Cervical Cancer Screening Rates Research Articles

Using sexual orientation and gender identity data in electronic health records to assess for disparities in preventive health screening services

BackgroundLesbian, gay, bisexual, transgender, and queer (LGBTQ) populations have an increased risk of multiple adverse health outcomes. Capturing patient data on sexual orientation and gender identity (SOGI) in the electronic health record (EHR) can enable healthcare organizations to identify inequities in the provision of preventive health screenings and other quality of care services to their LGBTQ patients. However, organizations may not be familiar with methods for analyzing and interpreting SOGI data to detect health disparities. PurposeTo assess an approach for using SOGI EHR data to identify potential screening disparities of LGBTQ patients within distinct healthcare organizations. MethodsFive US federally qualified health centers (FQHCs) retrospectively extracted three consecutive months of EHR patient data on SOGI and routine screening for cervical cancer, tobacco use, and clinical depression. The screening data were stratified across SOGI categories. Chi-Square and Fisher’s Exact test were used to identify statistically significant differences in screening compliance across SOGI categories within each FQHC. ResultsIn all FQHCs, cervical cancer screening percentages were lower among lesbian/gay patients than among bisexual and straight/heterosexual patients. In three FQHCs, cervical cancer screening percentages were lower for transgender men than for cisgender (i.e., not transgender) women. Within each FQHC, we observed statistically significant associations (P < 0.05) between SOGI categories and at least one screening measure. The small number of transgender patients, and limitations in EHR functionality, created challenges in interpretation of SOGI data. ConclusionsTo our knowledge, this is the first published report of using SOGI data from EHRs to detect potential disparities in healthcare services to LGBTQ patients. Our finding that lesbian/gay and transgender male patients had lower cervical cancer screening rates compared to heterosexual, bisexual, and cisgender women, is consistent with the research literature and suggests that using SOGI EHR data to detect preventive screening disparities has value. EHR functionality should allow for cross-checking gender identity with sex assigned at birth to reduce errors in data interpretation. Additional functionality, like clinical decision support based on anatomical inventories rather than gender identity, is needed to more accurately identify services that transgender patients need.

Self-collection of samples for HPV testing to increase participation in cervical cancer screening by immigrant women: An integrative review.

To examine methods and results of studies assessing self-collection of cervico-vaginal samples for human papillomavirus (HPV) testing by immigrant women for insights into how future research using this method with unique subpopulations of women may improve the rates of cervical cancer screening (CCS) compared to current strategies. Four electronic databases were systematically searched through March 2020, with no limits applied. A manual review of reference lists was also completed. The search resulted in 63 articles. After removal of duplicates, 36 were reviewed against inclusion criteria. A manual review of reference lists yielded two additional studies. The final sample included 15 relevant publications representing 13 unique empirical studies. Data related to study methodology and empirical results were extracted into table form. The methods of the studies were summarized and synthesized, including diversity of participants, community engagement, including collaboration with public health nurses or community health workers. In addition, methods and findings related to the educational components of the studies, and empirical findings related to various cultural groups, were described. To reduce health disparities in CCS, researchers should focus on diverse groups, such as immigrant women, to understand important individual and group-specific factors that may influence screening, including whether self-collection of samples for HPV testing along with appropriate education and support for follow-up will address these factors.

A survey of 20-year-old Japanese women: how is their intention to undergo cervical cancer screening associated with their childhood HPV vaccination status?

ABSTRACT Introduction In Japan, two groups of women, HPV vaccinated and unvaccinated, are approaching age 20, when they should begin cervical cancer screening. To improve Japan’s current poor cervical cancer screening rate, we need to know how these women are thinking about screening. Methods We conducted an internet survey of 20-y-old women, exploring their understanding of HPV and cervical cancer screening. We then gave them leaflets with basic information about HPV and cervical cancer, stressing the importance of early detection by screening. We analyzed the leaflet’s effects on their attitudes based on their vaccination status. Results Our study of 618 women found a significantly higher intention for engagement for cervical cancer screening in women HPV-vaccinated as teenagers (29% versus 17%). They were also more aware that: (1) HPV is transmitted by sexual intercourse (49.1% versus 39.2%); (2) the HPV vaccine prevents cervical cancer (49.0% to 34.0%); and (3) the appropriate cervical cancer screening interval is every 2 y (63.3% versus 56.2%). Women in both groups responded well to the leaflet, with significant improvements in intention to receive screening. However, 65%-67% were not swayed. Discussion HPV-vaccinated women were more knowledgeable about cervical cancer and had a greater intention to receive screening. Our educational leaflet was moderately effective in both groups for increasing intentions to screen, but the majority in both groups were still resistant to screening. Conclusion Japan needs to develop more effective educational programs and tools to vigorously impart the importance of cervical cancer screening.

Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis.

This study evaluates the effectiveness of patient navigation to increase screening for colorectal, breast, and cervical cancer in populations adversely affected by health care disparities. Eligible studies were identified through English-language searches of Ovid® MEDLINE®, PsycINFO®, SocINDEX, and Veterans Affairs Health Services database (January 1, 1996, to July 5, 2019) and manual review of reference lists. Randomized trials and observational studies of relevant populations that evaluated the effectiveness of patient navigation on screening rates for colorectal, breast, or cervical cancer compared with usual or alternative care comparison groups were included. Two investigators independently abstracted study data and assessed study quality and applicability using criteria adapted from the U.S. Preventive Services Task Force. Discrepancies were resolved by consensus with a third reviewer. Results were combined using profile likelihood random effects models. Thirty-seven studies met inclusion criteria (28 colorectal, 11 breast, 4 cervical cancers including 3 trials with multiple cancer types). Screening rates were higher with patient navigation for colorectal cancer overall (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; I2 = 93.7%; 22 trials) and by type of test (fecal occult blood or immunohistochemistry testing [RR 1.69; 95% CI 1.33 to 2.15; I2 = 80.5%; 6 trials]; colonoscopy/endoscopy [RR 2.08; 95% CI 1.08 to 4.56; I2 = 94.6%; 6 trials]). Screening was also higher with navigation for breast cancer (RR 1.50; 95% CI 1.22 to 1.91; I2 = 98.6%; 10 trials) and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19; based on the largest trial). The high heterogeneity of cervical cancer studies prohibited meta-analysis. Results were similar for colorectal and breast cancer regardless of prior adherence to screening guidelines, follow-up time, and study quality. In populations adversely affected by disparities, colorectal, breast, and cervical cancer screening rates were higher in patients provided navigation services. Registration: PROSPERO: CRD42018109263.

Perceived barriers to cervical cancer screening among refugee women after resettlement: A qualitative study

Background: Cervical cancer screening rates are low among refugee populations who have resettled in Australia, including among Bhutanese women who are at increased risk of cervical cancer. Understanding the barriers to accessing preventive health care is an important starting point to changing health behaviours. Objective: To identify perceived barriers to accessing cervical cancer screening programs among Bhutanese refugee women in Australia. Method: In-depth interviews with 30 Bhutanese refugee women resettled in Melbourne, Australia were analysed using an Interpretative Phenomenological Analysis (IPA) framework. Findings: A strong overarching theme was evident; health-seeking behaviour among the Bhutanese refugee women was strongly associated with symptoms and can be described as ‘no symptoms- no check-up’. Three major contributors to health behaviour were: poor knowledge, cultural motivations and refugee experience. Poor knowledge was a consequence of low health literacy and lack of information. Cultural motivations included the notion of the sacred body and related stigmas, and strong faith in doctors. A set of latent themes associated with health professional behaviour was also identified in the experiences women recounted: screening was not offered; opportunistic screening occurred without education; and the use of interpreters was inappropriate and involved a mix of failure to use publicly available trained interpreters and informal use of family members. A contrary theme was also evident among younger educated women: changing awareness. Conclusion: Health professionals in the countries of resettlement need greater awareness of the barriers to health-seeking behaviours among refugee populations: cultural influences and norms; poor knowledge of health services and health systems; and poor practice by health professionals.

Three segmentation techniques to predict the dysplasia in cervical cells in the presence of debris

Cervical Cancer is one of the most pandemic causes of cancer related death in females. Pap smear test is one of the most commonly used screening test for the cervical cancer. Existing algorithms focus on the segmentation of nucleus and cytoplasm either using single-cell images or multiple cells images. Images captured from the Pap smear slides are called smear images. Smear image contains cervical cells along with debris, debris are inflammatory cells, red blood cells, dye. Debris significantly influence the outcome of image segmentation. An accurate nuclei segmentation method can improve the success rate of cervical cancer screening. Therefore, this paper reveals about three segmentation techniques which are used for automated segmentation of cervical cell nuclei in the presence of debris. Three segmentation techniques namely, Automated Seed Region Growing, Extended Edge Based Detection and Modified Moving k-means techniques are proposed to extract the cervical cell nuclei. These techniques are extracting the area of nuclei from smear images using the morphological property of nucleus. Some debris have area that corresponds with the area of nucleus of normal cells, it may interfere with outcome and may give false positive results. The empirical area threshold value demonstrate the superior performance of all proposed methods. The qualitative and quantitative analysis also done on proposed techniques. Experimental analysis shows that Modified Moving k-means give favorable result in dysplasia detection in the presence of debris. A new dataset PapsmearJP is collected during the study with the help of a pathologist for the validation of the work.

Abstract B017: Rural interventions for screening effectiveness: Baseline cancer screening behaviors of rural women of Indiana and Ohio

Abstract Rural areas of the United States experience increased cancer incidence and mortality rates and lower cancer screening rates compared to urban areas. According to the National Center for Health Statistics, Ohio and Indiana are ranked 8th and 10th highest, respectively, for cancer mortality rates nationally. The Rural Interventions for Screening Effectiveness (RISE) Study conducted by The Ohio State University and Indiana University focuses on improving breast, cervical and colorectal cancer screening rates in rural areas of both states to reduce this cancer burden. RISE is testing two interventions to educate and encourage women in rural counties of Ohio and Indiana ages 50-74 years to complete any needed screenings. Participants complete baseline and 12-month surveys and receive usual care brochures, an interactive DVD, or the DVD along with phone-based assistance from a patient navigator. In order to be eligible to participate, women must be residents of a rural county of either state, outside of guidelines for breast, cervical, and/or colorectal cancer screening per medical record review, and have no personal history of inflammatory bowel disease, cancer (except non-melanoma skin cancer), or genetic conditions that increase cancer risk. Baseline demographic and cancer screening history data were collected from 1634 women (1041 Ohio, 593 Indiana), and 985 were ultimately eligible and enrolled in the study (599 Ohio, 386 Indiana). Women who were within guidelines for all three screening tests were excluded from the study; 442 (42.5%) in Ohio and 207 (34.9%) in Indiana. A larger proportion of Indiana women were outside of guidelines for all three screening tests (80 of 593 (13.5%)) compared to Ohio women (107 of 1041 (10.3%)). Across both states, more women were adherent to breast cancer screening guidelines (75.3%) than cervical (66%) or colorectal cancer screening guidelines (58.8%). A comparison of screening behaviors of Indiana and Ohio participants will be conducted to determine if differences between the two exist. Analyses will focus on being inside or outside of guidelines by individual test (breast, cervical, and colorectal) and all three tests combined. Although rural women of Midwest states are often considered to be very similar, differences in screening behaviors exist, even between women of neighboring states, and future efforts to improve the cancer burden in rural women could benefit from considering factors that contribute to these differences, such as access to quality care. Citation Format: Electra D Paskett, Ryan D Baltic, Mira L Katz, Gregory S Young, Susan Rawl, Victoria Champion. Rural interventions for screening effectiveness: Baseline cancer screening behaviors of rural women of Indiana and Ohio [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B017.

Abstract B001: Rural interventions to improve breast, cervical and colorectal screening rates: Recruitment strategies for women in rural areas

Abstract Rural areas of the United States have less access to quality healthcare, higher rates of cancer incidence and mortality, and lower screening rates compared to urban areas. The Rural Interventions for Screening Effectiveness (RISE) Study conducted by Indiana University and The Ohio State University focuses on improving breast, cervical and colorectal cancer screening rates in rural Indiana and Ohio by encouraging female residents ages 50-74 years to receive necessary screenings. Two interventions are tested: an interactive DVD, and the DVD combined with patient navigation. Recruitment occurred October 2017 - June 2019. This paper evaluates recruitment strategies used by RISE in order to better understand which method was most effective and to determine if participants differed demographically by recruitment method. An array of recruitment strategies were used, including purchasing contact lists to call women in the recruitment area, internet advertising, and physical advertisements placed within the communities. Outbound mailing and calling, the sole method initially planned, was performed for the first 6 months of recruitment, using purchased phone and address lists of female residents of rural counties of northeast Indiana and northwest Ohio. Internet advertising was primarily conducted using Facebook to target female users 50 years or older in rural areas of both states. Community advertising was performed by mailing flyers to be displayed in rural libraries, senior and community centers, and other locations where residents congregate. Recruitment strategies differed in effort, cost, and yield. Mailing and calling using purchased lists was used to attempt to reach 5240 women, successfully reaching and reviewing medical records for 275 women, yielding 154 eligible women. Median household income of these women was $50,000-$59,999 and median age was 63 years. This strategy was costly, high effort, and did not yield enough participants to warrant continuing. Community advertising involved identifying suitable locations and requesting permission to post promotional materials. Although this strategy’s reach cannot be determined, 163 women contacted staff to request more information, 67 progressed to medical record review, and 38 were enrolled. Median household income of these participants was $70,000-$79,999 and median age was 62 years. Through Internet advertising, 3116 spoke to interviewers about the study, with 1297 progressing to medical record review, yielding 793 eligible participants. Median household income was $70,000-$79,999; median age was 58 years. Although Internet recruitment was the most successful strategy, it may have unintentionally targeted younger or more affluent women who own and use smartphones or home computers with internet access. With technology becoming increasingly pervasive and as people become more hesitant to answer phone calls from foreign numbers, recruitment strategies must be evaluated to ensure the study population is truly being reached. Citation Format: Ryan D Baltic, Gregory S Young, Mira L Katz, Susan Rawl, Victoria Champion, Electra D Paskett. Rural interventions to improve breast, cervical and colorectal screening rates: Recruitment strategies for women in rural areas [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B001.

Abstract A128: Building sustainable partnerships between cancer centers and safety net community hospitals to increase access to and quality of cancer care

Abstract Background: Cervical cancer outcomes are influenced by race, socioeconomic status and region. African American women have the highest mortality rate from cervical cancer and Hispanic and American Indian/Alaska Native women have the highest cervical cancer incidence rates among racial/ethnic groups. Disparities in cervical cancer can be greatly improved by increasing access to and awareness of Pap screening and HPV vaccination among vulnerable populations. Safety net and community hospitals offer broader opportunities to reach at-risk individuals, however these hospitals face many challenges that mirror those of the patients they serve, including: decreased access to innovative research and treatment, decreased access to the full range of specialty care, and funding challenges. Public-Public partnerships between academic medical centers, cancer centers and private service organizations that extend to safety net and community hospitals can increase cervical cancer screening rates among individuals at greatest risk. Methods: The Loretto Hospital and Norwegian American Hospital serve communities that suffer the highest cervical cancer mortality rates in Chicago. Funded by the Bristol Myers Squibb Foundation, the University of Illinois Cancer Center partnered with these two community hospitals located on the west sides of Chicago to increase cervical cancer screening rates through clinical and community patient navigation. Evidence based methods such as small media interventions, client reminders, and one-on-one education will also be used to increase screening awareness and education. The evidence-based, implementation science program is guided by the RE-AIM framework. Reach, adoption and sustainability will be maximized through the integration of community hubs that comprise faith-, community-, school-based organizations and policy makers. Results: The project is a three year project. Now in its pre-implementation phase, the program is currently piloting data instrumentation and implementation processes. Preliminary results will be presented at the meeting. The Partnership development phase has been achieved and Full implementation will begin August 2019. Conclusion: It is expected that building partnerships between large academic medical centers, cancer centers and community hospitals will increase the capacity of community hospitals to offer quality screening and specialized care to community members and increase access to cervical cancer screening and education among at-risk populations ultimately decreasing cervical cancer disparities among underserved populations in the University of Illinois Cancer Center catchment. Citation Format: Vida Henderson, Jessica Madrigal, Jeanette Gonzalez, Erica Martinez, Katherine Tossas-Milligan, Patricia Doykos, Karriem Watson, Robert Winn. Building sustainable partnerships between cancer centers and safety net community hospitals to increase access to and quality of cancer care [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A128.

The association between cervical cancer screening participation and the deprivation index of the location of the family doctor's office.

BackgroundCervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors’ offices.MethodsTo access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors’ offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect.ResultsOf 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25–65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor’s office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001).ConclusionThe EDI linked to the location of the family doctor’s office seems to be a robust marker to predict female patients’ participation in cervical cancer screening.

Bridging Barriers to Cervical Cancer Screening in Transgender Men: A Scoping Review.

Estimates of high-risk human papillomavirus (HPV) infection and susceptibility to HPV-related cancer in transgender men (TM) are comparable to prevalence rates found in cisgender women. Regular and thorough screening for cervical cancer is equally as crucial for TM as for cisgender women; however, despite continued risk for cervical cancer in TM and associated recommendations for screening, studies indicate disparities in rates of cervical cancer screening (CCS) in TM compared to cisgender women. The current scoping review explores TM’s knowledge and experiences of CCS and barriers to screening uptake in this population. A range of barriers were identified including the need for health-care services to provide care for TM within the context of a nonbinary approach to gender identity and health. Findings synthesized from relevant research studies (n = 15; published 2008–2019) are presented, and recommendations are drawn from these findings to inform primary health-care providers’ clinical practice and care of TM.

A conjoint analysis study on self-sampling for human papillomavirus (HPV) testing characteristics among black women in Indiana

BackgroundSelf-sampling for HPV testing may be a method to increase overall cervical cancer screening rates among Black women, who are underscreened for cervical cancer in parts of the US. The purpose of this study was to assess preferred characteristics for delivery of HPV self-sampling kits, return of HPV self-sampling kits, and communication of HPV test results and explore sociodemographic factors (income, education, and marital status) associated with acceptability of self-sampling for HPV testing.MethodsSurvey data were gathered at an Indiana minority health fair. Participants evaluated 9 scenarios that varied along 3 dimensions: HPV self-sampling kit delivery (mail, pharmacy pick-up, or clinic pick-up), HPV self-sampling kit return (mail, pharmacy drop-off, or clinic drop-off), and HPV test results (mail, phone call, or text message). The 9 scenarios were produced from a fractional factorial design and rated on a 0 to 100 scale. Ratings-based conjoint analysis (RBCA) determined how each dimension influenced ratings. A measure for acceptability of self-sampling was obtained from the ratings of all 9 scenarios. The acceptability measure was regressed on sociodemographics.ResultsThe 98 participants ranged in age from 21 to 65 (M = 45). Across the 9 scenarios, overall acceptability to self-sample had a mean of 60.9 (SD = 31.3). RBCA indicated that HPV self-sampling kit return had the most influence on ratings, followed by HPV self-sampling kit delivery, and finally, HPV test result communication. Thirty-six percent of participants rated all self-sampling scenarios the same. Sociodemographic characteristics were not associated with acceptability of self-sampling.ConclusionsSelf-sampling for HPV testing was found to be generally acceptable to Black women in this pilot survey study. This information could be used by researchers developing self-sampling interventions and the implementation of self-sampling among providers.

Cervical cancer screening rates before and after the Great East Japan Earthquake in the Miyagi Prefecture, Japan

After disasters, issues pertaining to women's health such as irregular periods and bleeding are well surveyed. However, the management of women's health, especially changes in the rate of health checkups, has not been investigated. In the present study, we focused on the change in the cervical cancer screening rates (CCS-Rs) before and after the Great East Japan Earthquake in Miyagi Prefecture, Japan. The earthquake had a magnitude of 9.0, a profound disaster. We examined the CCS-R from 2009 to 2016 in 45 areas of the Miyagi Prefecture. Screening was completed using mobile vans. In the 4 areas impacted by the tsunami after the earthquake, a marked decrease in the CCS-R was observed in 2011 when the earthquake took place (more than a 3% decrease compared with that in the previous year). The CCS-Rs in these 4 regions remained lower in 2016 than in the previous year. In 2009-2016 except for 2014, CCS-Rs in coastal areas (9 areas) were significantly lower than those in the non-coastal areas (36 areas). A delay in seeking healthcare, also known as "patient's delay," is considered as one of the problems of cancer treatment in affected areas. It is possible that a decrease in the CCS-R may lead to low detection of advanced stages of cancer. Therefore, the establishment of a comprehensive medical system including medical screening after a disaster is important for the management of women's health.

Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest

Despite advances in cancer treatment and cancer-related outcomes, disparities in cancer mortality remain. Lower rates of cancer prevention screening and consequent delays in diagnosis may exacerbate these disparities. Better understanding of the association between area-level social determinants of health and cancer screening may be helpful to increase screening rates. To examine the association between area deprivation, rurality, and screening for breast, cervical, and colorectal cancer in patients from an integrated health care delivery system in 3 US Midwest states (Minnesota, Iowa, and Wisconsin). In this cross-sectional study of adults receiving primary care at 75 primary care practices in Minnesota, Iowa, and Wisconsin, rates of recommended breast, cervical, and colorectal cancer screening completion were ascertained using electronic health records between July 1, 2016, and June 30, 2017. The area deprivation index (ADI) is a composite measure of social determinants of health composed of 17 US Census indicators and was calculated for all census block groups in Minnesota, Iowa, and Wisconsin (11 230 census block groups). Rurality was defined at the zip code level. Using multivariable logistic regression, this study examined the association between the ADI, rurality, and completion of cancer screening after adjusting for age, Charlson Comorbidity Index, race, and sex (for colorectal cancer only). Completion of recommended breast, cervical, and colorectal cancer screening. The study cohorts were composed of 78 302 patients eligible for breast cancer screening (mean [SD] age, 61.8 [7.1] years), 126 731 patients eligible for cervical cancer screening (mean [SD] age, 42.6 [13.2] years), and 145 550 patients eligible for colorectal cancer screening (mean [SD] age, 62.4 [7.0] years; 52.9% [77 048 of 145 550] female). The odds of completing recommended screening were decreased for individuals living in the most deprived (highest ADI) census block group quintile compared with the least deprived (lowest ADI) quintile: the odds ratios were 0.51 (95% CI, 0.46-0.57) for breast cancer, 0.58 (95% CI, 0.54-0.62) for cervical cancer, and 0.57 (95% CI, 0.53-0.61) for colorectal cancer. Individuals living in rural areas compared with urban areas also had lower rates of cancer screening: the odds ratios were 0.76 (95% CI, 0.72-0.79) for breast cancer, 0.81 (95% CI, 0.79-0.83) for cervical cancer, and 0.93 (95% CI, 0.91-0.96) for colorectal cancer. Individuals living in areas of greater deprivation and rurality had lower rates of recommended cancer screening, signaling the need for effective intervention strategies that may include improved community partnerships and patient engagement to enhance access to screening in highest-risk populations.

Improved Rates of Cervical Cancer Screening Among Transmasculine Patients Through Self-Collected Swabs for High-Risk Human Papillomavirus DNA Testing.

Introduction: Nearly all cervical cancer cases are caused by one of several high-risk strains of the human papillomavirus (hr-HPV). Transmasculine (TM) individuals (persons who have a masculine spectrum gender identity, but were recorded female at birth) have low adherence to standard cervical cancer screening modalities. Introduction of self-collected vaginal swabs for hr-HPV DNA testing may promote initiation and adherence to cervical cancer screening among TM individuals to narrow screening disparities. The purpose of this study was to assess the rate of cervical cancer screening among TM individuals following the introduction of self-collected swabbing for hr-HPV DNA testing in comparison to clinician-administered cervical specimen collection.Methods: Rates of uptake and adherence to cervical cancer screening among TM individuals were assessed before and after the clinical introduction of self-collected swab testing in October 2017. Rates were compared with the rates of cervical cancer screening among cisgender women at a colocated Comprehensive Health Program during the time period of review.Results: Of the 121 TM patients seen for primary care in the 6-month baseline period before the October 2017 introduction of self-collected swabbing for hr-HPV DNA testing, 30 (25%) had cervical cancer screening documented in the electronic medical record. Following the implementation of self-swabbing, of 193 patients, 98 (51%) had a documented cervical cancer screening, a two-fold increase in the rates of adherence to cervical cancer screening (p<0.001).Conclusion: Self-collected swab testing for hr-HPV can increase rates of adherence to screening recommendations among an otherwise under-screened population.

Reduction from 2011 to 2017 in adherence to breast cancer screening and non-improvement in the uptake of cervical cancer screening among women living in Spain

ObjectivesTo analyze the uptake of breast and cervical cancer screening according to the 2017 Spanish National Health Survey (SNHS), to compare uptake rates with those obtained in the previous SNHS 2011 and to identify predictors for the uptake for these two screening tests. Study designCross-sectional study. Main outcome measuresUptake rates of breast cancer and cervical cancer screening were analyzed for women aged 40–69 and aged 25–65 years, respectively. Independent variables included sociodemographic characteristics and factors related to health status and lifestyle. ResultsWe found that 66.8 % of women aged 40–69 years had undergone mammography in the previous two years. Positive predictors for mammography uptake were age (50–69 years); marital status (married); Spanish nationality; university education; one or more chronic diseases; no alcohol consumption; physical activity; body mass index <30 kg/m2; and not smoking. We observed that 73.0 % of women aged 25–65 years had undergone cervical cytology screening in the previous three years. Positive predictors for uptake were age (25–52 years); marital status (married); Spanish nationality; middle-high educational level; no chronic diseases; no alcohol consumption; physical activity; body mass index <30 kg/m2; and not smoking. There was a significant decrease in the uptake rate for breast cancer screening from the previous SNHS 2011 (OR 0.89; 95 % CI 0.83–0.94). ConclusionsThe adherence rate for mammography in Spain in 2017 was below the recommended 70 % and was significantly lower than in 2011. The figures for cervical cancer screening were over 70 % and stable over time.

Cervical cancer screening coverage, management of squamous intraepithelial lesions and related costs in France.

Until 2018, cervical cancer screening in France was an unorganized individual screening, with the exception of some pilot programs in some territories. We aimed to assess, before the implementation of organized cervical cancer screening and human papillomavirus (HPV) nonavalent vaccine introduction in the vaccination schedule in 2018, (i) the individual cervical cancer screening coverage, (ii) the management of squamous intraepithelial lesions (SIL) and (iii) the related costs. We used the Système National des Données de Santé (SNDS) (Echantillon Généraliste de Bénéficiaires [EGB] and Programme de Médicalisation des systèmes d’information [PMSI]) to assess the cervical screening coverage rate in France between January 1st, 2012 and December 31st, 2014, and to describe diagnostic investigations and therapeutic management of SIL in 2013. After extrapolation to the general population, a total of 10,847,814 women underwent at least one smear test over the 3-year study period, corresponding to a coverage rate of 52.4% of the women aged 25 to 64 included. In 2013, 126,095 women underwent HPV test, 327,444 women underwent colposcopy, and 9,653 underwent endocervical curettage; 31,863 had conization and 12,162 had laser ablation. Besides, 34,067 women experienced hospital stays related to management of SIL; 25,368 (74.5%) had high-grade lesions (HSIL) and 7,388 (21.7%) low-grade lesions (LSIL). Conization was the most frequent in-hospital therapeutic procedure: 89.5% (22,704) of women with an in-hospital procedure for HSIL and 64.7% (4,781) for LSIL. Mean cost of smear test, colposcopy and HPV tests were around 50€. Total cost for hospital stays in 2013 was estimated at M41€, or a mean cost of 1,211€ per woman; 76% were due to stays with HSIL. This study highlights the low coverage rate of individual cervical cancer screening and a high burden related to SIL management.

Cervical cancer screening in the Canadian armed forces: An estimation of screening participation rates using the CF-HERO surveillance system

BackgroundMilitary women are faced with unique circumstances, including frequent relocation and occupational factors that may influence their participation in routine cervical cancer screening. No data on programmatic participation in cervical cancer screening in Canadian Armed Forces women has been synthesized to date. ObjectiveTo estimate cervical cancer screening rates in Canadian military women using clinical and administrative data sources. MethodsActively serving Regular Force females who were >25 years of age between January 1st 2015 and December 31st 2017 were included in the study. Scanned documents containing Papanicolaou (Pap) test results were extracted from electronic health records and further linked to demographic data sources. Screening coverage rates were calculated over the three-year study period, and results were stratified by both military command and rank. ResultsThe study period yielded over 23,000 person-years of data. The average screening rate over this period was 77.7 %, and was highest in the 45−60 year age group. Variations in rates were observed by rank and command, with higher screening rates observed in Officers and Royal Canadian Navy staff. Overall, screening rates showed a declining trend for all groups across the study period. ConclusionsCervical cancer screening rates amongst CAF members are currently below recommended guidelines and appear to be declining. These trends mirror those observed more widely in the general Canadian population, and may be a consequence of recent changes to guidelines for both cervical cancer and human papillomavirus (HPV) screening.

Cervical cancer screening behaviors and proximity to federally qualified health centers in South Carolina

IntroductionLack of participation in cervical cancer screening in underserved populations has been attributed to access to care, particularly among women in rural areas. Federally Qualified Health Centers (FQHCs) were created to address this need in medically underserved populations. This study observed proximity to three health centers in relation to cervical cancer screening rates in South Carolina. MethodsData were obtained from FQHC patient visits (from 3 centers) between 2007–2010 and were limited to women eligible for cervical cancer screening (n = 24,393). ArcGIS was used to geocode patients addresses and FQHC locations, and distance was calculated. Modified Poisson regression was used to estimate relative risk of obtaining cervical cancer screening within one yearor ever, stratified by residential area. ResultsFindings differed markedly by center and urban/rural status.At two health clinics, rural residents living the furthest away from the clinic (∼9 miles difference between quartile 4 and quartile 1) were more likely to be ever screened (RRs = 1.05 and 1.03, p-values < 0.05), while urban residents living the furthest away were less likely to be ever screened (RR = 0.85, p-value < 0.05). At the third center, only urban residents living the furthest away were more likely to be ever screened (RR = 1.02, p-value < 0.05). ConclusionsIncreased travel distance significantly increased the likelihood of cervical cancer screening at two FQHC sites while significantly decreasing the likelihood of screening at the 3rd site.These findings underscore the importance of contextual and environmental factors that impact use of cervical cancer screening services.

A Storytelling Intervention in a Mobile, Web-Based Platform: A Pilot Randomized Controlled Trial to Evaluate the Preliminary Effectiveness to Promote Human Papillomavirus Vaccination in Korean American College Women.

Korean American women have substantially greater incidence rates of cervical cancer and the lowest rates of cervical cancer screening in the United States. However, there has been minimal research to promote human papillomavirus (HPV) vaccination among this population. A pilot randomized controlled trial was conducted to evaluate preliminary effectiveness of a storytelling video intervention using mobile, Web-based technology. One hundred and four Korean American college women were randomized to the experimental group (storytelling video) or the comparison group (information-based written material). The effects of the intervention were assessed immediately postintervention and at the 2-month follow-up. Both groups improved in knowledge of and attitude toward the HPV vaccine at the postintervention. At the 2-month follow-up, the experimental group was twice as likely to receive the HPV vaccine compared to the comparison group. This preliminary evidence supports the use of a storytelling video intervention and shows substantial promise for further development and testing in larger scale studies.