Cervical Cancer Screening Results Research Articles

Communicating Probabilities of Cervical Cancer Screening Results with Icon Arrays or Tree Diagrams: A Longitudinal Experiment

ABSTRACT Simple graphical displays such as icon arrays and tree diagrams have been proposed for communicating health risks and supporting informed decisions. The UK’s National Health Service (NHS) uses tree diagrams to communicate the chances of different cervical cancer screening results, but their effectiveness has not been compared to icon arrays. We conducted a well-powered longitudinal experiment involving 3,100 UK women eligible for cervical screening (25–64 years) to examine the effectiveness of icon arrays to communicate possible cervical screening results, relative to the UK NHS’s tree diagram and to a numerical-only format. We also examined whether the presence (vs. absence) of explanatory text referring to different types of results (i.e. distinguishing between HPV positive results with vs. without abnormal cervical cells) moderated effects of presentation format. Presentation format did not affect verbatim or gist knowledge of probabilities at initial assessment (i.e. immediately after participants viewed the displays), but icon arrays were associated with better gist knowledge of absolute magnitudes than tree diagrams and numerical-only formats at 1-month follow-up. Participants exposed to icon arrays also perceived lower likelihood of adverse screening results and reported stronger screening intentions at initial assessment. For displays without explanatory text, icon arrays were also associated with more positive user evaluations and less negative affective reactions than tree diagrams at initial assessment. Overall, our findings suggest that icon arrays support enduring knowledge of approximate magnitudes of probabilities and are better suited than tree diagrams for communicating possible screening results.

Patient Perceptions on the Follow-Up of Abnormal Cancer Screening Test Results.

Timely follow-up after an abnormal cancer screening test result is needed to maximize the benefits of screening, but is frequently not achieved. Little is known about patient experiences with the process of following up abnormal screening results. Assess patient experiences and perceptions regarding the process of a diagnostic workup following abnormal breast, cervical, or colorectal cancer screening results. Survey of participating patients between April 2021 and June 2022 after reaching the primary outcome time point in a randomized controlled trial to improve follow-up of overdue abnormal screening results. Patients from 44 participating practices in three primary care practice networks. Self-reported ease of scheduling follow-up, perceived barriers or concerns, provider trust, and satisfaction with communication and care received for the follow-up of abnormal screening results. Overall, 241 (25.0%) patients completed the survey including 66 (32.8%) with breast, 79 (25.3%) with cervical, and 96 (21.3%) with colorectal screening test; median age 55years, 79.7% women, 80.5% non-Hispanic white, and 51.0% did not complete recommended follow-up. Most patients were worried that the test would find cancer (63.1%), but fewer worried about discomfort or side effects (34.4%), and neither were associated with completing follow-up. However, 17% of patients did not think they needed follow-up tests or appointments and were less likely to complete follow-up (10.5% vs. 24.0%, respectively, p-value 0.009). Most patients were very satisfied with their overall care (71.0%), but only 50.2% strongly agreed that they trusted their provider to put their medical needs above all else when making recommendations. Patients with overdue abnormal breast, cervical, and colorectal cancer screening test results reported important deficiencies in the management of recommended follow-up. Addressing patient concerns about fear of cancer and effectively communicating the need for follow-up procedures may improve timely follow-up after an abnormal cancer screening result. ClinicalTrials.gov NCT03979495.

Cervical cancer screening outcomes among First Nations and non‐First Nations women in Alberta, Canada

BackgroundCervical cancer disproportionately affects First Nations women in Canada but there is limited information on their participation in organized cervical cancer screening programs. MethodsThis co-led retrospective cohort study linked population-based Alberta Cervical Cancer Screening Program point of care data with First Nations identifiers. This Screening Program database includes cervical cancer screening history, screen test results, colposcopy procedure findings, and pathology results for all women in Alberta. First Nations identifiers were obtained from Alberta Health who steward these data on their behalf. Data were available from 2012 to 2018 for women 25 – 69 years of age who were age eligible to participate in cervical cancer screening. Screening participation and retention rates, and screening outcomes were compared between First Nations and non- First Nations women using descriptive statistics with trends estimated using joinpoint models. ResultsAge standardized screening participation and retention rates of First Nations women were lower than those for the non-First Nations women, with an average difference of 13.9 % lower for participation rates (95 % confidence interval = 12.9–14.8 %; P <.0001) and 7.2 % for retention rates (95 % confidence interval = 2.2 % to 12.72; P = 0.013). First Nations women consistently had higher percentages of high risk (high-grade squamous intraepithelial lesion, atypical glandular cells, atypical squamous cells where HSIL cannot be excluded, Carcinoma in situ) abnormal cytology tests than non-First Nations women. ConclusionIdentifying where inequities were found in cervical cancer screening participation and retention in this study is the first step to reduce the disproportionate burden of cervical cancer for First Nations women in Canada.

The Effect of Shared Decision-making on Decision Self-efficacy and Decisional Conflict of Women with Low-grade Squamous Intraepithelial Lesion in Cervical Cytology: An Experimental Study

Background: Women often face decisional challenges and hesitation while choosing the appropriate method to follow up on their abnormal results of cervix cytology. Objective: The present study aimed to determine the effect of shared decision-making (SDM) on decision self-efficacy (DSE) and decisional conflict (DC) about follow-up methods among women with abnormal cervix cytology results. Methods: This interventional study was performed on 54 women referred to the subspecialty clinic of gynecologic oncology. The women were assigned into intervention and control groups using a randomized block design with block sizes of 4 and 6 and an allocation ratio of 1:1. The intervention group received counseling based on the SDM and a decision aid (DA) booklet. The data collection tools included the questionnaires of the demographic and obstetrics characteristics, DC, DSE, and Decision Regret. The collected data were analyzed using SPSS24 software, and independent t-tests and ANCOVA were used. Results: After the intervention, the total mean score of the DC in the intervention group was significantly lower than that in the control group [MD: -22.84 with 95% CI: -23.52 to -21.95, (P &lt;0.001)]. The mean score of DSE in the intervention group was significantly higher than that in the control group [MD: 14.56 with 95% CI: 21.47 to 7.65, (P &lt;0.001)]. Conclusion: The present study results indicated that counseling based on the SDM effectively promotes DSE and reduces DC among women with minor abnormal cervical cytology. Therefore, it is recommended that healthcare providers use SDM for women with abnormal cervical cancer screening results.

A Systematic Review of Interventions to Promote Cervical Cancer Screening among Immigrant Vietnamese Women.

Vietnamese women have a higher incidence rate of cervical cancer and are less likely to have ever been screened for cervical cancer than their White counterparts in the US. This review synthesizes findings from published interventions to promote cervical cancer screening in this vulnerable population. Articles were identified through a systematic search of PsycInfo, Embase, Pubmed, Web of Science, and the Cochrane Register of Controlled Trials in October 2022. Articles were included if they were published in a peer-reviewed journal, written in English, included one or more interventions promoting cervical cancer screening, assessed at least one outcome relevant to screening, and included a sample of ≥ 70% Vietnamese participants. Quality assessment scores were computed using the Downs and Black Checklist. Fifteen articles met review inclusion criteria. Studies were, on average, of good quality. Most studies were conducted in the US (n = 12), used a quasi-experimental design (n = 9), and employed multiple intervention strategies (n = 12). Intervention strategies included educational sessions, lay health worker (LHW) outreach, small media, mass media, patient navigation, and community or healthcare-based strategies. The most common study outcomes were screening intention and receipt. All but two studies reported improved cervical cancer screening outcomes following intervention. Findings support the effectiveness of multicomponent culturally tailored interventions to improve cervical cancer screening outcomes in immigrant Vietnamese women. Further research is needed to determine whether these interventions will be as successful in non-US countries and to address broader community- and healthcare-based factors in screening.

Association Between Clinician Confidence and Making Guideline-Recommended Decisions in the Management of Abnormal Cervical Cancer Screening Results.

Guidelines for managing abnormal cervical cancer screening results are complex and adherence is challenging for clinicians. Previous studies have identified gaps in knowledge as a possible cause; few have explored the confidence clinicians have in their management decisions. Confidence in decision-making may influence management practices, particularly when guidelines are complex and evolving. Assess whether confidence in decision-making is associated with making guideline-concordant recommendations for abnormal cervical cancer screening results. A clinician survey used vignettes to ask clinicians to make a management recommendation for different abnormal results and rate their level of confidence in their response. Physicians and advanced practice providers (APPs) at three diverse health systems in Washington, Texas, and Massachusetts. Correct response to each vignette based on either the 2012 or 2019 American Colposcopy and Cervical Pathology (ASCCP) management guidelines. In total, 501 clinicians completed the survey between October and December 2020 (response rate 53.7%). Overall, most clinicians made guideline-recommended management decisions for two vignettes (73.2 and 73.7%), but fewer were confident in their selection (48.3% and 46.6%, respectively). Clinicians who reported high levels of confidence were more often correct than those who reported lower levels of confidence (85.8% vs. 62.2% and 87.5% vs. 60.7%, both p<0.001). After adjusting for clinician and practice characteristics, confidence remained significantly associated with selecting the correct answer. Clinician confidence in management decisions for abnormal cervical cancer screening results was significantly associated with knowing guideline-concordant recommendations. Given the complexity of cervical cancer management guidelines, solutions to improve clinician confidence in decision-making are needed.

Enhancing Cervical Cancer Screening with 7-Type HPV mRNA E6/E7 Testing on Self-Collected Samples: Multicentric Insights from Mexico.

Cervical cancer remains a significant public health issue, particularly in regions with low screening uptake. This study evaluates the effectiveness of self-sampling and the 7-type HPV mRNA E6/E7 test in improving cervical cancer screening outcomes among a referral population in Mexico. A cohort of 418 Mexican women aged 25 to 65, referred for colposcopy and biopsy due to abnormal cytology results (ASC-US+), participated in this study. Self-samples were analyzed using both the 14-type HPV DNA test and the 7-type HPV mRNA E6/E7 test. The study assessed the sensitivity, specificity, positive predictive value (PPV), and the necessity of colposcopies to detect CIN3+ lesions. Participant acceptability of self-sampling was also evaluated through a questionnaire. The 7-type HPV mRNA E6/E7 test demonstrated equivalent sensitivity but significantly higher specificity (77.0%) and PPV for CIN3+ detection compared to the 14-type HPV DNA test (specificity: 45.8%, p < 0.001). The use of the HPV mRNA test as a triage tool reduced the number of colposcopies needed per CIN3+ case detected from 16.6 to 7.6 (p < 0.001). Self-sampling was highly accepted among participants, with the majority reporting confidence in performing the procedure, minimal discomfort, and willingness to undertake self-sampling at home. Self-sampling combined with the 7-type HPV mRNA E6/E7 testing offers a promising strategy to enhance cervical cancer screening by improving accessibility and ensuring precise diagnostics. Implementing these app roaches could lead to a significant reduction in cervical cancer morbidity and mortality, especially in underserved populations. Future research should focus on the long-term impact of integrating these methods into national screening programs and explore the cost-effectiveness of widespread implementation.

Assessing Management of Abnormal Cervical Cancer Screening Results and Concordance with Guideline Recommendations in Three US Healthcare Settings.

Follow-up of abnormal results is essential to cervical cancer screening, but data on adherence to follow-up are limited. We describe patterns of follow-up after screening abnormalities and identify predictors of guideline-concordant follow-up. We identified the index screening abnormality (positive human papillomavirus test or atypical squamous cells of undetermined significance or more severe cytology) among women of ages 25 to 65 years at three US healthcare systems during 2010 to 2019. We estimated the cumulative incidence of surveillance testing, colposcopy, or treatment after the index abnormality and initial colposcopy. Logistic regressions were fit to identify predictors of guideline-concordant follow-up according to contemporaneous guidelines. Among 43,007 patients with an index abnormality, the cumulative incidence of any follow-up was 49.6% by 4 years for those with atypical squamous cells of undetermined significance/human papillomavirus-negative and higher for abnormalities warranting immediate colposcopy. The 1-year cumulative incidence of any follow-up after colposcopy was 70% for patients with normal results or cervical intraepithelial neoplasia I and 90% for patients with cervical intraepithelial neoplasia II+. Rates of concordant follow-up after screening and colposcopy were 52% and 47%, respectively. Discordant follow-up was associated with factors including age, race/ethnicity, overweight/obese body mass index, and specific types of public payor coverage or being uninsured. Adherence to the recommended follow-up of cytologic and histopathologic abnormalities is inconsistent in clinical practice. Concordance was poor for mild abnormalities and improved, although suboptimal, for more severe abnormalities. There remain gaps in the cervical cancer screening process in clinical practice. Further study is needed to understand the barriers to the appropriate management of cervical abnormalities.

Cervical cancer screening outcomes for HIV-positive women in the Lubombo and Manzini regions of Eswatini-Prevalence and predictors of a positive visual inspection with acetic acid (VIA) screen.

This study aimed to describe the prevalence and predictors of a positive VIA (visual inspection with acetic acid) cervical cancer screening test in women living with human immunodeficiency virus (HIV). We retrospectively analysed data from women aged ≥15 who accessed VIA screening from health facilities in the Lubombo and Manzini regions of Eswatini. Sociodemographic and clinical data from October 2020 to June 2023 were extracted from the client management information system (CMIS). VIA screening outcome was categorised into negative, positive, or suspicious. A logistic regression model estimated the adjusted odds ratio (AOR) of the predictors of a positive VIA screen at p<0.05 with 95% confidence intervals. Of 23,657 participants, 60.8% (n = 14,397) were from the Manzini region. The mean age was 33.3 years (standard deviation 7.0), and 33% (n = 7,714) were first-time screens. The prevalence of a positive VIA was 2.6% (95% CI: 2.2%, 3.0%): 2.8% (95% CI: 2.2%, 3.5%) in Lubombo and 2.4% (95% CI: 2.0%, 2.9%) in Manzini (p = 0.096). Screening at mission-owned (AOR 1.40; p = 0.001), NGO-owned (AOR 3.08; p<0.001) and industrial/workplace-owned health facilities (AOR 2.37; p = 0.044) were associated with increased odds of a positive VIA compared to government-owned health facilities. Compared to those aged 25-34, the odds of a positive VIA increased by 1.26 for those in the 35-44 age group (AOR 1.26; p = 0.017). Predictors with lower odds for a positive VIA test were: being on anti-retroviral therapy (ART) for 5-9 years (AOR 0.76; p = 0.004) and ≥10 years (AOR 0.66; p = 0.002) compared to <5 years; and having an undetectable viral load (AOR 0.39; p<0.001) compared to unsuppressed. Longer duration on ART and an undetectable viral load reduced the odds, while middle-aged women and screening at non-public health facilities increased the odds of a positive VIA screen.

Epidemiological Profile of Human Papillomavirus in a Healthcare Center in Portugal: Implications for Public Health Policies.

Introduction Human papillomavirus (HPV) infection, a prevalent sexually transmitted disease, affects the majority of sexually active individuals at least once in their lifetime. Cervical cancer stands as a significant contributor to mortality among women. Cervical cancer screening (CCS) and HPV vaccination are recent, with few studies about their impact on the prevalence of HPV types. The emergence of novel predominant pathogen strains can be driven by vaccine-induced pathogen strain replacement, thereby enhancing and altering selection. Objective The aim of the study was to characterize the high-risk (HR) HPV infection in two Portuguese primary care units (PCUs). Materials and methods In this observational, cross-sectional, and descriptive study, we included women aged 25-64 years and registered in two PCUs, who were screened by SiiMA Rastreios (population-based screening management application), and were HR-HPV positive, between August 2015 and May 2018. The results of cervical cancer screening (CCS) can be accessed through the SiiMA Rastreios information system. For data treatment, we used MS Excel (Microsoft Corporation, Redmond, Washington, USA), IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, USA), and non-parametric tests. Results In our study, we included 4,614 women aged between 25 and 64 years old. CCS was performed on 24.47%, of whom 39.95% were tested for HR-HPV. The infection rate was 18.85%, and all 14 types of infection were identified. The most common HPV type was 31, followed by 16 and 68. We found HPV other than 16/18 in 84.43%. We found coinfections in 34.1%, with no statistically significant difference by age group. In the 25-34 age group, the incidence of infection was 33.7% vs. 17.54% in the 35-54 age group and 4.55% in the 55-64 age group. HPV16 was the most common infection in the 25-34 age group. In nulliparous women, the most common was HPV31. The relationship between smoking habits and HR-HPV infection was statistically significant, but economic insufficiency was not. Conclusion The infection incidence in this study was slightly higher than in the 2011 national study. Statistically, the infection rate was significantly higher in the younger age groups. The most frequent type varied from the national and international study results. This may be due to regional differences in HPV infection, changes in the pattern of incidence, or the effect of vaccination. The HPV pattern may be changing, so the scientific community must keep updated to develop increasingly efficient screening and vaccination programs.

Lives Saved Through Increasing Adherence to Follow-Up After Abnormal Cervical Cancer Screening Results.

To model the potential number of cancers prevented and life-years saved over a range of adherence rates to cervical cancer screening, surveillance follow-up, and follow-up colposcopy that may result from removing financial barriers to these essential clinical services. A previously validated decision-analytic Markov microsimulation model was used to evaluate the increase in adherence to screening, surveillance, and colposcopy after an abnormal cervical cancer screening result. For each incremental increase in adherence, we modeled the number of cervical cancer cases avoided, the stages at which the cancers were detected, the number of cervical cancer deaths avoided, and the number of life-years gained. Compared with current adherence rates, the model estimated that an optimized scenario of perfect screening, surveillance, and colposcopy adherence per 100,000 women currently eligible for screening in the United States was 128 (95% CI, 66-199) fewer cervical cancers detected (23%), 62 (95% CI, 7-120) fewer cervical cancer deaths (20%), and 2,135 (95% CI, 1,363-3,057) more life-years saved. Sensitivity analysis revealed that any increase in adherence led to clinically meaningful health benefits. The consequences of not attending routine screening or follow-up after an abnormal cervical cancer screening result are associated with preventable cervical cancer morbidity and premature mortality. Given the potential for the removal of consumer cost sharing to increase the use of necessary follow-up after abnormal screening results and to ultimately reduce cervical cancer morbidity and mortality, public and private payers should remove cost barriers to these essential services.

Analysis of risk factors associated with cervical HPV infection and their effects on female sexual function and anxiety: a multicenter cross-sectional study based on Chinese women.

This research aimed to explore the determinants of cervical HPV infection and evaluate how cervical cancer screening outcomes influence sexual functioning and anxiety among women across three provinces in China. Study participants were categorized into HPV-positive or HPV-negative groups, after which they completed the General Characteristics Questionnaire and the SAS Anxiety Scale. The HPV-positive cohort was further divided into four subgroups: Subgroup 1 consisted of individuals with HPV types 16 or 18 but no cytological abnormalities. Subgroup 2 included those with cytological abnormalities and infections with HPV types 16 or 18. Subgroup 3 included participants infected with high-risk HPV types other than 16 and 18, who did not show cytological abnormalities, while Subgroup 4 encompassed individuals with both cytological abnormalities and infections with high-risk HPV types other than 16 and 18. All participants were assessed using the Female Sexual Function Index Scale (FSFI), which measures sexual function across these subgroups. A total of 531 questionnaires were analyzed. Logistic regression identified several risk factors for HPV infection, including manual labor, service occupations, other occupations, low- and middle-income groups, and cervical columnar epithelial ectasia, as well as an increase in the number of previous sexual partners. Conversely, protective factors included condom use during sexual activity and mutual genital hygiene prior to intercourse. The incidence of lower genital tract infections was significantly higher in the HPV-positive group compared to the HPV-negative group, with rates of chlamydia (13.3% versus 4.6%, P<0.001), gonococcal infections (5.2% versus 0.4%, P<0.001), and mycobacterial diseases (38.9% versus 23.4%, P<0.001). Additionally, anxiety levels were significantly higher in the HPVpositive group compared to the HPV-negative group (p<0.005). Anxiety levels and cytological outcomes were significantly correlated across the four HPV-positive subgroups (p<0.05), with type 16/18 infections being associated with notably lower FSFI scores compared to other high-risk HPV types (p<0.05). The findings suggest that infections with HPV type 16/18, especially when accompanied by abnormal cytological findings,significantly elevate anxiety and distress in women and are associated with reduced FSFI scores. These results highlight the complex impact of HPV infection on women's sexual health and psychological well-being with HPV type 16/.

Abstract C124: Racial and ethnic disparities in follow-up of abnormal cervical cancer screening results

Abstract Background: Despite well-defined practice guidelines for management of abnormal cervical cancer (CC) screening results, the incidence of CC is disproportionately higher in Black and Hispanic women compared to White women. Black women experience the highest overall CC mortality rates, irrespective of subtype or stage. Disparities in CC prevention may be related to differential follow-up of abnormal CC screening and delays in CC diagnosis. In a cohort of primarily Black and Hispanic patients, we investigated racial and ethnic disparities in factors associated with colposcopy attendance following abnormal CC screening. Methods: In a large urban OB/GYN clinic in Connecticut, clinical and demographic medical record data was collected for patients with abnormal CC screening results from 2/2021 to 1/2022. Factors related to colposcopy completion were examined for colposcopy indicated patients. In univariate and multivariate analysis (SAS 9.4), we analyzed the relationship between clinical and demographic characteristics and key junctures in the colposcopy referral and completion cascade. Colposcopy scheduling outcomes were compared by race/ethnicity using the Mann-Whitney U test. Analyses of race/ethnicity were stratified by primary language spoken (non-Hispanic Black, Hispanic English-speaking, Hispanic Spanish-speaking, and White/Other). Results: Of the 248 patients indicated for colposcopy, 44% identified as Black, 39% identified as Hispanic, and 18% identified as White/Other. Among Hispanic patients, 62% spoke English and 38% spoke Spanish as their primary language. The majority of colposcopy indicated patients were publicly insured by Medicare or Medicaid. Colposcopy appointments were attended by 86.7% (215) of indicated patients, with 63.3% (157) attending within the guideline recommended interval of 8 weeks from CC screening for high-grade cytology and 90 days for low-grade cytology. In univariate analysis, colposcopy attendance was significantly lower in Black vs. White/Other patients (p&amp;lt;0.05). Multivariate analysis also showed that Black patients experienced the greatest disparity in colposcopy attendance, followed by Hispanic English-speaking patients (p&amp;lt;0.01). Although rates of guideline-concordant colposcopy attendance were lowest in Black and Hispanic English-speaking patients, these differences were not significant as guideline-concordant completion rates decreased across all groups. No significant relationships were found between race/ethnicity and the number of cancellations, no shows, or reschedules of colposcopy appointments. Conclusions: Although we identified significant differences in colposcopy attendance across race/ethnicity, there were no significant differences in guideline-concordant colposcopy attendance or appointment scheduling outcomes related to delays in colposcopy (i.e. cancellation, no show, or reschedule). Future studies on colposcopy delays will focus on multi-level factors that may disproportionately burden racial/ethnic minority groups and lead to disparities in follow-up of abnormal CC screening results. Citation Format: Anisha V. Patel, Guangyu Tong, Beth A. Jones, Raul U. Hernandez-Ramirez, Wanyi Tang, Sarah Megiel, Abigail Girgis, Jamie Foster, Donna Spiegelman, Sangini S. Sheth. Racial and ethnic disparities in follow-up of abnormal cervical cancer screening results [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 C124.

Status of common sexually transmitted infection in population referred for colposcopy and correlation with human papillomavirus infection

BackgroundTo investigate the prevalence of common sexually transmitted infections (STIs) and the association of STI/human papillomavirus co-infection in young and middle-aged women with previous abnormal cervical findings referred for colposcopy.Methods719 cervical-swab cytobrush specimens were obtained from women aged ≤ 50 years who were referred for colposcopy at Peking University First Hospital due to previous abnormal cervical findings. HPV 21 typing and a panel of pathogenic STIs were tested for using the 21 HPV GenoArray Diagnostic Kit (HBGA-21PKG; HybriBio, Ltd., Chaozhou, China) and a nucleic acid STI detection kit (HybriBio Ltd. Guangzhou, China), after which colposcopy with multipoint positioning biopsy was performed.ResultsThe overall prevalence of STIs among HPV positive women with previous abnormal cervical cancer screening results was 63.7% (458/719), with Ureaplasma parvum serovar 3, Ureaplasma parvum serovar 6 and herpes simplex virus type 2 having significantly higher prevalence among high-risk HPV positive patients (19.3%, Χ2 = 5.725, P = 0.018; 21.5%, Χ2 = 4.439, P = 0.035; 5.7%, Χ2 = 4.184, P = 0.048). Among patients positive for the high-risk human papillomavirus, the prevalence of Neisseria gonorrhoeae infection in human papillomavirus 16/18 positive patients was significantly higher than that in other patients (2.5%, Χ2 = 4.675; P = 0.043). Histopathologically, Chlamydia trachomatis infection was more frequently detected in lower than or equal to low-grade squamous intraepithelial lesion infection status (13.0%, Χ2 = 3.368; P = 0.041).ConclusionsThe high prevalence of HPV coinfection with other sexually transmitted pathogens, particularly Ureaplasma parvum serovar 3, Ureaplasma parvum serovar 6, and herpes simplex virus type 2, calls for routine STI screening and effective STI prevention and management in patients with abnormal cervical cancer screening results.

Telomerase reverse transcriptase gene polymorphisms and cervical cancer susceptibility in high-risk human papillomavirus-infected women.

To investigate the relationship between Human telomerase reverse transcriptase (hTERT) gene polymorphisms and the susceptibility and clinicopathological parameters of cervical cancer in women infected with high-risk human papillomavirus (HR-HPV). A total of 380 patients with HPV-infected cervical cancer who were admitted to the Jilin province Maternal and Child Health Care Hospital (Jilin province Obstetrics Quality Control Center) from July 2019 to July 2023 were selected as case group, and 408 women with negative HPV results in the cervical cancer screening results of the physical examination in the same hospital were selected as the control group. Restriction fragment length polymorphisms polymerase chain reaction was used to detect the polymorphisms of hTERT, and its relationship with the susceptibility to high-risk HPV infection and clinicopathological parameters in patients with cervical cancer was analysed. Individuals carrying the GA and AA genotypes of rs2736122 were significantly associated with an increased risk of cervical cancer when compared with the GG genotype and the adjusted ORs were 0.53 (0.37-0.79) for the AA genotype and 0.73 (0.59-0.88) for the A allele genotype. Besides, GG genotype or G allele of rs2853677 presented a significant influence on cervical cancer, with ORs of 0.59 (0.41-0.86) and 10.77 (0.63-0.94), respectively, when compared with the AA genotype. And rs2853677 have statistically significant difference in tumour diameter and degree of differentiation subgroup(p < 0.05). The results of this study indicate that the hTERT gene rs2736122AA and rs2853677 GG genotypes can increase the susceptibility of high-risk HPV infection in cervical cancer patients. And rs2853677 is related to tumours above 4 cm and highly differentiated tumours. But both have nothing to do with the patient's chemotherapy sensitivity.

A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results

Realizing the benefits of cancer screening requires testing of eligible individuals and processes to ensure follow-up of abnormal results. To test interventions to improve timely follow-up of overdue abnormal breast, cervical, colorectal, and lung cancer screening results. Pragmatic, cluster randomized clinical trial conducted at 44 primary care practices within 3 health networks in the US enrolling patients with at least 1 abnormal cancer screening test result not yet followed up between August 24, 2020, and December 13, 2021. Automated algorithms developed using data from electronic health records (EHRs) recommended follow-up actions and times for abnormal screening results. Primary care practices were randomized in a 1:1:1:1 ratio to (1) usual care, (2) EHR reminders, (3) EHR reminders and outreach (a patient letter was sent at week 2 and a phone call at week 4), or (4) EHR reminders, outreach, and navigation (a patient letter was sent at week 2 and a navigator outreach phone call at week 4). Patients, physicians, and practices were unblinded to treatment assignment. The primary outcome was completion of recommended follow-up within 120 days of study enrollment. The secondary outcomes included completion of recommended follow-up within 240 days of enrollment and completion of recommended follow-up within 120 days and 240 days for specific cancer types and levels of risk. Among 11 980 patients (median age, 60 years [IQR, 52-69 years]; 64.8% were women; 83.3% were White; and 15.4% were insured through Medicaid) with an abnormal cancer screening test result for colorectal cancer (8245 patients [69%]), cervical cancer (2596 patients [22%]), breast cancer (1005 patients [8%]), or lung cancer (134 patients [1%]) and abnormal test results categorized as low risk (6082 patients [51%]), medium risk (3712 patients [31%]), or high risk (2186 patients [18%]), the adjusted proportion who completed recommended follow-up within 120 days was 31.4% in the EHR reminders, outreach, and navigation group (n = 3455), 31.0% in the EHR reminders and outreach group (n = 2569), 22.7% in the EHR reminders group (n = 3254), and 22.9% in the usual care group (n = 2702) (adjusted absolute difference for comparison of EHR reminders, outreach, and navigation group vs usual care, 8.5% [95% CI, 4.8%-12.0%], P < .001). The secondary outcomes showed similar results for completion of recommended follow-up within 240 days and by subgroups for cancer type and level of risk for the abnormal screening result. A multilevel primary care intervention that included EHR reminders and patient outreach with or without patient navigation improved timely follow-up of overdue abnormal cancer screening test results for breast, cervical, colorectal, and lung cancer. ClinicalTrials.gov Identifier: NCT03979495.

Cervical cancer screening outcomes in public health facilities in three states in Nigeria

BackgroundCervical cancer continues to generate a significant burden of disease and death in low- and middle-income countries (LMICs). Lack of awareness and poor access to early screening and pre-cancer treatment contribute to the high mortality. We describe here cervical cancer screening outcomes in public health facilities in three states in Nigeria.MethodsWe conducted an observational study in 177 government health facilities in Lagos, Kaduna, and Rivers State, Nigeria from January to December 2021, in which we reviewed programmatic data collected through the newly introduced Cervical Cancer Prevention Program. Women who received screening and provided consent were enrolled into the study. Data were extracted from registers in the health facilities using SurveyCTO and descriptive statistical analysis was conducted using StataSE 15 (StataCorp, College Station, TX, USA).ResultsEighty-three thousand, five hundred ninety-three women were included in the analysis including 6,043 (7%) WLHIV. 67,371 (81%) received VIA as their primary screening while 16,173 (19%) received HPV DNA testing, with 49 (< 1%) receiving both at the same time. VIA positivity was 7% for WLHIV and 3% for general population, while HPV prevalence was 16% for WLHIV and 8% for general population. Following a positive HPV result, 21% of women referred, completed triage examination. 96% of women identified with precancerous lesions, received treatment. 44% of women with suspected cancer were successfully referred to an oncology center for advanced treatment. Following treatment with thermal ablation, seven adverse events were reported.ConclusionsThe Program has successfully increased women’s access to screening and treatment of precancerous lesions. Almost all women who were eligible for pre-cancerous lesion treatment received it, often on the same day when screened using VIA. However, for women referred for a triage exam or due to suspected cancer, many did not complete their referral visits. More effort is required to ensure HPV positive women and women with suspected cancer are adequately linked to care to further reduce morbidity and mortality associated with cervical cancer in Nigeria. Implementation studies should be conducted to provide insights to improve the utilization of the existing centralized and point of care (POC) platforms to facilitate same day results, and to improve triage and treatment rates.

Correlates of cervical cancer prevention advocacy and cervical cancer screening in Uganda: Cross-sectional evaluation of a conceptual model.

An approach to increasing cervical cancer (CC) screening is to empower women who have been screened to act as advocates and encourage other women they know to get screened. We examined correlates of CC screening advocacy and CC screening uptake among constructs in our conceptual model of factors driving engagement in advocacy. A cross-sectional, correlational analysis was conducted with survey data from 40 women (index participants) who had recently screened for CC, and 103 female members of their social network (alter participants) who had not been screened. Variables measured included CC prevention advocacy, as well as internalized CC stigma, sharing of CC screening result, CC knowledge, healthy bodily intake (i.e., diet; alcohol and cigarette use) and self-efficacy related to CC service utilization and CC prevention advocacy, which were hypothesized to be associated with advocacy. Bivariate and multivariable regression analyses, controlling for clustering, were conducted. Among index participants, greater engagement in advocacy was positively correlated with CC knowledge, sharing of CC screening result, and CC service utilization self-efficacy. Women who had screened positive and received treatment for precancerous lesions reported greater CC prevention advocacy, CC knowledge and healthy living, compared to those who screened negative. In multiple regression analyses, CC screening was positively associated with CC prevention advocacy and being age 36 or older, and CC prevention advocacy was also positively associated with CC service utilization self-efficacy. These findings support the validity of our conceptual model regarding factors associated with engagement in CC prevention advocacy among women screened for CC. The strong association between CC prevention advocacy and both CC screening uptake and CC service utilization self-efficacy suggests the potential value of advocacy promotion among women who have been screened, as well as for increasing screening uptake.

The Pap Hub: A Novel Centralized System for Cervical Cancer Screening and Prevention

Summary Complex guidelines for managing the results of cervical cancer screening create specific challenges in ensuring appropriate follow-up for patients. The authors describe the development and implementation of a centralized Pap Hub system for the real-time coordination of up-to-date cervical cancer screening and follow-up at HealthPartners in Minnesota. Preliminary review of 8-year trends in screening rates under the Pap Hub shows an overall improvement in screening rates that exceeded the national average. The review also demonstrated that despite an overall improvement in screening rates in the population, there exist and remain disparities between white patients and patients of color. Qualitative review of the end-user experience with the Pap Hub showed a high degree of satisfaction for both patients and providers in coordination of cervical cancer screening and follow-up.

ACCEPTANCE AND OUTCOMES OF CERVICAL CANCER SCREENING AMONG WOMEN OF NORTH INDIA

Cervical cancer is one of the preventable cancer, still it is fourth leading cause of death of women worldwide and second leading cause of death of women in India. Screening for cervical cancer using high performance test and vaccination against HPV(Human papilloma virus) are recommended by WHO as global strategy to eliminate cervical cancer. The very rst indigenous vaccine CERVAVAC is also launched in India in year 2023,however data from nationally representative survey(NFHS-5) showed very low awareness and acceptance of cervical cancer screening among women. Present study is a descriptive cross sectional study done in camp based settings (25-30 women in each camps) from November 2021 to november 2022 at peripheral health centers of Lucknow district of state Uttar Pradesh of North India. Aim of the study was to assess the acceptance and outcomes of cervical cancer screening among ASHA(accredited social health activist) from health centers and women visiting peripheral health centers. Result showed that total 43% women accepted screening(41.4% ASHA, 31.4% women visiting health center). On bivariate analysis education level(p=0.003 ), employment status (p&lt;0.001)and knowledge of cervical cancer(p=0.02) found to be predictors of cervical cancer screening. Liquid based cytology test was carried to screen those who were willing and it was found that as per Bethesda system of classication among those who opted for screening(N=110), 4(3.1%) were having ASCUS (Atypical squamous cells of undetermined signicance), 2(1.5%) had LSIL (low squamous intraepithelial lesions), 4(3.1%) reported to have HSIL (High squamous intraepithelial lesion), 9 (7.7%) had non neoplastic inammation, 93(84.6%) were negative for any neoplastic or non- neoplastic lesion. All Positive screened participants were referred to higher centre for further management.