Cervical Cancer Screening Practices Research Articles

Mapping HPV Vaccination and Cervical Cancer Screening Practice in the Pacific Region-Strengthening National and Regional Cervical Cancer Prevention.

To provide background information for strengthening cervical cancer prevention in the Pacific by mapping current human papillomavirus (HPV) vaccination and cervical cancer screening practices, as well as intent and barriers to the introduction and maintenance of national HPV vaccination programmes in the region. A cross-sectional questionnaire-based survey among ministry of health officials from 21 Pacific Island countries and territories (n=21). Cervical cancer prevention was rated as highly important, but implementation of prevention programs were insufficient, with only two of 21 countries and territories having achieved coverage of cervical cancer screening above 40%. Ten of 21 countries and territories had included HPV vaccination in their immunization schedule, but only two countries reported coverage of HPV vaccination above 60% among the targeted population. Key barriers to the introduction and continuation of HPV vaccination were reported to be: (i) Lack of sustainable financing for HPV vaccine programs; (ii) Lack of visible government endorsement; (iii) Critical public perception of the value and safety of the HPV vaccine; and (iv) Lack of clear guidelines and policies for HPV vaccination. Current practices to prevent cervical cancer in the Pacific Region do not match the high burden of disease from cervical cancer. A regional approach, including reducing vaccine prices by bulk purchase of vaccine, technical support for implementation of prevention programs, operational research and advocacy could strengthen political momentum for cervical cancer prevention and avoid risking the lives of many women in the Pacific.

Impact of Health Education on Knowledge, Attitude and Practice of Cervical Cancer Screening Among Secondary School Teachers in Enugu State

A cross sectional, descriptive interventional study directed by four research questions and three hypotheses was used to determine the impact of health education on knowledge, attitude and practice of cervical cancer screening among secondary school teachers. Population was secondary school teachers in Enugu State. Sample size of 380 teachers in 14 schools in Enugu North Local Government Area was drawn as sample using multi-stage sampling technique. Instrument used was questionnaire. Data were presented in tables and analyzed using measures of central tendencies and percentages. Hypotheses were tested using chi-square. Findings revealed relative good knowledge, positive attitudes, poor practice and significant impact of health education on their knowledge, attitude and practice. Recommendations were made as well as suggestions for further studies.

Awareness and Practice of Cervical Cancer Screening among Women Accessing Care in a Rural Tertiary Hospital in Nigeria

Background. The burden of cervical cancer is on the increase, especially in developing countries, where programmed or regular screening for the disease with Papanicolaou smear is inadequate. The objective was to determine the awareness and practice of cervical cancer screening in a rural tertiary hospital in Nigeria. Methodology. 220 consecutive and consenting women of age 20–70years attending Federal Teaching Hospital, Ido-Ekiti and Comprehensive Health Centre, Oke-Isa, Ado-Ekiti, Ekiti State were recruited between April and August 2009. Relevant data were collected using interviewer-administered semi-structured questionnaires. Results. Mean age ± SD of participants was 41.2 ± 12.6 years and mean age at sexual debut was 20 years. Twenty three (10.7%) participants were single and all were sexually active. 147 (68.4%) had more than one life time sexual partner. 78 (36.3%) of participants were aware of cervical cancer but only 39(18.2%) were aware of its screening, and majority (71.8%) got to know about cervical cancer through health workers. Increasing age, multiple sexual partners, parity more than 4, having a partner who has multiple sexual partners and polygamy were significantly associated with development of pre-malignant lesions for cervical cancer in this study. Conclusion. Majority of the participants were not aware of CC and the steps to be taken to prevent it from occurring. This poses a tremendous health education challenge.

Cervical cancer: Knowledge of Risk Factors and Practice of Preventive Measures among Female Primary School Teachers in Urban Anambra State, Nigeria

Aim / Background: Cervical cancer is one of the most common forms of cancer among women worldwide. This study was aimed at establishing baseline knowledge of cervical cancer risk factors and practice of its preventive measures among female primary school teachers in urban Anambra State, Nigeria. Methods: A descriptive cross-sectional study in which data on knowledge and practice variables were collected from 250 female school teachers aged 18 to 65 years, using self-administered questionnaires. Same was analysed and data presented in frequency tables. Result: Only 15(6.4%) of the respondents felt they were at risk of cervical cancer even as 149(59.6%) had no idea of any symptom of cervical cancer; and none knew early stages of the disease could present with no symptoms. Moreover, 137(58.3%) knew no risk factor for cervical cancer while a smaller proportion knew HPV infection 20(8.5%) and cigarette smoking 23(9.8%) as risk factors. Only 1(0.4%) respondent had ever had a cervical screening as over 75% of respondents reported not knowing about the screening test as their main reason for not doing the test. About 23% of respondents would recommend cervical screening to another woman. Conclusion: This study has shown very poor knowledge of cervical cancer and its risk factors; and even a poorer practice of cervical cancer screening among the respondents. Female teachers must be well informed about this disease in order for them to give the right information to their students. Therefore, in both formal and informal settings, regular and sustained health education on cervical cancer should be directed at this group.

Knowledge of Cervical Cancer and Practice of Pap Smear Testing among Secondary School Teachers in Nnewi North Local Government Area of Anambra State, South Eastern Nigeria

Introduction: Cervical cancer is one of the commonest cancers of the female genital tract and accounts for about a hundred and ninety thousand deaths each year, most of which occur in developing countries. Early cervical screening methods have contributed to the fall of cervical cancer deaths in the developed world. This is different in developing countries where people have limited knowledge about this disease condition and the screening methods for prevention. This study determined the knowledge and practice of cervical cancer screening among female secondary school teachers in Nnewi North Local Government Area of Anambra State. Method: This was a cross-sectional descriptive study in which self-administered questionnaires were returned by 142 respondents and results were analyzed using Statistical Package for Social Sciences version 17. Results: The mean age of the respondents was 35.6 ± 1.76 years. A high proportion of the respondents were aware of cervical cancer 106 (74.6%). About 44 (41.5%) knew of cervical cancer screening by Pap smear, out of which only 20.5% had done a pap smear. The most common reasons given for not doing the test were; not deeming the test necessary, not knowing where the test could be done and feeling of not being at risk of developing cervical cancer. Conclusion/Recommendation: Though the level of awareness of cervical cancer screening was high, the level of uptake of Pap smear was still very low. A national cervical cancer Pap smear campaign should be intensified to change the negative perception towards Pap smear test.

Lesbians' attitudes and practices of cervical cancer screening: a qualitative study.

BackgroundCervical cancer is the third most prevalent cancer in women, and since the introduction of the Papanicolaou test (Pap test or Pap smear), the incidence of cervical cancer and mortality rates worldwide have declined substantially. However significant disparities have been identified between the cervical screening rates of heterosexual and lesbian women. This study explores the attitudes and practices that lesbians have towards cervical cancer screening and aims to identify why such disparities occur.MethodsA qualitative methodology based on feminist perspectives was used to collect narrative data from lesbians about their attitudes and practices of cervical screening through the use of semi structured interviews. Nine women who self-identified as lesbian that were living in New South Wales were recruited for the study. Interviews were digitally recorded and transcribed verbatim. Data were analysed using a thematic analysis approach.ResultsFour main themes emerged from the data namely: Encountering cervical cancer: “my friends had some early cancer cells detected”, Misconceptions related to risk: “I am a lesbian I don’t need one”, Imposed screening: “It’s a requirement of IVF treatment” and, Promoting cervical screening: “I think it should be spoken about in schools”.ConclusionsConsistent with the literature, the findings show that the majority of these women do not undertake cervical screening at the recommended rate. This study highlights the multiple and complex issues related to cervical cancer screening for lesbians, mainly through misconceptions and underestimation of risk. Specific and targeted educational and promotional strategies are required for both lesbians and health professionals to enhance cervical cancer screening rates for lesbians in Australia.

Attitudes and practice of cervical cancer screening among female university students from 25 low, middle income and emerging economy countries.

Cervical cancer, the third commonest cancer in women worldwide, can be prevented through early detection by cervical screening (Pap smear). The aim of this study was to investigate the attitudes and practice of cervical cancer screening among female undergraduate university students from 25 low, middle income and emerging economy countries. Using anonymous questionnaires, data were collected from 9,194 female undergraduate university students aged 18-26 years (mean age 20.9, SD=2.0) from 26 universities in 25 countries across Asia, Africa and the Americas. Overall, 11.6% of the female students indicated that they had conducted one or more times a cervical (Pap) smear test; 8.3% among 18-20 year-olds and 15.6% among 21-26 year-old students. There was considerable country variation on having had a cervical (Pap) smear test among 21-26 year-old female university students, ranging from 59.2% in Colombia and 50.9% in Barbados to 0% in India and 1.0% in Tunesia. Logistic regression showed that cervical cancer screening importance or positive attitude were highly associated with the cervical screening practice. Moreover, risky sexual behaviour and tobacco use, two cervical cancer risk factors, were associated with screening. Cervical cancer screening practices were found to be inadequate and efforts should be made to develop programmes that can increase the uptake of cervical cancer screening.

Analyse de la pratique du frottis cervico-utérin de dépistage pendant la grossesse en France : étude bicentrique rétrospective de cohorte

To evaluate the practice of cytologic cervical cancer screening during the follow-up of pregnancy. A retrospective cohort study was conducted from July to November 2013. During this period, 300 women attending to the obstetrical department of two universitary hospitals were randomly included immediately after their delivery. Among included women, 155 (51.7%) had a normal cervical cytology performed within the past 3 years. Overall, 75 (25%) women had a cervical cytology performed during their pregnancy. Although patients who did not have a cervical cytology performed within the past 3 years were significantly more likely to have a cervical cytology performed during the follow up of their pregnancy (AOR: 2.30; 95% CI: 1.03-5.26; P=0.049), only 39 (26.9%) of the 145 women who did not have a cervical cytology performed within the last 3 years had a catch up cytology performed. Age 25 or older had no significant influence on the probability that a cervical cytology had been performed during pregnancy (ORA: 1.11; 95% CI: 0.51-2.43; P=0.786). Although the follow-up of pregnancy allows for the catch up of non attendant women to cytologic cervical cancer screening, such catch up remains insufficient and most of cervical cytologies performed during pregnancy are done irrespectively of the current guidelines.

Adherence to Cervical Cancer Screening Guidelines by Gynecologists in the Pacific Northwest

In 2012, US organizations released updated cervical cancer screening guidelines calling for less frequent screening. We surveyed practicing gynecologists in the Pacific Northwest region to understand their screening practices, gauge their uptake of the new guidelines, and identify reasons why they may not follow the new guidelines. Gynecologists from Washington, Oregon, Montana, and Idaho were sent an online survey on behalf of their state's medical association. The survey consisted of 9 questions on sex, practice setting, community size, cervical cancer screening practices, and reasons for not following the 2012 guidelines. Of 947 gynecologists, 123 (13.0%) completed the survey. Sixty-four respondents (52.0%) reported that they follow or plan to follow the new guidelines. Reasons cited for not following the new guidelines included concern over missed opportunities for women's health education (43 respondents or 72.9%), patients wanting more frequent screening (39 respondents or 66.1%), and concern about missing dysplasia or cancerous lesions (28 respondents or 47.5%). Although the new guidelines call for a 3-year interval between routine Pap tests or a 5-year interval between routine Pap/human papillomavirus cotests, 75 gynecologist respondents (61.0%) still recommended annual or biannual Pap screening for patients younger than 30 years, and 55 respondents (67.9%) recommended rescreening within 3 years for women 30 years and older with negative cotest results. While over half of the gynecologist survey respondents reported adherence or planned adherence to the 2012 guidelines, over half also reported using screening schedules that are more frequent than recommended by new guidelines. Concerns highlighted by survey participants provide an opportunity for physician and patient education on the evidence supporting the new guidelines.

Differences Among Primary Care Physicians' Adherence to 2009 ACOG Guidelines for Cervical Cancer Screening

In 2009, the American Congress of Obstetrics and Gynecology (ACOG) guidelines for cervical cancer screening changed significantly, to recommend less frequent screening than prior guidelines. The extent to which physicians in different specialties implemented these guidelines in the years following publication is unknown. Cross-sectional survey completed by 316 physicians in internal medicine, family medicine, and gynecology. Survey items assessed respondents' cervical cancer screening practices in women of different ages and medical histories. We used descriptive statistics to generate response distribution for survey items, and logistic regression models to compare responses among specialties. Our response rate was 55% (316/575). Thirty-four percent of respondents' screening practices were inconsistent with ACOG guidelines for women under age 21, and 49% were inconsistent with guidelines for women over age 30. Internists (50%) were less likely than family medicine (89%, p<0.001) and gynecology (80%, p=0.02) physicians to delay pap testing until age 21. Internists (41%) were less likely than both family medicine (60%, p=0.009) and gynecology (68%, p=0.03) physicians to follow guidelines for women over age 30 (p=0.003). Overall 22% percent of physicians followed guidelines for women ages 21-29 years, with no significant differences between specialties. Differences remained significant in multivariable models. Despite consensus among national organizations as to optimal regimens for cervical cancer screening, a significant proportion of providers, especially in internal medicine, do not adhere to ACOG's 2009 guidelines. The lack of comprehensive guideline implementation suggests that adherence to new 2012 guidelines, which advocate for less frequent screening, will likely be suboptimal and discrepant by specialty.

Current Cervical Cancer Screening Knowledge, Awareness, and Practices Among U.S. Affiliated Pacific Island Providers: Opportunities and Challenges

Cervical cancer is a leading cause of cancer mortality in nearly all U.S. Affiliated Pacific Island Jurisdictions (USAPIJ); however, most jurisdictions are financially and geographically limited in their capacity to deliver routine screening. We conducted a cross-sectional survey of 72 health care providers from five of the six USAPIJ in 2011 to assess knowledge, beliefs, practices, and perceived barriers regarding routine cervical cancer screening. We compared the responses of providers from jurisdictions that were funded by the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) with those that were not funded. Most providers reported cervical cancer prevention as a priority in their clinical practices (90.3%) and use the Papanicolaou test for screening (86.1%). Many providers reported knowledge of screening guidelines (76.4%); however, more than half reported that annual screening is most effective (56.9%). Providers in non-NBCCEDP-funded jurisdictions reported greater acceptance of visual inspection with acetic acid (93.9%) and self-sampling for human papillomavirus testing (48.5%) compared with NBCCEDP-funded jurisdictions (15.4% and 30.8% respectively). Providers from non-NBCCEDP-funded jurisdictions reported inadequate technological resources for screening women (42.4%), and approximately 25% of providers in both groups believed that screening was cost-prohibitive. Although cervical cancer screening is a priority in clinical practice, beliefs about annual screening, costs associated with screening, and varying levels of support for alternative screening tests pose barriers to providers throughout the USAPIJ. Further exploration of using evidence-based, lower cost, and sustainable screening technologies is warranted in addition to emphasizing timely follow-up of all positive cases.

Cervical cancer knowledge and screening behaviors among female university graduates of year 2012 attending national graduate orientation program, Bhutan.

BackgroundCervical cancer is the leading female cancer in Bhutan. This study describes the level of cervical cancer knowledge and screening behaviors among female university graduates attending the National Graduate Orientation Program (NGOP), 2012.MethodsA cross-sectional study of female graduates attending NGOP was conducted using self-administered anonymous questionnaire developed through literature reviews and expert discussions to elicit information on demographic characteristics, knowledge, screening behaviors and determinants of cervical cancer. The association of demographic and other important study characteristics with uptake of Pap test was investigated using cross tabulation and Fischer Exact test. Frequencies and percentages were calculated for all the questions.ResultsThe average age of the participants was 23.43 ± SD 2.73. About 92% (n = 513) of the respondents were aged 25 years or less and 7.9% (n = 44) of the respondents were aged 26 or more. The study revealed low cervical cancer knowledge and poor screening behavior among the graduates. The mean knowledge score was 3.571 (SD1.75, Range 0–8). About 6% (n=34) of the respondents reported undergoing Pap test at least once and 94% reported as never having done Pap test. The most commonly cited reasons for not doing Pap test included “never thought I needed one” (57%, n = 320), “embarrassment of being examined by male health professional” and “fear of finding out cancer”. The study revealed evidence of significant association between increasing age, those who are married, knowledge score and those recommended for screening by health professionals with the uptake of Pap test.ConclusionOur study revealed poor knowledge and screening behaviors among female university graduates in Bhutan. This may be suggestive of even poorer awareness and screening practices among young unmarried women who are less educated or with no education. Although our study group is not appropriate for measuring practice of cervical cancer screening in the country, the findings are expected to highlight the shortcomings and trigger development of comprehensive cervical cancer control programs in Bhutan.

Liquid-based cytology and human papillomavirus testing: A pooled analysis using the data from 13 population-based cervical cancer screening studies from China

ObjectiveThe objective of this study was to evaluate the impact of introducing HR-HPV testing in cytology regarding cervical cancer screening practice. MethodsA pooled analysis of liquid-based cytology (LBC) and HR-HPV testing using data from 13 population-based cervical cancer screening studies conducted in China was performed. Participants (n=25,404) received LBC and HR-HPV testing. Women found to be positive on screening were referred for colposcopy and biopsy. The effectiveness of screening strategies that use: LBC with HR-HPV triage for atypical squamous cells of undetermined significance (ASC-US), HR-HPV testing with cytology triage for HPV positive tests, or LBC and HPV cotesting was compared with that of LBC screening alone. ResultsLBC with HR-HPV triage for ASC-US had similar sensitivity compared with LBC alone, but significantly increased specificity for both cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and CIN3 or worse (CIN3+) endpoints, and had the best balance between sensitivity and specificity among the strategies. LBC and HR-HPV cotesting had the highest sensitivity and negative predictive value (NPV) and could permit a safe extension of screening intervals. Through the use of an immediate colposcopy threshold of ASC-US or worse for HR-HPV positive women and the use of a raised threshold of low-grade squamous intraepithelial lesion (LSIL) or worse for HR-HPV negative women, LBC and HR-HPV cotesting could provide the same effectiveness as LBC testing with HR-HPV triage for ASC-US at baseline tests. ConclusionsThe results of the current study support the use of the cervical cancer screening guidelines in China.

Are Immigrants and Nationals Born to Immigrants at Higher Risk for Delayed or No Lifetime Breast and Cervical Cancer Screening? The Results from a Population-Based Survey in Paris Metropolitan Area in 2010

ObjectivesThis study aims to compare breast cancer screening (BCS) and cervical cancer screening (CCS) practices of French women born to French parents with those of immigrants and nationals born to immigrants, taking their socioeconomic status into account.MethodsThe study is based on data collected in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For women with no history of breast or cervical cancer, multivariate logistic regressions and structural equation models were used to investigate the factors associated with never having undergone BCS or CCS.ResultsWe confirmed the existence of a strong gradient, with respect to migration origin, for delaying or never having undergone BCS or CCS. Thus, being a foreign immigrant or being French of immigrant parentage were risk factors for delayed and no lifetime screening. Interestingly, we found that this gradient persisted (at least partially) after adjusting for the women’s socioeconomic characteristics. Only the level of income seemed to play a mediating role, but only partially. We observed differences between BCS and CCS which suggest that organized CCS could be effective in reducing socioeconomic and/or ethnic inequities.ConclusionSocioeconomic status partially explained the screening nonparticipation on the part of French women of immigrant origin and foreign immigrants. This was more so the case with CCS than with BCS, which suggests that organized prevention programs might reduce social inequalities.

Current practice patterns in cervical cancer screening in Indiana

The purpose of this study is to describe current health care provider cervical cancer screening practice patterns for average-risk women in the state of Indiana in comparison to the 2012 guidelines as well as earlier guidelines. We also aim to describe what factors are associated with increased adherence to guidelines, and what factors may impede adherence. We conducted a vignette-based survey among a convenience sample of obstetricians, gynecologists, midwives, nurse practitioners, and physician assistants attending the Indiana American Congress of Obstetricians and Gynecologists Section meeting in January 2013. Questionnaires were returned by 51% (112/218) of attendants. Of the 111 providers with completed surveys, 42 (38%) follow current guidelines. Of providers, 86% start screening at age 21 years. Of providers, 33% screen women aged 21-29 years every 3 years. Of providers, 33% follow recommendations for cotesting every 5 years for patients 30-65 years of age. The majority of providers follow guidelines to stop screening after a benign hysterectomy or age 65 years (75% and 51%, respectively). The majority of providers follow the 2012 guidelines for the initiation and cessation of cervical screening; however, most providers screen more frequently than currently recommended for patients between ages 21-65 years.

Knowledge, attitude and practice of cervical cancer screening in women visiting a tertiary care hospital of Delhi

Background: Cervical cancer being a major cause of morbidity and mortality in women in developing countries, its awareness is essential. Aim: The aim of this study is to assess the knowledge, attitude and practices of women regarding the basic screening test for detection of cancer cervix. Settings and Design: Population based cross-sectional study. Materials and Methods: Cross-sectional prospective study was conducted. Information from consenting participants (450) was collected using structured questionnaire. Answers were described in terms of knowledge, attitude and practice and their respective adequacy with respect to Papanicolaou (Pap) test, the most common test used for early detection of cervical cancer. Adequacy was compared between the categories of socio demographic and clinical variables. Statistical Analysis: The data collected was analyzed using statistical package (SPSS version 18.0). Adequacy was compared between the categories of the control variables by χ2 test with a 5% significance level. Results: Knowledge, attitude and practices regarding Pap test were adequate in 32.7%, 18.2% and 7.3% of women respectively. Major impediment to adequate practice was lack of request by physician. Knowledge, attitudes and practices were found to increase significantly with increasing age and education. Conclusion: Effective information, education and communication strategies are required to improve the level of awareness of public. Health-care professional should be proactive in imparting knowledge at every opportunity.

Cervical Cancer Screening Practices among Rural Indian Women

Background: Cervical cancer is a major health problem in India. The aim of this paper was to find the cervical cancer screening practices among rural Indian women. Method: This cross- sectional study was carried out in 3 villages of Udupi, India among 407 married women in the aged 221- 65 years. Data was collected using interviewer administered questionnaires. Results: The mean age of the women who participated in the study was 43.17 ± 13.43 with the age range from 21- 65 years. It was determined that more than half of the women (68.3 %) were Hindu. 37.1% had completed primary school education. Majority of the participants (40%) had monthly income less than 5000 rupees. 98% were living with their spouse. Most of them (77.3 %) were married within 18-25 years. Majority of the women belonged to joint family (53.6 %). It was found that none of the 407 participants had ever had a Pap test in their lifetime and only 6.1 % were aware of the Pap test as a screening modality for cervical cancer. Lack of awareness was cited by more than half of the women as the reason for not undergoing cervical cancer screening. Conclusion: From this it can be inferred that lack of awareness is a major barrier for not undergoing screening. An organized health education programme focusing on women with the participation of health care workers is sorely needed.

Knowledge and Perspectives of Breast and Cervical Cancer Screening Among Female African Immigrants in the Washington D.C. Metropolitan Area

Black women in the USA have both a higher percentage of late-stage diagnoses as well as the highest rates of mortality from breast cancer when compared to women of other ethnic subgroups. Additionally, Black women have the second highest prevalence of cervical cancer. Many reports evaluating the cancer outcomes of Black women combine data on African-born immigrants and US-born Blacks. This categorization ignores subtle yet important cultural differences between the two groups, which may ultimately affect breast and cervical cancer screening practices. Therefore, this study investigated knowledge and awareness levels of breast and cervical cancer screening practices among female African-born immigrants to the USA residing in the Washington D.C. metropolitan area. Data were collected from 38 participants through key informant interviews, focus group sessions, and a sociodemographic questionnaire over a 3-month study period. Results suggest that fatalism, stigma, and privacy are among the major factors that affect the decision to seek preventative screening measures for breast and cervical cancer among this population. Additionally, the study implies that cervical cancer awareness is significantly lower among this population when compared to breast cancer. This study highlights differences between women of African descent residing in the USA and the need for continued research to increase understanding of the manner in which immigrant status affects health-seeking behavior. This information is critical for researchers, physicians, and public health educators aiming to design culturally appropriate interventions to effectively reduce the prevalence of breast and cervical cancer among female African immigrants living in the USA.

Screening for Cervical Cancer - Uptake and Associated Factors in a Representative Sample in the City of Patras, West-Greece

The aim of this study is to provide a profile of cervical cancer screening practices among the women in Patras and to assess factors associated with cervical cancer screening uptake. Data from a representative sample of 873 women were analyzed. 67.2% had at least one Pap test in their life, with 54.4% having been tested in the previous three years. Women aged 35-44 and 45-54 years were more likely to have had a recent Pap test (OR>3) as well as married/partnered women (OR=2.4). Unemployed women and women with the lowest educational level were less likely to have had a recent Pap test. Compared to women with a monthly household income of <500€, those with higher income were more likely to have had a Pap test. The prevalence of Pap testing in Patras is very low. Our findings support the necessity of implementation of national screening programs or targeted screening interventions mainly in the identified under-screened population subgroups, i.e. women with socioeconomic disadvantages.

The Cost-Effectiveness Analysis of a Quadrivalent Human Papillomavirus Vaccine (6/11/16/18) for Females in Japan

ObjectiveWe assessed the epidemiological and economic impact of a quadrivalent human papillomavirus (HPV) (6/11/16/18) vaccine for females in preventing cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN 2/3), cervical intraepithelial neoplasia grade 1 (CIN 1), and genital warts in Japan by using a transmission dynamic model. MethodsA published mathematical model of the transmission dynamics of HPV infection and disease was adapted for Japan. Model inputs were used from Japan or the Asia/Pacific region when available; otherwise, the default values in the original model were used. The transmission dynamic model was used to assess the epidemiological and economic impact of a quadrivalent HPV (6/11/16/18) vaccine for females in preventing cervical cancer, CIN 2/3, CIN 1, and genital warts in Japan.Maintaining current cervical cancer screening practices, we evaluated two strategies: routine vaccination of females by age 12 years (S1), and S1 combined with a temporary (5 years) female catch-up program for age 12 to 24 years (S2). The vaccine coverage rate was 80% for the routine and 50% for the catch-up vaccination programs. ResultsCompared with no vaccination, both vaccination strategies significantly reduced the incidence of HPV 6/11/16/18–related disease. The most effective strategy was S2. By using this strategy over 100 years in the Japanese population, the estimated cumulative percentage reduction in incident HPV 6/11/16/18–related genital warts-female, genital warts-male, cervical CIN 1, CIN 2/3, and cervical cancer cases was 90% (2,113,723 cases), 86% (2,082,637 cases), 72% (263,406 cases), 71% (1,328,366 cases), and 58% (323,145 cases), respectively. The cost-effectiveness ratios were JPY 1,244,000, and JPY 1,205,800 per quality-adjusted life-year gained for S1 and S2 compared with no vaccination, respectively, over a time horizon of 100 years. ConclusionWe conclude that a quadrivalent HPV vaccination program for females can reduce the incidence of cervical cancer, CIN, and genital warts in Japan at a cost-per-quality-adjusted life-year ratio within the range defined as cost-effective.