Participation In Cervical Cancer Screening Research Articles

The ESSAG-trial protocol: A randomized controlled trial evaluating the efficacy of offering a self-sampling kit by the GP to reach women underscreened in the routine cervical cancer screening program

BackgroundIn Flanders (Belgium), women not screened for cervical cancer (CC) within the last three years receive an invitation letter from the regional screening organization, the Centre for Cancer Detection (CCD), encouraging them to have a cervical specimen taken by their general practitioner (GP) or gynecologist. However, the coverage for CC screening remains suboptimal (63%). The offer of a self-sampling kit (SSK, for HPV testing) by a GP may trigger participation among women who do not attend regular screening. MethodsThe ESSAG-trial is a cluster-randomized controlled trial with three arms, each including 1125 women aged 31–64 years, who were not screened for CC in the last 6 years. In arm A, GPs offer a SSK when eligible women consult for any reason. In arm B, women receive a personal GP signed invitation letter including an SSK at their home address. In the control arm, women receive the standard invitation letter from the CCD. The primary outcome is the response rate at three months after inclusion. Secondary outcomes are: screen test positivity; compliance with foreseen follow-up among screen-positives; costs per invited and per screened women; as well as contrasts between trial arms and between socio-demographic categories. ConclusionThe ESSAG-trial will assess the effect of GP-based interventions using SSKs on CC screening participation among hard-to-reach populations. Findings will inform policymakers about feasible strategies on increasing CC screening that may be rolled-out throughout the whole region. Trial registrationClinicalTrials.gov: NCT05656976

Sociodemographic characteristics associated with cervical cancer screening participation by send-to-all and opt-in HPV self-sampling: Who benefits? Results from a randomized controlled trial among long-term non-attending women in Norway.

With the objective to investigate associations between sociodemographic characteristics and participation in interventions designed to increase participation in cervical cancer screening among under-screened women, we randomized a random sample of 6000 women in Norway aged 35-69 years who had not attended cervical screening for ≥10 years to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self-sampling kit (opt-in), or (iii) a self-sampling kit unsolicited (send-to-all). We analyzed how sociodemographic characteristics were associated with screening participation within and between screening arms. In the send-to-all arm, increased screening participation ranged from 17.1% (95% confidence interval [95% CI] = 10.3% to 23.8%) to 30.0% (95% CI = 21.5% to 38.6%) between sociodemographic groups. In the opt-in arm, we observed smaller, and at times, non-significant increases within the range 0.7% (95% CI = -5.8% to 7.3%) to 19.1% (95% CI = 11.6% to 26.7%). In send-to-all versus control comparisons, there was greater increase in participation for women in the workforce versus not (6.1%, 95% CI = 1.6% to 10.6%), with higher versus lower income (7.6%, 95% CI = 2.2% to 13.1%), and with university versus primary education (8.5%, 95% CI = 2.4% to 14.6%). In opt-in versus control comparisons, there was greater increase in participation for women in the workforce versus not (4.6%, 95% CI = 0.7% to 8.5%), with higher versus lower income (6.3%, 95% CI = 1.5% to 11.1%), but lower increase for Eastern European versus Norwegian background (-12.7%, 95% CI = -19.7% to -5.7%). Self-sampling increased cervical screening participation across all sociodemographic levels, but inequalities in participation should be considered when introducing self-sampling, especially with the goal to reach long-term non-attending women.

What are the barriers towards cervical cancer screening for vulnerable women? A qualitative comparative analysis of stakeholder perspectives in seven European countries

ObjectivesThe aim of this study was to map and compare stakeholders’ perceptions of barriers towards cervical cancer screening for vulnerable women in seven European countries.DesignIn Collaborative User Boards, stakeholders were...

Baseline knowledge on risk factors, symptoms and intended behavior of women and men towards screening and treatment of cervical cancer in rural Uganda: a cross-sectional study

BackgroundKnowledge of risk factors and symptoms of cervical cancer has been found to promote uptake of screening of cervical cancer. Most interventions targeted women without much involvement of men (husbands/decision makers) who are often decision makers in many low- and middle-income countries. This study aimed at assessing baseline knowledge and intended behavior of both women and men to enable design specific targeted messages to increase uptake of cervical cancer screening and promote early detection of women with symptoms.MethodsThis cross-sectional study was conducted in two districts in Western Uganda using the modified African Women Awareness of CANcer (AWACAN) questionnaire. Women aged 30—49 years and their husbands/decision makers were interviewed. Knowledge on risk factors and symptoms, intended behavior and barriers towards participation in cervical cancer screening and treatment were assessed. Descriptive and logistic regression analyses were done to establish the association between knowledge levels and other factors comparing women to men.ResultsA total of 724 women and 692 men were enrolled. Of these, 71.0% women and 67.2% men had ever heard of cervical cancer and 8.8% women had ever been screened. Knowledge of risk factors and symptoms of cervical cancer was high and similar for both women and men.Lack of decision making by women was associated with low knowledge of risk factors (X2 = 14.542; p = 0.01), low education (X2 = 36.05, p < 0.01) and older age (X2 = 17.33, p < 0.01). Men had better help seeking behavior than women (X2 = 64.96, p < 0.01, OR = 0.39, 95% CI: 0.31—0.50) and were more confident and skilled in recognising a sign or symptom of cervical cancer (X2 = 27.28, p < 0.01, OR = 0.52, CI (0.40—0.67).ConclusionThe baseline knowledge for cervical cancer was high in majority of participants and similar in both women and men. Their intended behavior towards screening was also positive but screening uptake was very low. This study suggests developing messages on multiple interventions to promote screening behavior in addition to education, consisting of male involvement, women empowerment and making services available, accessible and women friendly.

Psychometric properties of a modified health belief model for cervical cancer and visual inspection with acetic acid among healthcare professionals in Ethiopia.

Evidence supports that the Health Belief Model (HBM) can explain and predicts certain health behaviors, including participation in cervical cancer (CC) screening. The purpose of this study was to evaluate the psychometric properties of a modified HBM for CC and visual inspection with acetic acid (VIA) in female healthcare professionals in Addis Ababa, Ethiopia, 2020. Psychometric properties related to CC and VIA were tested using 42-item modified HBM self-administered questionnaire and a cross-sectional study design with simple random sampling. Kaiser-Meyer-Olkin and Bartlett's sphericity test indicated that data sampling adequacy for exploratory factor analysis was 0.792 (χ2 = 3189.95, df = 351, p < .001). Items with cross-loading and factor loadings ≥ 0.5 were retained. Confirmatory factor analysis (CFA) was conducted to determine model fit. The final analysis included 194 women, (mean age 30±4.34). Twelve items with ≤ 0.5 were removed and 30 retained items loaded into 6 factors; (benefits of VIA, perceived seriousness of CC, barrier (fear of negative outcome), self-efficacy, susceptibility to CC, and barriers (health system delivery)) explained 65% of the total variance. Cronbach's alpha for the total instrument was 0.8 and reliability for the 6 subscales was 0.76-0.92. Composite reliability and average variance extracted indicated good internal consistency and convergent validity. CFA identified 6 additional items to be removed with high residual covariance. The final 24 items of the modified HBM had an acceptable model fit (goodness-of-fit index (GFI) = 0.861, adjusted GFI = 0.823, comparative fit index = 0.937, root mean square error of approximation = 0.059). The modified HBM for CC and VIA with 24 items had adequate psychometric properties and may be used by Ethiopian healthcare professionals for research or clinical purposes. To support external validity the updated 24 items tool is suggested for application in further study in different populations in Ethiopia.

Abstract 3942: Mailed at-home self-sampling for HPV testing increases screening participation among under-screened patients in a U.S. safety net health system: Results of the PRESTIS trial

Abstract Background: In global settings, self-sampling for human papillomavirus (HPV) testing is associated with a pooled 2-fold increase in cervical cancer screening participation over usual care among underscreened persons. The Prospective Evaluation of Self-Testing to Increase Screening (PRESTIS) Trial is the first pragmatic randomized controlled trial (RCT) in the U.S. to evaluate the effectiveness of mailed at-home self-sampling for HPV testing in a safety net health system setting. Safety net systems provide care to medically underserved individuals at elevated cervical cancer risk. We hypothesized that patients who were mailed a self-sampling kit would have greater screening participation compared with those receiving usual care; and that patient navigation, a patient-centered intervention to address barriers to care, would further increase participation. Methods: PRESTIS is a three-arm pragmatic RCT of n=2,270 patients in a U.S. safety net health system who are under-screened for cervical cancer (i.e., no Pap in 3.5 years or Pap/HPV co-test in 5.5 years). Eligible participants were identified through the electronic health record (EHR) and randomized to arms: 1) telephone recall to provider-performed screening (usual care); 2) telephone recall + mailed self-sampling kit for HPV testing; or 3) telephone recall + mailed self-sampling kit + telephone-based patient navigation. Self-sampled swabs were tested for high-risk (HR)-HPV. HR-HPV+ patients were navigated to clinical follow-up. The primary outcome, incidence of screening participation, was ascertained by EHR review at 6 months post-randomization and defined as return of a completed kit or attendance for provider-performed screening. Results: Participants were enrolled 02/2020-08/2023. Primary outcomes have been ascertained for n=2,115 participants. Participants were predominantly Hispanic/Latina (68.6%); 53.4% indicated Spanish as primary language; and 60.3% were uninsured. Mean age was 47.9 years (SD: 10.4 years); median time since last screening test was 9.5 years (range: 1.6-21.7 years). In intent-to-treat analyses, screening participation was 15.3% (95% CI 13.0% - 17.9%) in Arm 1; 44.0% (40.4% - 47.6%) in Arm 2; and 51.4% (47.7% - 55.0%) in Arm 3. Relative incidence of screening in Arms 2 and 3 versus Arm 1 was 2.90 (2.42 - 3.47) and 3.36 (2.82 - 4.01), respectively. Relative incidence of screening in Arm 3 versus Arm 2 was 1.16 (1.04 - 1.29). Conclusion: Compared with usual care, mailed at-home self-sampling increased screening participation among an under-screened population by almost three-fold when used alone and over 3.3-fold when combined with telephone-based patient navigation. After FDA approval, self-sampling for HR-HPV testing has the potential to dramatically increase participation in cervical cancer screening in underserved populations. Citation Format: Jane R. Montealegre, Elizabeth Y. Chiao, Matthew L. Anderson, Susan G. Hilsenbeck, Shaun Bulsara, Susan L. Parker, Maria Daheri, Trisha L. Amboree, Kathleen M. Schmeler, Maria L. Jibaja-Weiss, Mohammad Zare, Ashish A. Deshmukh, Michael E. Scheurer. Mailed at-home self-sampling for HPV testing increases screening participation among under-screened patients in a U.S. safety net health system: Results of the PRESTIS trial [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 3942.

Cervical cancer risk assessment using machine learning integrated fuzzy MCDM methodology

Cervical cancer is entirely preventable if diagnosed at an early stage; however, the current rate of cervical cancer screening participation is not very adequate, and early detection approaches are still open and demanding. Evaluating the risk levels of potential patients in a practical and economic way is crucial to direct risky candidates to screening and establishing potential treatments to conquer the disease. In this study, a machine learning-integrated fuzzy multi-criteria decision-making (MCDM) methodology is proposed to assess the cervical cancer risk levels of patients. In this context, based on behavioral criteria obtained from the publicly accessible cervical cancer behavior risk data set from the UCI repository, the risk levels of patients are evaluated. The proposed methodology is established in three stages: In the first stage, using a machine learning technique, i.e., feature selection, the most effective criteria for predicting cervical cancer risk are selected. In the second stage, the criteria for importance through intercriteria correlation (CRITIC) method is used to assign objective importance levels to the criteria. In the third stage, the cervical cancer risk levels of candidate patients are prioritized using the technique for order preference by similarity to the ideal solution (TOPSIS) and, alternatively, the evaluation based on distance from the average solution (EDAS) techniques. The proposed methodology is developed in an interval-valued Pythagorean fuzzy atmosphere for quantifying the uncertainty in the nature of the problem. This study demonstrates that the feature selection algorithm can be efficiently utilized to determine the fundamental criteria of an MCDM problem and to aid in the early identification of cervical cancer.

Cervical Cancer Awareness and Screening Practices Amongst Women in Ras Al-Khaimah, UAE and Migrant Women in Sydney, Australia

Cervical cancer is the fifth most common cancer in the UAE and the fourteenth most common cancer among women in Australia (Sung et al., 2021). Despite the introduction of vaccinations and cervical screening programs in both countries, Emirati and non-Emirati women living in Ras Al Khaimah and migrant women living in Sydney still face significant health disparities when accessing cervical cancer screening services. Currently, there is a lack of literature examining the obstacles to and facilitators of cervical screening among these groups of women. This study aimed to better understand the knowledge and awareness of cervical cancer and factors that hinder or promote access to cervical screening among these groups, which is crucial if healthcare professionals and policymakers are to deliver culturally sensitive services. This study was conducted in Ras Al Khaimah (RAK) and Sydney. The results identified several barriers to cervical cancer screening participation, including lack of knowledge, emotional, cultural, religious and psychological barriers, and organizational factors. The findings have implications for policies to address these barriers and encourage women to participate in health awareness initiatives and screening services.

Trends in cervical cancer screening in Norway 2012-2017: a comparison study of non-immigrant and immigrant women.

Immigrant women in Norway have lower cervical cancer screening participation than non-immigrant women. Our aim in this study was to assess whether the observed increase in screening participation during 2012-2017 was different between Norwegian-born women and immigrant women. Data were collected from three national registries. The study included 1,409,561 women, categorized according to country of birth and immigrant background: (i) Norway, Norwegian parents; (ii) Norway, immigrant parent(s); (iii) Europe, excluding Norway; (iv) Africa; (v) Asia, including Turkey; and (vi) other countries. Trends and differences between groups were analyzed using Poisson regression analyses with adjustments for variables other studies have found to influence screening participation. Trends were assessed by including half-years as a continuous variable in the models and reported as prevalence ratios with 95% confidence intervals. Screening participation increased in all groups, but was not statistically significant among women from Africa in the adjusted model. The highest increase was among Norwegian women, with a 2.2% increase per year. Interaction tests showed significantly smaller increases in screening among women born in Europe (p interaction < 0.0001), Africa (p interaction < 0.0001), Asia (p interaction < 0.0001), and countries in the "Other" category (p interaction = 0.004). There was also a smaller increase among Norwegian-born women with one or more immigrant parent(s), but this was not significant (p interaction = 0.178). The gap in screening participation and the increasing differences in trends suggest that healthcare services do not reach all women in Norway to the same extent. One should attempt to improve this while working toward further increasing screening participation for all.

Influencing Elements Impacting the Participation in Cervical Cancer Screening Among Women of Childbearing Age at Jinja Regional Referral Hospital, Eastern Uganda

This research aimed to gauge cervical cancer screening participation and its influencing factors among Women of Reproductive Age (WRA) at Jinja Regional Referral Hospital (JRRH) in Eastern Uganda. Conducted from January to April 2021, the study utilized a cross-sectional descriptive design, surveying 370 WRA through pretested semi-structured questionnaires. Analysis was performed using SPSS version 20, presenting outcomes through tables, frequencies, percentages, and logistic regression analyses. Among the 370 respondents, merely 24.3% (90 individuals) had undergone cervical cancer screening. Of these, 14.1% had one screening, 7.0% had two screenings, and 3.2% had been screened three or more times. The primary mode of screening (11%) occurred during medical camps. Regarding awareness, 89.7% had heard of cervical screening, predominantly through radio broadcasts (41.0%), with 41.4% recognizing its purpose and 52.4% acknowledging its role in early detection and treatment. Furthermore, 94.3% viewed cervical cancer screening as a beneficial practice, with 81.1% advocating for other women to undergo screening, while 90% believed in promoting this practice. Culturally and religiously, the acceptance of cervical cancer screening was widespread. Demographically, most respondents (66.5%) fell within the 15-30 age bracket, with the majority identifying as Anglicans (33.8%) and 88.9% being Ugandan nationals. Educational attainment was predominantly at the secondary (37.0%) and tertiary (39.2%) levels. Regression analysis indicated that being Anglican significantly influenced the uptake of cervical cancer screening [OR=2.219(1.039 – 3.899); 95% CI, P=0.038)]. Despite increased knowledge and awareness about cervical cancer screening’s purpose, treatment, and associated complications, uptake remains below desired levels. Notably, a substantial number of women did not seek screening due to the absence of signs or symptoms and lack of advice from medical professionals, exposing a gap in primary healthcare significance. The study underscores the need for heightened health education across healthcare platforms to emphasize the critical importance of cervical cancer screening and encourage more women to partake in this essential preventive practice. Keywords: Cancer, Women, Cervical cancer screening, Pap smear test

Factors affecting cervical cancer screening among Yemeni immigrant women in Klang Valley, Malaysia: A cross sectional study

Introduction Cervical cancer is a significant public health problem for women worldwide. It is the fourth most frequent cancer in women globally. While early detection of cancerous lesions through screening tests leads to a better prognosis and a better chance of being cured, the number of people who go for screening is still low, especially for groups that are marginalized, like immigrant women. Objective The purpose of this study was to identify cervical cancer screening practices and factors influencing screening status among Yemeni immigrant women living in the Klang Valley, Malaysia. Method A cross-sectional study among 355 randomly selected respondents between the ages of 20 and 65 was conducted through an online survey. A questionnaire was sent directly to the participants via WhatsApp. The analysis was conducted using SPSS 25 with a significance level of 0.05. It included descriptive analysis, chi-square and multiple logistic regression. Results The response rate was 59%, with the majority of the respondents being married and between the ages of 35 and 49. Screening was reported at 23.1% in the previous three years. The final model revealed that age group 50–65 years (AOR = 5.39, 95% CI: 1.53–18.93), insurance status (AOR 2.22, 95% CI = 1.15–4.3), knowledge (AOR = 6.67, 95% CI = 3.45–12.9), access to health care facilities (AOR = 4.64, 95% CI = 1.29–16.65), and perceived barriers (AOR = 2.5, 95% CI = 1.3–4.83) were significant predictors of cervical screening uptake among Yemeni immigrant women in Malaysia (p&lt;0.05). Conclusion According to the results, cervical cancer screening was found to be low among Yemeni immigrant women. The predictors were age group 50–65 years, insurance status, knowledge, access to health care facilities and perceived barriers. Efforts to enhance immigrant women’s participation in cervical cancer screening must tackle barriers to access to healthcare services as well as expand cervical cancer screening education programs.

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.

Impact of health-related behavioral factors on participation in a cervical cancer screening program: the lifelines population-based cohort

BackgroundRegular participation in cervical cancer screening is critical to reducing mortality. Although certain sociodemographic factors are known to be associated with one-time participation in screening, little is known about other factors that could be related to regular participation. Therefore, this study evaluated the association between health-related behavioral factors and regular participation in cervical cancer screening.MethodsThe Lifelines population-based cohort was linked to data for cervical cancer screening from the Dutch Nationwide Pathology Databank. We included women eligible for all four screening rounds between 2000 and 2019, classifying them as regular (4 attendances), irregular (1–3 attendances), and never participants. Multinomial logistic regression was performed to evaluate the association between behavioral factors and participation regularity, with adjustment made for sociodemographic factors.ResultsOf the 48,325 included women, 55.9%, 35.1%, and 9% were regular, irregular, and never screening participants. After adjustment for sociodemographic factors, the likelihood of irregular or never screening participation was increased by smoking, obesity, marginal or inadequate sleep duration, alcohol consumption and low physical activity, while it was decreased by hormonal contraception use.ConclusionAn association exists between unhealthy behavioral factors and never or irregular participation in cervical cancer screening.

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.

Cervical cancer screening attendance related factors among women in Latvia

Abstract Cervical cancer is the second leading cause of death in Latvia among women aged 15-44. Since 2009 organized cancer screening has been available, but responsiveness from the target population was still not optimal - only half of the invited persons participated in screening in 2022. Our study aimed to analyse sociodemographic factors and knowledge about screening concerning participation in the screening procedure. Data from a cross-sectional population survey conducted in 2021-2022 were analysed (n = 1313). The survey was part of the project “Towards elimination of cervical cancer: intelligent and personalized solutions for cancer screening” (EMP416). A multivariate model was adjusted for independent variables found to be statistically significantly associated with the outcome in univariate analysis. The dependent variable was participation in cervical cancer screening. Independent variables - knowledge about screening, age, education, marital status, and employment 81 % (n = 1063) of respondents participated in cervical cancer screening. The odds of screening attendance were higher among women aged 30-39 (aOR=3.6, p &amp;lt; 0.001), 40-49 (aOR=2.8, p = 0.005), 50-59 (aOR=12.3, p = 0.001) in comparison to women aged 25-29 years. Secondary (aOR=5.9, p &amp;lt; 0.001) and university (OR = 13.1, p &amp;lt; 0.001) education in comparison to primary education and being married (OR = 3.7, p &amp;lt; 0.001) to being single, as well as being employed (OR = 2.0, p = 0.085) and economically inactive (OR = 3.1, p &amp;lt; 0.05) in comparison to unemployment was associated with cervical cancer screening attendance. Knowledge about screening was associated with higher odds of participation (OR = 4.1, p = 0.001). Knowledge about screening is positively related to attendance. Differences were observed across various sociodemographic groups emphasizing the importance of providing targeted information for vulnerable social groups such as the elderly, single and unemployed women, and women with lower education to promote cervical cancer screening. Key messages • Cervical cancer screening is important, but target group responsiveness to it is still not optimal. Targeted public health activities are needed to improve cervical cancer screening attendance. • Equity in cervical cancer screening attendance could be ensured by targeting vulnerable social groups, specifically, the elderly, single and unemployed women, and women with lower education.

Participation, Barriers, and Facilitators of Cancer Screening Among LGBTQ+ Populations: A Review of the Literature

ABSTRACT Compared with cisgender and heterosexual individuals, members of the LGBTQ+ community experience worse health outcomes. This is due to a combination of structural inequities and life experiences, including higher rates of mental illness and suicidality, sexually transmitted infections, and certain cancers. Men who have sex with men are at higher risk of anal cancer, and lesbian and bisexual women are often diagnosed with breast cancer at younger ages than heterosexual women partly due to lower parity and higher bodyweight. Despite these increased risks, some evidence shows the LGBTQ+ population is less likely to participate in early detection and cancer screening programs; however, the etiology of this is unknown. This review aims to summarize the current literature on cancer screening uptake in the LGBTQ+ population, including barriers and facilitators associated with screening participation. Studies published between January 2001 and April 2022 involving individuals identified as a gender or sexual minority that assessed participation in and/or facilitators and barriers to a cancer screening procedure were included. Barriers and facilitators identified in quantitative studies were reported on the individual-, provider-, and administrative/system-level scale. A total of 50 publications were included, 38 of which were quantitative, 10 were qualitative, and 2 used mixed methods. Among 16 relevant studies, considerable variation was identified when analyzing whether sexual minority women had lower participation in cervical cancer screening programs. Among 15 studies assessing the participation of sexual minority women compared with heterosexual women in breast cancer screening, 5 studies found no difference, whereas the remainder suggested lower rates of screening among sexual minority women. Fewer studies assessed screening among sexual minority men; however, sexual minority men were more likely to report anal cancer screening than heterosexual men. Cervical cancer screening participation among transgender men and gender diverse participants was lower than cisgender participants in almost all studies. Of 9 studies reporting breast cancer screening among gender diverse or transgender individuals, 5 found lower participation among transgender or gender diverse individuals compared with cisgender women. One study identified greater odds of up-to-date mammography among transgender men compared with cisgender women. The most common individual-level barriers to screening are related to knowledge of the screening tests themselves, including screening guidelines, procedures, pain, embarrassment, and a fear of results. One of the strongest correlates in studies was perceived discrimination from health care providers, which often resulted in lack of disclosure of sexual orientation or gender identity. Provider-level factors mostly included provider communication and relationship with the patient, and patients preferred providers experienced with LGBTQ+ clients and that used sexuality-inclusive language. Having open communication about sexual orientation and gender identity was a positive facilitator for all patients. System-level barriers included inclusive documentation and physical environments in health care. This review highlights key disparities including the lower screening rates among transgender patients in all categories and lower screening rates for cervical cancer and mammography among sexual minority women. It also highlights a significant need for representative data on all LGBTQ+ populations.

Body mass index and cervical cancer screening among women aged 15–69 years in Eswatini: evidence from a population-based survey

BackgroundCervical cancer stands as one of the most prevalent cancer types among women, despite its preventable nature through early screening and vaccination strategies. The link between being overweight or obese and various adverse health outcomes, including an elevated cancer risk, is well established. Within this study, our central objective was to explore the correlation between body mass index (BMI) and cervical cancer screening (CCS) rates. Moreover, we sought to investigate whether socioeconomic status potentially modulates this relationship.MethodsOur analysis encompassed 1791 respondents who participated in the World Health Organization’s STEPwise approach to noncommunicable disease risk factor surveillance carried out in Eswatini in 2014. We assessed the connection between BMI, along with other determinants, and CCS through both unadjusted and adjusted logistic regression models.ResultsThe uptake of CCS was 14.4% and the prevalence of overweight and obesity was estimated at 28.1 and 34.9% respectively. After accounting for other pertinent variables, the likelihood of obtaining CCS was amplified for individuals classified as obese (adjusted odds ratio [aOR] = 1.99, 95% confidence interval [CI] = 1.26–3.12) or overweight (aOR = 1.98, 95% CI = 1.05–3.74). Furthermore, factors such as being separated or divorced (aOR = 2.03, 95% CI = 1.11–3.72) and engaging in regular physical exercise (aOR = 3.02, 95% CI = 1.21–6.02) were associated with increased odds of undergoing CCS.ConclusionsThis study underscores the noteworthy role played by both overweight and obesity, in conjunction with various socioeconomic factors, in shaping CCS patterns among the surveyed women. For Eswatini, targeted interventions aimed at enhancing CCS participation should take into account the multifaceted factors highlighted within this investigation.

Acceptability of risk-based triage in cervical cancer screening: A focus group study.

Compared to the previous cytology-based program, the introduction of primary high-risk human papillomavirus (hrHPV) based screening in 2017 has led to an increased number of referrals. To counter this, triage of hrHPV-positive women in cervical cancer screening can potentially be optimized by taking sociodemographic and lifestyle risk factors for cervical abnormalities into account. Therefore, it is essential to gain knowledge of the views of women (30-60 years) eligible for cervical cancer screening. The main goal of this qualitative study was to gain insight in the aspects that influence acceptability of risk-based triage in cervical cancer screening. A focus group study in which participants were recruited via four general medical practices, and purposive sampling was used to maximize heterogeneity with regards to age, education level, and cervical cancer screening experiences. The focus group discussions were transcribed verbatim and analyzed using reflexive thematic analysis. A total of 28 women (average age: 45.2 years) eligible for cervical cancer screening in The Netherlands participated in seven online focus group discussions. Half of the participants was higher educated, and the participants differed in previous cervical cancer screening participation and screening result. In total, 5 main themes and 17 subthemes were identified that determine the acceptability of risk-stratified triage. The main themes are: 1) adequacy of the screening program: an evidence-based program that is able to minimize cancer incidence and reduce unnecessary referrals; 2) personal information (e.g., sensitive topics and stigma); 3) emotional impact: fear and reassurance; 4) communication (e.g., transparency); and 5) autonomy (e.g., prevention). The current study highlights several challenges regarding the development and implementation of risk-based triage that need attention in order to be accepted by the target group. These challenges include dealing with sensitive topics and a transparent communication strategy.

Hyperlocal disparities in breast, cervical, and colorectal cancer screening: An ecological study of social vulnerability in Miami-Dade county

Neighborhoods have been identified as important determinants of health-related outcomes, but limited research has assessed the influence of neighborhood context along the cancer continuum. This study used census tract-level data from the United States Census Bureau and Centers for Disease Control and Prevention to characterize Miami-Dade County census tracts (n = 492) into social vulnerability clusters and assess their associated breast, cervical, and colorectal cancer screening participation rates. We identified disparities by social vulnerability cluster in cancer screening participation rates. Further investigation of geographic disparities in social vulnerability and cancer screening participation could inform equity-focused cancer control efforts.

Associations between sociodemographic factors and breast, cervical, and colorectal cancer screening in the United States.

Cancer is the second leading cause of death globally and in the U.S., but screening can reduce cancer-related deaths. We analyzed data from a nationwide survey to compare how sociodemographic factors were associated with never or not timely screening for multiple types of cancer, and the use of different colorectal cancer screening procedures. We analyzed data from the 2019 U.S. National Health Interview Survey. To understand breast, cervical, and colorectal cancer screening participation among those recommended to screen, we respectively analyzed 8,110 women 45 to 74 years of age, 9,583 women 21 to 65 years of age, and 13,497 individuals 50 to 75 years of age at survey. Weighted Poisson regression was used to estimate the unadjusted and confounding-adjusted prevalence ratio and 95% confidence intervals. In our analysis populations, 6.9% never had a mammogram, 14.6% never screened for cervical cancer, and 26.8% never screened for colorectal cancer; the prevalence respectively increased to 24.7%, 23.8%, and 32.3% for not timely screening according to national guidelines. The prevalence of never screening was 81.9% for non-invasive colorectal cancer tests, compared with 32.5% for colonoscopy or sigmoidoscopy. Individuals with lower education level, with no health insurance, or in poverty had higher prevalence of never screening for all three cancers. There was low sociodemographic disparity for the use of non-invasive colorectal cancer screening tests. Socioeconomically disadvantaged individuals have higher prevalence of never or not timely screening. The utilization of non-invasive colorectal cancer screening procedures remains low across sociodemographic groups.