Cervical Cancer Screening Recommendations Research Articles

Primary Care Providers' Experiences Recommending and Performing Cervical Cancer Screening for Women with Intellectual Disabilities: A Qualitative Study.

Women with intellectual and developmental disabilities (I/DD) are less likely to receive cervical cancer screening (CCS) relative to women without disabilities. Primary care providers (PCPs) play key roles in recommending CCS. The purpose of this study was to identify factors PCPs consider when recommending and performing CCS for women with I/DD. Using a qualitative approach, in-depth semi-structured interviews (N = 13) were conducted with majority family medicine-trained PCPs. Through inductive data analysis, it was found that most PCPs reported recommending CCS; however, follow-through for performing CCS varied. PCPs attempted to align their CCS recommendations with national guidelines and provided counseling and education to families and patients about CCS while taking an individualized risk-benefit approach. Despite most PCPs reporting a lack of knowledge or training related to providing I/DD-specific care, PCPs attempted to draw upon experiences with similar populations to recommend and perform CCS. There is an opportunity to improve knowledge of PCPs related to performing CCS for women with I/DD.

Characteristics of Clinicians Caring for Transgender Men and Nonbinary Individuals and Guideline Concordance of Clinicians' Cervical Cancer Screening Counseling for Cisgender Individuals Versus Transgender Men and Nonbinary Individuals with a Cervix.

Purpose: We examined characteristics of clinicians caring for transgender men and nonbinary (TMNB) individuals and guideline concordance of clinicians' cervical cancer screening recommendations. Methods: Using a survey of clinicians who performed ≥10 cervical cancer screenings in 2019, we studied characteristics of clinicians who do versus do not report caring for TMNB individuals and guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women. Results: In our sample (N = 492), 49.2% reported caring for TMNB individuals, and 25.4% reported performing cervical cancer screening for TMNB individuals with a cervix. Differences in guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women (45.8% vs. 50% concordant) were not statistically significant. Conclusion: Sizable proportions of clinicians cared for and performed cervical cancer screening for TMNB individuals. Research is needed to better understand clinicians' identified knowledge deficits to develop interventions (e.g., clinician trainings) to improve gender-affirming cervical cancer prevention.

Knowledge regarding human papillomavirus and cervical cancer prevention among medical students from Chulalongkorn University in Thailand

BackgroundCervical cancer is one of the leading causes of death among women in Thailand. General practitioners, within their primary healthcare role, play a vital role in the cervical cancer screening program, as they are the healthcare professionals most easily accessible to the general population. This study aims to determine the level of knowledge of cervical cancer and human papillomavirus (HPV) infection, HPV vaccination, and cervical cancer screening among last-year medical students.MethodsA cross-sectional study was conducted among sixth-year medical students using an electronic self-administered questionnaire. The two-part questionnaire comprised demographic data and 12 true/false questions that assessed knowledge regarding HPV infection, HPV vaccination, and cervical cancer screening recommendations. Pilot testing revealed a high Cronbach’s alpha and test–retest reliability coefficient.ResultsA 67% response rate was achieved. Among the 198 respondents, only one (0.5%) student correctly answered over 80% of the questions while most respondents (172, 71.7%) correctly answered less than 60% of the questions. Less than half of the respondents correctly identified crucial aspects such as the primary cause of cervical cancer, recommended vaccination age, cytology sensitivity compared to HPV testing, and the recommended screening frequency for average-risk women.ConclusionsThis study highlights a significant lack of comprehension among Thai medical students concerning HPV infection, vaccination, and cervical cancer screening guidelines. Encouraging educational enhancement, effective communication, and heightened awareness of these crucial topics within the medical school curriculum are imperative.

Breast and cervical cancer screenings across gender identity: results from the Behavioral Risk Factor Surveillance System before and during the COVID-19 pandemic.

Although national medical organizations often neglect to include trans and gender diverse (TGD) people in their breast and cervical cancer screening recommendations, the World Profession Association of Transgender Health recommends that TGD people who are at risk for these cancers follow existing guidelines for cisgender women. Despite WPATH's recommendations, TGD people are less likely to get screened in large part due to discrimination. The COVID-19 pandemic has limited access to cancer screenings among cisgender people, but it is unknown how this has impacted TGD people. Using national survey data from the Behavioral Risk Factors Surveillance System (BRFSS), we examined differences in cervical and breast cancer screening noncompliance across gender identity at two time points: before and during the COVID-19 pandemic. Screening noncompliance increased during the COVID-19 pandemic among cisgender and TGD people (e.g., transgender men, gender non-conforming people). Compared to cisgender women, transgender men and gender non-conforming respondents had higher odds of breast cancer screening noncompliance before and during COVID-19. Transgender men had lower odds of cervical cancer screening noncompliance than cisgender women before COVID-19, but higher odds during the pandemic. Gender non-conforming respondents also had lower odds of cervical cancer screening noncompliance during COVID-19 compared to cisgender women. Screening noncompliance for breast and cervical cancer was more common among TGD people than cisgender women; while these disparities existed before the COVID-19 pandemic, they were exacerbated during the pandemic. Future work should move beyond descriptive statistics and elucidate underlying causes to inform interventions.

Abstract A008: Addressing medical distrust among African Americans and adherence to cancer screening recommendations during COVID-19

Abstract Cancer is a leading cause of death in the United States especially among racial and ethnic minorities, and other medically underserved populations. Cancer disparities are an important public health issue with health communication implications particularly for African Americans. African Americans have the highest mortality rate and shortest survival rate for most cancers. Reducing the cancer burden depends on early detection through preventative screening and addressing social determinants of health that drive cancer health inequities. Despite the evidence that adherence to providers’ recommendation of cancer screening guidelines decreases incidence and mortality rates, participation in cancer screening remain low among African Americans due to social and economic factors. The reasons for cancer-related health disparities are multifactorial and encompass physician and patient barriers. Medical distrust has emerged as a significant issue impacting cancer prevention especially during the coronavirus disease (COVID-2019) pandemic. Mistrust of the medical and research communities reflects the history of abuse and discrimination in the U.S., and has resulted in disparate health outcomes, as well as less frequent use of preventive health services. It is critical that populations at increased cancer risk have access to trusted, credible cancer health information and medical services to promote adherence to screening recommendations. To address this need, this cross-sectional study will examine the patient-provider communication practices among African American adults receiving primary care in the District of Columbia and their adherence to breast, cervical, colon and prostate cancer screening recommendations during the COVID era. The study is guided by an understanding of the social determinants of health. Specifically, the study will examine the relationship of trust, structural racism, and religiosity on cancer prevention behavior. The project will describe the perceptions of health inequities within the healthcare system and trust in cancer information sources that influence cancer screening behaviors among African Americans. This project is relevant to the reduction of cancer disparities and cancer prevention for African Americans. Patient-provider communication is a known barrier and facilitator of cancer screening behavior where an awareness of historical distrust of medical institutions, systemic racism, and religiosity are important factors in providing culturally appropriate care. The results of this pilot project will be used to inform best practices for patient-provider communication for cancer prevention. Findings will be used to develop culturally tailored interventions to promote compliance for cancer screening during the COVID era and beyond. Citation Format: Finie Hunter-Richardson, Pamela L. Carter-Nolan, Carla D. Williams, Mark S. Johnson. Addressing medical distrust among African Americans and adherence to cancer screening recommendations during COVID-19 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A008.

Late Cervical And Vaginal Clear Cell Adenocarcinoma In Women Exposed In Utero To Diethylstilbestrol: Evaluation And Screening.

We aimed to evaluate the risk of cervical and vaginal clear cell adenocarcinoma (CCA) in women, aged 50 years or more, exposed in utero to diethylstilbestrol (DES) and contribute to a reevaluation of the recommendations for cervical and vaginal cancer and pre-cancer screening for these women. We carried out a retrospective review for patients received in a cancer institute. Two cohorts were consecutively studied, the first from 1970 to 2003 and the second from 2004 to 2021, and then linked. During the first period, we observed 61 CCA cases, with a mean age at diagnosis of 23 years (7-42), 36 (59%) following DES exposure in utero. During the second period, we found 27 cases, with one case of DES exposure (4%) for a women diagnosed at the age of 40 years. The mean age of the second cohort was 38 years (14-79). For the seven women aged 50 years or more at the time of CCA diagnosis, DES exposure was excluded for five and considered unlikely for the other two. In total, 88 cases of cervical or vaginal CCA were observed over a period of 51 years in a cancer center. The 37 cases associated with DES exposure represented approximatively one third of the CCA related to DES expected in France. DES exposure was improbable for the seven cases of CCA for women aged 50 years or more. These results do not support the hypothesis of late cervical or vaginal CCA in women exposed to DES in utero and indicate the need for larger multicentric studies. For the present, we propose specific screening for women exposed to DES in utero in terms of : 1) methods: association of cytology and hrHPV testing, with cervical and vaginal sampling, 2) timing : annual, or without exceeding a three-year interval, continuing after 65 years of age and after hysterectomy.

Training health care providers to administer VIA as a screening test for cervical cancer: a systematic review of essential training components

BackgroundTraining health care providers to administer visual inspection after application of acetic acid (VIA) is paramount in improving cervical cancer screening services for women in low- and middle-income countries. The objective of this systematic review was to create a framework of essential VIA training components and provide illustrating examples of how VIA training programs can be carried out in different clinical settings.MethodsA systematic review of PubMed, Embase, and Web of Science (from 2006 to 2021) was undertaken. Our inclusion criteria comprised articles reporting on implemented cervical cancer screening programs using VIA in a screen-and-treat approach. Trained health care providers with any level of health education were included, and the outcome of interest was the reporting of training components. Data were extracted by two reviewers, and a narrative synthesis of the training programs was performed. We developed a framework of seven essential training components and applied it to assess how training courses were conducted in different settings.Results13 primary studies were eligible for inclusion, including 2,722 trained health care providers and 342,889 screened women. Most training courses lasted 5–7 days and included theoretical education, practical skill development, and competence assessment. It was unclear how visual aids and training in client counselling and quality assessment were integrated in the training courses. After the training course, nearly all the VIA training programs made provisions for on-job training at the providers’ own clinical settings through supervision, feedback, and refresher training.ConclusionsThis study demonstrates the feasibility of implementing international training recommendations for cervical cancer screening in real-world settings and provides valuable examples of training program implementation across various clinical settings. The diverse reporting practices of quality indicators in different studies hinder the establishment of direct links between these data and training program effectiveness. To enhance future reporting, authors should emphasize specific training components, delivery methods, and contextual factors. Standardized reporting of quality indicators for effective evaluation of VIA training programs is recommended, fostering comparability, facilitating research, and enhancing reporting quality in this field.

A Brief Summary of the Current Role of Human Papillomavirus Testing in Cervical Cancer Screening

Cervical cancer screening recommendations proposed by natural societies and organizations have been reviewed and revised numerous times over the last decade. The most recent guidelines from the American Cancer Society and U.S. Preventive Services Task Force added human papillomavirus (HPV) primary screening for women starting at age 25 or 30 years, respectively, and ending at age 65 for those with an adequate history of negative screening. Cervical cancer screening for HPV has significantly reduced the incidence of cervical cancer. Currently, the majority of cervical cancers are reported among women who have never been screened or who were under-screened. Many organizations and institutions have explored different strategies to improve screening participation among the difficult-to-reach populations, including community outreach and specimen self-collection for HPV testing.

Cervical Cancer Screening Recommendations: Now and for the Future.

Cervical cancer is the fourth most common cancer worldwide, with over 600,000 new cases annually and approximately 350,000 cancer-related deaths per year. The disease burden is disproportionately distributed, with cancer-related mortality ranging from 5.2 deaths per 100,000 individuals in highly-developed countries, to 12.4 deaths per 100,000 in less-developed countries. This article is a review of the current screening recommendations and potential future recommendations.

Foreword: Contemporary Recommendations for Cervical Cancer and Anal Cancer Screening and Prevention.

Foreword: Contemporary Recommendations for Cervical Cancer and Anal Cancer Screening and Prevention.

Contributors: Contemporary Recommendations for Cervical Cancer and Anal Cancer Screening and Prevention.

Contributors: Contemporary Recommendations for Cervical Cancer and Anal Cancer Screening and Prevention.

Pap smear recommendations in older women, does the data support stopping?

To review the recommendations for cervical cancer screening in older women and to determine the evidence upon which the current and emerging recommendations are based on. To evaluate the possible consequences of stopping cervical cancer screening in older women. Recommendations are to space cervical cancer screening intervals for women aged 21-65 and stop in women older than 65. Cervical cancer incidence and mortality burden are significant in women over the age of 65. Human papillomavirus (HPV) vaccination rates are poor in older women. Advanced cervical cancer rates are increasing, including adenocarcinoma rates. Vulvar carcinoma rates are also increasing, and gynecological care and exams are less frequent when women are not getting routine pap testing. The current review shows that there is limited evidence on which to base the recommendation to stop screening. There is confusion among patients and physicians, and other healthcare providers over who to screen and when, and this is exacerbating the already known difficulty accessing healthcare among racial and ethnic minorities, underinsured, and rural populations, but rates of cancer are also rising most rapidly in white women. Recommendations to space or stop screening are often based on the perceived psychological distress of women undergoing testing and the cost of population screening.

Using Implementation Mapping to increase uptake and use of Salud en Mis Manos: A breast and cervical cancer screening and HPV vaccination intervention for Latinas.

Despite CDC recommendations for breast and cervical cancer screening and HPV vaccination, cancer control behaviors are underutilized among low-income Latinas. Salud en Mis Manos (SEMM), adapted from Cultivando La Salud, is a community health worker- (CHW-) delivered evidence-based intervention (EBI), shown to increase breast and cervical cancer screening. We used Implementation Mapping to create SEMM-Dissemination and Implementation Assistance (SEMM-DIA), a set of implementation strategies designed to support implementation and maintenance of SEMM in clinic settings. Specifically, we used Implementation Mapping's five iterative tasks to guide the use of theories and frameworks, evidence, new data, and stakeholder input to develop strategies to accelerate and improve implementation fidelity, reach, and maintenance of the SEMM intervention. The resulting implementation mapping logic model also guides the SEMM-DIA evaluation plan to assess reach, effectiveness, implementation, and maintenance. Increased use of implementation planning frameworks is necessary to accelerate the translation of EBIs to public health practice. This work demonstrates the application of Implementation Mapping to develop SEMM-DIA, providing a model for the development of other implementation strategies to support translation of evidence-based health promotion interventions into clinic settings.

Perceptions of Transgender and Nonbinary Persons Toward Breast and Cervical Cancer Development, Screening, and Potential Impact on Gender-Affirming Hormone Therapy.

Approximately 1.6% of adult Americans identify as transgender (TG) or nonbinary (NB) and many take gender-affirming hormone therapy (GAHT). Little data exist to inform breast and cervical cancer risks, gender-specific screening guidelines, and inclusive cancer treatment algorithms that consider GAHT. We aimed to assess TGNB persons' perceptions on breast and cervical cancer development, screening knowledge and practices, and attitude toward GAHT in the setting of a hormone receptor-positive breast cancer diagnosis. This single-institution survey study was conducted through an LGBTQ+ focused clinic from 2021 to 2022. Noncisgender patients age ≥ 18 years who were English speaking were eligible to participate. A 5-point Likert scale was used to assess concern of developing breast (all participants) and cervical cancer (those assigned female sex at birth). Demographic and quantitative variables were examined in comparison with responses via chi-squared tests. Eighty-six participants completed the survey: 43% TG men, 24% TG women, and 20% NB persons. Most (84.9%) were age < 40 years, and 86% were non-Hispanic White. The majority were unaware of breast (77%) or cervical (60%) cancer screening recommendations for their sex assigned at birth or their gender. Approximately 35% reported concern regarding breast cancer development and of those age > 40 years; only 50% had undergone screening mammography. Of those assigned female sex at birth with an intact cervix, 47% were concerned about cervical cancer development and 46.6% had a Papanicolaou smear within the past 5 years. Nearly all (87.2%) were on GAHT, and 35.1% reported they would not consider stopping GAHT if diagnosed with a hormone receptor-positive breast cancer. The findings support the need for patient and provider education on screening options and large prospective cohort data to elucidate optimal gender-specific screening guidelines and treatment algorithms.

Non-adherence to cervical cancer screening recommendations among women in Eswatini: a cross-sectional study

BackgroundIn 2018, Eswatini had the world's highest age-standardised cervical cancer incidence rate. Cervical cancer screening reduces women’s risk of invasive cervical cancer. Data on adherence to cervical cancer screening recommendations in Eswatini are scarce. The purpose of the current study was to determine Eswatini women’s self-reported adherence to cervical cancer screening recommendations, attitudes toward screening, and factors associated with non-adherence.MethodsA cross-sectional survey of women (n = 377) aged 25 to 59 accessing primary healthcare clinics (n = 4) in Eswatini assessed screening participation, attitudes and knowledge regarding cervical cancer screening, and socio-demographic variables. Adjusted logistic regression was used to assess factors associated with non-adherence to Eswatini cervical cancer screening recommendations.ResultsOne hundred and sixty-six (44%) women were classified as adherent to cervical cancer screening recommendations. Attitudinal barriers endorsed by over one-third of participants included a perceived low risk of cervical cancer (n = 161, 43%) and a view that screening is likely to be painful (n = 146, 38%). Participants had higher odds of being classified as non-adherent if they: were single compared with married (OR = 1.78, 95% CI: 1.05, 3.01, p = 0.03), perceived screening as likely painful (OR = 4.43, 95% CI: 2.62, 7.46, p < 0.001); and had not been advised by a doctor/ nurse to screen (OR = 2.82, 95% CI: 1.71, 4.64, p < 0.001). Also, a 1-year increase in age was associated with an increase in the odds of being classified as non-adherent (OR = 1.42, 95% CI: 1.39, 1.45, p = 0.01).ConclusionsSelf-reported adherence was moderate among this group of women. Tailored interventions are needed to increase participation in cervical cancer screening, especially for those women with characteristics associated with being classified as non-adherent. Primary healthcare clinic nurses (and other health providers) may contribute toward improving participation in cervical cancer screening by advising eligible women to screen and providing health education addressing negative attitudes toward screening.

Cancer screening behaviors and preferences among women in southern India

IntroductionIn 2020, India’s cancer cases were estimated at 1.32 million (International Agency for Research on Cancer et al., 2020) and were predicted to double by 2040 (Smith and Mallath, 2019). MethodsStarting in March 2019, we recruited 211 adult women in the Trivandrum area of India who had an outpatient office visit within the past 6 months to participate in a structured survey. We identified the study population from the Gokulam Medical College and four peripheral centers. Two trained interviewers collected survey information from the participants, including information on breast, oral, and cervical cancer screening eligibility, history, recommendations, and screening initiation. For analysis, we stratified the sample into two groups by age: a priority screening group, aged 30–65 (n = 132), and an overall group, containing the entire sample, aged 19–85 (n = 211). Results14.22% of respondents in the overall group and 14.39% in the priority screening group reported receiving a prior cancer screening. Among women who had not received cancer screening, the most common reasons were "no provider recommendation” (42.18%) and not knowing they needed to be screened (40.76%). Most women estimated their risk of developing cancer to be “very low” (64.93%), although the vast majority also believed early detection could improve cancer outcomes (84.83%). Among those who had not been screened for cancer, 61.61% overall and 65.15% in the priority screening group responded that they would undergo all eligible cancer screenings if recommended by their provider. The figure jumps to 79.62% in the overall group and 77.27% in the priority screening group if additional respondent-identified barriers to screening were addressed. ConclusionProvider recommendations can be used to mitigate the suboptimal screening uptake and late-stage diagnosis that exacerbate the mortality and economic burden due to cancer in India. Policy summaryThis study finds that provider recommendations can shape the trajectory of outcomes by increasing cancer screening among women.

Women's behaviours towards cervical cancer screening in the COVID-19 pandemic: A moderated-mediation-model based on Information-Motivation-Behavioural Skills.

(1) To establish a predictive model based on the Information-Motivation-Behavioural Skills model, which can analyse the factors affecting the behaviours of women towards cervical cancer screening in the COVID-19 pandemic, and (2) to test the mediating effects of behavioural skills in the model, and (3) to test the moderated mediation effect of age. A cross-sectional study was conducted among 354 women aged 30-65 between May and August 2021 in Turkey. Data were collected by using an online survey. The direct and indirect effects were tested in the structural equation model and the moderated-mediation effect was tested in the PROCESS macro. Behavioural skills mediate the effect of motivation on cervical cancer screening behaviours. In addition, age has a moderated mediation effect on this mediation effect. Our study revealed that as women's motivation for cervical cancer screening increased, their behavioural skills also increased. It can be stated that middle-aged and older women with higher behavioural skills are more likely to have screening during the pandemic and to comply with national recommendations. This study is the first quantitative study to test the impact of the components of the Information-Motivation-Behavioural Skills model on cervical cancer screening during the COVID-19 pandemic. In addition, the results reveal the mediating effect of behavioural skills in the relationship between motivation and cervical cancer scanning behaviour and the moderated mediation effect of age. Our results can provide insight for nurses into how to triage women with delayed cervical cancer screening, how to build screening capacity, and how intervention strategies should be developed to improve compliance with cervical cancer screening and follow-up recommendations in women at risk during and after the pandemic.

Can Catch-Up Vaccinations Fill the Void Left by Suspension of the Governmental Recommendation of HPV Vaccine in Japan?

In 2013, the Ministry of Health, Labor, and Welfare (MHLW) in Japan announced a suspension of the governmental recommendation for routine HPV vaccinations. In 2020, MHLW started individual notifications of HPV vaccine to the targeted girls. In April 2022, the governmental recommendation was restarted, and catch-up vaccinations started. We evaluated the benefits and limitations of the MHLW’s new vaccination strategies by estimating the lifetime risk for cervical cancer for each birth FY under different scenarios to suggest a measure for the vaccine suspension generation. It was revealed that catch-up immunization coverage among the unvaccinated must reach as high as 90% in FY2022, when the program begins, in order to reduce the risk of the females already over the targeted ages to the same level or lower than that of women born in FY1994-1999 who had high HPV vaccination rates. For women whose vaccination coverage waned because of their birth FYs, strong recommendations for cervical cancer screening should be implemented.

Loss to follow-up associated with prolonged cervical cancer screening intervals (365)

Loss to follow-up associated with prolonged cervical cancer screening intervals (365)

Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations: PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC)

BackgroundHigh-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women’s participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence.MethodsPREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy.DiscussionPRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization’s recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid.Trial registrationClinicalTrials.gov, NCT05234112. Registered 10 February 2022