilising different platforms and strategies for reaching diverse populations.

206 Cervical Cancer Disparities: Knowledge, Screening and Willingness to adopt testing modalities among Hispanic/Latinx Women in Lake County, Indiana

OBJECTIVES/GOALS: There are notable disparities in cervical cancer screening. Theobjective of this study was to examine knowledge, screening practices, attitudes towards cervical cancer screening, and willingness to adopt screening innovations such as self-sampling and HPV rapid testing for cervical cancer among Hispanic women in Lake County, Indiana. METHODS/STUDY POPULATION: This mixed-methods study encompassed an online cross-sectional survey (n=231) and in-depth interviews (n=9) of individuals with a cervix aged 21-65 residing in Lake County, Indiana. Outcome variables focused on cervical cancer knowledge, willingness to adopt self-sampling, and willingness to adopt HPV rapid testing. Descriptive statistics included frequencies and percentages. A cervical cancer knowledge score was computed from 7 questions. Scores below the mean 3.62 were labeled ‘low’ while higher scores were ‘high’. We also examined associations between demographic and outcome variables. Quantitative analysis was conducted using SPSS software. Qualitative analysis was conducted using NVIVO software to thematically analyze interviews using deductive and inductive coding techniques. RESULTS/ANTICIPATED RESULTS: Majority of participants identified as Hispanic (58%), aged 31 or older (58%). While 80.5% reported being screened for cervical cancer, only 44.6% demonstrated ‘high' cervical cancer knowledge. 89.6% felt screening is important as emphasized in qualitative findings for its preventive value. Over half were willing to take their vaginal swab in clinic (55.8%) and at home (51.9%). However, among the Hispanic/Latinx groups reluctance to adopt self-sampling was notable (56.7% in clinic and 62.7% at home). Qualitative analysis revealed concerns about test accuracy. Willingness to use a hypothetical HPV rapid had higher acceptance (69.7%), with 52.2% in the Hispanic/Latinx group. Qualitative findings highlight benefits like increased screening access, comfort, and convenience offered by an HPV rapid test. DISCUSSION/SIGNIFICANCE: Hispanic/Latinx women in the sample were less willing to adopt cervical cancer screening methods such as self-sampling and rapid testing compared to non-Hispanic whites. Despite being considered beneficial for testing among vulnerable populations, our study found limited acceptance from these populations for various reasons.

Abstract 7290: Novel plasmid-based screening method for cervical cancer

Abstract Introduction: Alabama (AL) is tied for third-highest incidence rate and has second-highest death rate of cervical cancer as of 2020. Globally, cervical cancer has the fourth-highest incidence among cancers in women; 90% of deaths from cervical cancer in 2020 occurred in low- and middle-income (LMIC) countries. Inhibitor of differentiation/DNA binding 1 (Id1) expression correlates with tumorigenesis, clinical grade/stage, and aggressiveness of cervical cancer. Thus, Id1 expression could be exploited in novel screening approaches that aim to improve survival rates of cervical cancer in LMIC and clinically underserved settings. As a first step in developing an Id1-based screening approach, these preclinical studies utilized a plasmid that induces expression of a secreted reporter enzyme (secreted embryonic alkaline phosphatase, SEAP), controlled by the Id1 promoter sequence (pId1-SEAP). These studies examined relationships between Id1 expression and kinetics of reporter expression following plasmid transfection to detect human cervical cancer cells. Methods and Results: To confirm the relevance of Id1 as a target in cervical cancer, immunohistochemical staining for Id1 was performed on a human cervical cancer tissue microarray. Western blotting was performed to determine Id1 expression in human cervical cancer cell lines (HeLa, SiHa, CaSki). Optimal transfection conditions with pId1-SEAP were determined experimentally for each line, and then media was sampled through a 48-hour period post-transfection to quantify reporter SEAP expression. Immunohistochemical stain for Id1 showed that early stage and late stage human cervical cancer tissues expressed significantly (p &amp;lt; 0.05) higher levels of Id1 compared to normal tissues, with stain optical density values being 3e5±1e5 for early and late stage compared to 3e4±3e4 for normal tissues (early stage p=0.0001, late stage p=0.0002). Western blot for Id1 in HeLa, SiHa, and CaSki lines showed that all three positively expressed Id1, with Beta-actin-normalized expression values of 0.78±0.12, 1.12±0.05, and 0.76±0.08, respectively. The cell lines transfected with pId1-SEAP expressed SEAP at rates significantly higher than control cells, with the highest rates of production seen during the 36-48-hour post-transfection period. Rates of SEAP production (counts/hour) during this time period were 1e4±3e3 (p=0.0278), 8e2±1e2 (p=0.0834), and 3e2±5e1 (p=0.0683) for transfected HeLa, SiHa, and CaSki cells, respectively. Conclusions: The pId1-SEAP system enabled sensitive detection of cervical cancer cells. These preliminary data support future studies evaluating the in vivo performance of the system in preclinical models of early stage cervical cancer. Further development of this approach could enable sensitive and reliable detection of cervical cancer during early stages when treatment is most effective. Citation Format: Abbigael Eli, Yolanda Hartman, Benjamin B. Kasten, Rebecca Arend, Jason Warram. Novel plasmid-based screening method for cervical cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7290.

Extended HPV typing test performed better predict value for CIN2+ among elderly women in China

ObjectiveThe aim of this study was to examine the cervical cancer screening practices among women residing in Lingang New District of Shanghai. Moreover, the study aimed to delve into the characteristics of HPV infection and cervical lesions in older women (≥60 years old), seeking for more effective method for cervical cancer screening. MethodsThis is a cross-sectional study enrolled women who were referred to colposcopy and cervical histological examination due to abnormal cytology or HPV tests from Shanghai Sixth People's Hospital between January 2018 and December 2022. ResultsA total of 1,931 women (mean age: 41.8 ± 12.5, range: 18–88 years old) were enrolled, 119 individuals aged ≥ 60 and 1732 aged <60. The infection rates of HPV52, 33, 35, 56, 26 and 81 were significantly higher in the elderly group. Multiple HPV infection rates were also higher in this group and were associated with cervical lesions. The probability of LSIL, HSIL and Ca in women over 60 years old was significantly higher compared to women under 60. The top three HPV genotypes in elderly women with CIN2+ were HPV16, 52, and 58. The Yoden index was higher for extended typing for HPV 31/33/45/52/58(0.41) compared to cytology(0.29), high risk HPV without specific typing(0.07), cotest(cytology and high risk HPV, 0.06 or 0.30), or the current shunt strategy(0.07). ConclusionsElderly women still need to continue cervical cancer screening, and extended typing test for HPV16/18/31/33/45/52/58 is a more effective method for this age group.

The risk of vaginal, vulvar and anal precancer and cancer according to high-risk HPV status in cervical cytology samples.

High-risk human papillomavirus (hrHPV) is the cause of virtually all cervical cancers, most vaginal and anal cancers, and some vulvar cancer cases. With HPV testing becoming the primary screening method for cervical cancer, understanding the link between cervical hrHPV infection and the risk of other anogenital cancers is crucial. We assessed the risk of vulvar, vaginal and anal cancer and precancer (VIN2+, VaIN2+ and AIN2+) in a prospective cohort study including 455,349 women who underwent cervical hrHPV testing in Denmark from 2005 to 2020. We employed Cox proportional hazard models, adjusting for age, calendar year and HPV vaccination status, and estimated hazard ratios (HRs) and 95% confidence intervals (CI). We used the Aalen Johansen estimator to calculate the absolute risks of VIN2+, VaIN2+ and AIN2+. In total, 15% of the women were hrHPV positive at baseline. A positive cervical hrHPV test was associated with increased incidence of vulvar, vaginal and anal squamous cell carcinoma (SCC). Five-year risk estimates of VIN2+, VaIN2+ and AIN2+ among hrHPV-positive women (0.45%, 0.14% and 0.12%) were higher than among hrHPV-negative women (0.14%, 0.01% and 0.05%). Particularly high risk was observed among the hrHPV-positive women of the oldest age, with a history of anogenital precancer and those not HPV vaccinated. In conclusion, our study confirms the association between cervical hrHPV infection and non-cervical anogenital precancers and cancers. Currently, no established risk threshold or guidelines for follow-up. As HPV testing becomes the primary method for cervical cancer screening, future data will help define high-risk groups and acceptable risk thresholds.