Cervical Cancer Screening Results Research Articles

Results of Cervical Cancer Screening in the Rural Population of Lucknow West, India, through a Camp Approach

Objective: Cytological screening was carried out in rural women of Lucknow West, India, through a camp approach to detect cervical cancer in its preinvasive phase and to see whether the primitive living conditions in the villages have any effect on the incidence of precancer and carcinoma of the cervix and the associated predisposing factors of cervical carcinogenesis. Study Design: During a span of 4 years (May 2013 to March 2017), a total of 135 camps were organized under the auspice of Era’s Lucknow Medical College and Hospital (Lucknow, India). Only 4,269 (31.2%) out of 13,500 women who were motivated and counseled attended the camp and 2,369 (55.1%) of them underwent a Pap smear examination. Results: The incidence of squamous intraepithelial lesions of the cervix (SIL) was found to be very high (18.2%) in the 2,369 women who were screened, but the majority of them were of a low grade. The SIL incidence was very high for all predisposing factors like gynaecological symptoms, age, and clinical lesions of the cervix. However, the SIL rate showed a rise with increasing parity. Candida albicans was more common in rural women (4.7%) than Trichomonas vaginalis (1.1%), and a low incidence of viral sexually transmitted diseases (STD) was seen. Conclusions: Organizing camps in the villages through proper counseling and motivation may help in the screening of larger numbers of women for early detection of cervical cancer, the adequate treatment of which will check the progression of the disease and thus minimize the incidence of carcinoma of the cervix and its associated mortality in the rural population of India.

5 - Pooled analysis of HPV infection in paired anal and cervical samples, by HIV status

Background In light of HPV16's unique carcinogenicity in the anus, knowledge of anal HPV16 prevalence may be a useful surrogate for stratifying groups of women at differing anal cancer risk based on routinely available cervical cancer screening outcomes. Methods 47 relevant studies including 12,000+ samples were identified in PubMed up to March, 2018, Collaborators were invited to share individual-level data on at least age, and type-specific HPV infection in paired cervical and anal samples, by HIV status. Results The pooled dataset currently includes 4,729 HIV-negative and 968 HIV-positive women. Among HIV-negative women, anal HPV16 prevalence increased from 1% in 3,118 cervical HR-HPV-negative to 10% in 848 h-HPV-positive women (PR=7.4,5.1–10.5), and from 2% in 3,998 cervical HPV16-negative to 30% in 273 cervical HPV16-positive women (PR=14.8,11.2–19.7). Among HIV-positive women, anal HPV16 increased from 7% in 451 cervical HR-HPV-negative to 19% in 408 cervical HR-HPV-positive women (PR=2.8,1.9–4.2), and from 9% in 750 cervical HPV16-negative to 38% in 109 cervical HPV16-positive women (PR=4.3,3.1–6.0). Anal HPV16 also increased with severity of cervical cytopathology, but the association was not significant after adjustment for cervical HPV status, irrespective of HIV status. In all strata of cervical outcomes, anal HPV16 infection was higher in HIV-positive than HIV-negative women, most often significantly so. Conclusions Cervical abnormalities predict anal HPV16 prevalence, but do not offer additional discriminatory power over cervical HPV status. Cervical HPV16-positive women, whether HIV-positive (38%) or HIV-negative (30%), show similar anal HPV16 prevalence as meta-analyses of HIV-positive MSM (~35%), the population with highest known anal cancer risk.

Dynamic changes in Japan\u2019s prevalence of abnormal findings in cervical cytology depending on birth year

Japan’s governmental recommendation of HPV vaccine has now been suspended for more than 4 years. In and before 2013, the targets of 20-year-old cervical cancer screening were females born in and before 1993, i.e., those who could not have received HPV vaccination because it was not yet publicly introduced. The targets during 2014–2019 are, or will be, those born in 1994–1999, i.e., those who came of age during a period with the highest HPV immunization rate. We analyzed the statistical data for each birth year, for the cumulative HPV vaccination rates achieved as of age 16, and for the corresponding results of cervical cancer screening at age 20. The rate of abnormal findings in cervical cytology increased slightly from 3.68% in 2010 (birth year: 1990) to 4.35% in 2013 (birth year: 1993); however, it dynamically dropped to 2.99% in 2014 (birth year: 1994) and 3.03% in 2015 (birth year: 1995). In total, the rate of abnormal findings in cervical cytology was 3.96% in 2010–2013, but significantly dropped to 3.01% in 2014–2015 (p = 0.014). This is the first description of dynamic changes occurring in the abnormal rate of cervical cancer screening as a result of positive changes in national HPV vaccination rates.

A prospective study of risk-based colposcopy demonstrates improved detection of cervical precancers

Sensitivity for detection of precancers at colposcopy and reassurance provided by a negative colposcopy are in need of systematic study and improvement. We sought to evaluate whether selecting the appropriate women for multiple targeted cervical biopsies based on screening cytology, human papillomavirus testing, and colposcopic impression could improve accuracy and efficiency of cervical precancer detection. In all, 690 women aged 18-67 years referred to colposcopy subsequent to abnormal cervical cancer screening results were included in the study (ClinicalTrials.gov: NCT00339989). Up to 4 cervical biopsies were taken during colposcopy to evaluate the incremental benefit of multiple biopsies. Cervical cytology, human papillomavirus genotyping, and colposcopy impression were used to establish up to 24 different risk strata. Outcomes for the primary analysis were cervical precancers, which included p16+ cervical intraepithelial neoplasia 2 and all cervical intraepithelial neoplasia 3 that were detected by colposcopy-guided biopsy during the colposcopy visit. Later outcomes in women without cervical intraepithelial neoplasia 2+ at baseline were abstracted from electronic medical records. The risk of detecting precancer ranged from 2-82% across 24 strata based on colposcopy impression, cytology, and human papillomavirus genotyping. The risk of precancer in the lowest stratum increased only marginally with multiple biopsies. Women in the highest-risk strata had risks of precancer consistent with immediate treatment. In other risk strata, multiple biopsies substantially improved detection of cervical precancer. Among 361 women with cervical intraepithelial neoplasia <2 at baseline, 195 (54%) had follow-up cytology or histology data with a median follow-up time of 508 days. Lack of detection of precancer at initial colposcopy that included multiple biopsies predicted low risk of precancer during follow-up. Risk assessment at the colposcopy visit makes identification of cervical precancers more effective and efficient. Not finding precancer after a multiple-biopsy protocol provides high reassurance and allows releasing women back to regular screening.

Postpartum Cervical Cancer Screening Adequacy and Results: Comparison of Results 2-3 Versus 6-8 Weeks Postpartum [20E

INTRODUCTION: Postpartum follow up earlier than the traditional 6-8 week interval has been proposed as a means to enhance care provision to women after childbirth. Our study’s objective was to compare cervical cancer screening adequacy and results when screening was performed either 2-3 or 6-8 weeks postpartum. METHODS: The data for this study was obtained as part of a randomized controlled trial that recruited primiparous women who delivered at term with an expressed intent to breastfeed to postpartum appointment intervals of either 2-3 or 6-8 weeks following childbirth. When cervical cancer screening was performed, the results were reviewed for adequacy and findings. The results were compared for each group using chi-squared analysis; adequacy was compared using an odds ratio with 95% confidence interval. RESULTS: The rates of cytologic adequacy were comparable between the group (95.0 versus 100% in the 6-8 week group, p=0.21); the odds ratio for “unsatisfactory” cytology in the 2-3 week follow up group was 0.06 (95% CI &lt; 0.01-41.8). The distribution of cytologic results was comparable between the group (p=0.09); no one in either group had a high-grade cytologic result or cervical cancer. When performed, the rates of positive and negative high-risk human papillomavirus results was comparable between the groups (p=0.92). CONCLUSION: Our study indicates that cervical cancer screening can be completed earlier during the postpartum period than traditionally accepted without compromising cytologic adequacy or results. This information may be useful in shaping future recommendations regarding the timing and medical services provided during the postpartum period.

Psychological impact of positive cervical cancer screening results among Japanese women.

While cervical cancer screening is useful for detecting and then treating the disease at an early stage, most women with screen-positive results are free from cervical cancer but nevertheless subject to the unnecessary worry entailed in receiving such results. The purpose of this study was to examine whether receiving a screen-positive result was actually related to psychological distress among Japanese women who underwent cervical cancer screening. We conducted a questionnaire survey at health facilities in a semiurban city of Ibaraki prefecture, involving 1744 women who underwent cervical cancer screening and 72 who received screen-positive results and then underwent further testing. We used the K6 scale to assess their psychological distress (K6 score≥5) and performed multiple logistic regression analyses to estimate the relative effect of receiving screen-positive results on psychological distress. Psychological distress was more prevalent among women with screen-positive results (OR 2.22; 95% CI 1.32-3.74), while it was also related to history of mental health consultation (OR 2.26; 95% CI 1.69-3.01) and marital status (OR 1.32; 95% CI 1.02-1.70). Receiving a positive cervical cancer screening result was associated with psychological distress. To alleviate this psychological impact, the current form of communicating the screening results should be reconsidered.

Outcomes of cervical cancer screening at ndola central hospital

Outcomes of cervical cancer screening at ndola central hospital

A comparison between Pap and HPV screening tests and screening methods.

The present study assesses the results of cervical cancer (CC) screening over two 3-year periods (2008-2010 and 2011-2013) by comparing two screening tests [Papanicolaou (Pap) and human papillomavirus (HPV) tests] and two screening methods (organized and spontaneous). The study population includes women aged 25-64 years who underwent CC screening between 2008 and 2010 and/or 2011 and 2013, divided into those who responded to an invitation letter (organized screening) and those who spontaneously underwent testing at a public or private facility (non-programmed screening). Between 2008 and 2010, the response rates increased from 27.7% in 2008 to 44.5% in 2009 and 67.6% in 2010 (P<0.001). Women aged 25-34 years had the lowest response rate, whereas respondents were more frequent among women aged 35-44 and 45-54 years. Significant differences (P<0.001) were identified between organized and spontaneous screening test results with regard to diagnostic categories high-grade squamous intraepithelial lesion (50.5 vs. 49.5%), low-grade squamous intraepithelial lesion (42.8 vs. 57.2%) and undetermined lesion atypical glandular cells (AGC; 57.5 vs. 42.5%) or atypical squamous cells of undetermined significance (ASC-US; 54.2 vs. 45.8%). Compared with spontaneous screening, the organized programme resulted in a larger number of women screened for CC; it reduced the frequency of undetermined diagnoses (AGC, ASC-US), and identified a larger number of high-grade lesions.

Investigation of Cervical Cancer Screening Outcomes

Cervical cancer is the most common cancer among women after breast, and colorectal cancers in the world and an important health problem. This study is a cross sectional retrospective study that was conducted to investigate cervical cancer screening outcomes of women in the middle of Turkey

Providers' Views on a Community-Wide Patient Navigation Program: Implications for Dissemination and Future Implementation.

The DuPage Patient Navigation Collaborative (DPNC) adapted and scaled the Patient Navigation Research Program's intervention model to navigate uninsured suburban DuPage County women with an abnormal breast or cervical cancer screening result. Recent findings reveal the effectiveness of the DPNC in addressing patient risk factors for delayed follow-up, but gaps remain as patient measures may not adequately capture navigator impact. Using semistructured interviews with 19 DPNC providers (representing the county health department, clinics, advocacy organizations, and academic partners), this study explores the critical roles of the DPNC in strengthening community partnerships and enhancing clinical services. Findings from these provider interviews revealed that a wide range of resources existed within DuPage but were often underused. Providers indicated that the DPNC was instrumental in fostering community partnerships and that navigators enhanced the referral processes, communications, and service delivery among clinical teams. Providers also recommended expanding navigation to mental health, women's health, and for a variety of chronic conditions. Considering that many in the United States have recently gained access to the health care system, clinical teams might benefit by incorporating navigators who serve a dual working purpose embedded in the community and clinics to enhance the service delivery for vulnerable populations.

US Navy Women's Experience of an Abnormal Cervical Cancer Screening.

Recent policy revisions allow greater inclusion of military women in operational and/or deployable positions (ie, shipboard, overseas, and war zone duty assignments), but these positions can create unique health care challenges. Military members are often transient due to deployments and change of duty stations, impacting timely follow-up care for treatable health conditions. There has been minimal research on challenges or strategies in preventive health screening and follow-up for US military women. The purpose of this qualitative research study was to describe US Navy women's experiences with abnormal cervical cancer screenings requiring colposcopic follow-up care. Ship- and shored-based women receiving care at a military colposcopy clinic completed interviews about their experience. Two forms of narrative analysis, Labov's sociolinguistic structural analysis and Braun and Clarke's thematic analysis, were employed to gain a more robust understanding of the women's experiences. The sample was comprised of 26 women (16 ship-based, 10 shore-based). Five themes were identified: 1) It's like this bombshell (initial abnormal results notification); 2) I didn't understand (self-discovery process); 3) Freaked (emotional toll); 4) It's kind of like this back and forth (scheduling and navigating care); and 5) It really opened my eyes (lessons learned). The women's stories highlighted some issues unique to military health care, such as operational demands and follow-up care; other issues are likely common for most women learning about an abnormal cervical cancer screening result. Areas important for practice and future research include improving notification practices, providing information, understanding women's fear, and continuity of care. Research exploring educational initiatives and self-management practices are critical within military populations.

Multiple biopsies and detection of cervical cancer precursors at colposcopy.

Women with abnormal cervical cancer screening results are referred to colposcopy and biopsy for diagnosis of cervical cancer precursors (high-grade squamous intraepithelial lesions [HSILs]). Colposcopy with a single biopsy can miss identification of HSILs. No systematic study has quantified the improved detection of HSIL by taking multiple lesion-directed biopsies. The Biopsy Study was an observational study of 690 women referred to colposcopy after abnormal cervical cancer screening results. Up to four directed biopsies were taken from distinct acetowhite lesions and ranked by colposcopic impression. A nondirected biopsy of a normal-appearing area was added if fewer than four directed biopsies were taken. HSIL identified by any biopsy was the reference standard of disease used to evaluate the incremental yield and sensitivity of multiple biopsies. In the overall population, sensitivities for detecting HSIL increased from 60.6% (95% CI, 54.8% to 66.6%) from a single biopsy to 85.6% (95% CI, 80.3% to 90.2%) after two biopsies and to 95.6% (95% CI, 91.3% to 99.2%) after three biopsies. A significant increase in sensitivity of multiple biopsies was observed in all subgroups. The highest increase in yield of HSIL was observed for women with a high-grade colposcopic impression, HSIL cytology, and human papillomavirus (HPV) type 16 positivity. Only 2% of all HSILs diagnosed in the participants were detected by biopsies of normal-appearing transformation zone. Collection of additional lesion-directed biopsies during colposcopy increased detection of histologic HSIL, regardless of patient characteristics. Taking additional biopsies when multiple lesions are present should become the standard practice of colposcopic biopsy.

Self-sampling experiences among non-attendees to cervical screening

ObjectiveHigh coverage and attendance is essential to positive cervical cancer screening results. Offering self-sampling for HPV-testing to the non-attendees of the program may improve attendance rates. Information on women's perceptions and experiences with self-sampling (acceptability) is needed to further optimize attendance by this method. MethodsA questionnaire study focusing on women's experiences on the screening method was embedded in a trial investigating the effects and feasibility of self-sampling among non-attendees of cervical screening in 31 Finnish municipalities in 2011–2012 (n=4688). Reasons for non-attendance in routine screening were also surveyed. ResultsResponse rate to the questionnaire was 98.8% (909/920) among women who performed self-sampling. Self-sampling participants reported mainly good experiences. Negative experiences (difficulties in sample taking, pain, fear, anxiety, insecurity) were reported rarely, but more commonly among women with a mother tongue other than Finnish or Swedish (immigrants). Most common reason for non-attendance in routine screening was a recent Pap-smear elsewhere (opportunistic screening). Practical reasons (pregnancy, scheduling difficulties) were reported by 42%, emotional or attitudinal reasons by 17%, and 16% forgot to take part. Response yield to questionnaire was unsatisfactory among those women who declined the self-sampling option. ConclusionsOptimizing the practical aspects of screening and offering a self-sampling option to non-attendees can help to overcome a large variety of both practical and emotional barriers to traditional screening. More research is needed among the non-attendees to routine screening who decline also the self-sampling option.

Improving cervical cancer screening attendance in Finland.

High attendance is essential to cervical cancer screening results. Attendance in the Finnish program is currently at 70%, but extensive opportunistic screening occurs beside the organized. A shift from opportunistic to organized screening is imperative to optimize the costs and impact of screening and minimize potential harms. We evaluated the effect of reminder letters (1st reminder) and self-sampling test (2nd reminder) on program attendance. The study population consisted of 31,053 screening invitees in 31 Finnish municipalities. 8,284 non-attendees after one invitation received a reminder letter and 4,536 further non-attendees were offered a self-sampling option. Socioeconomic factors related to participation were clarified by combining screening data to data from Statistics Finland. Reminder letters increased participation from 72.6% (95% CI 72.1, 73.1) to 79.2% (95% CI 78.8, 79.7) and self-sampling further to 82.2% (95% CI 81.8, 82.7). Reminder letters with scheduled appointments resulted in higher increase than open invitations (10 vs. 6%). Screening of original non-attendees increased the yield of CIN3+ lesions by 24%. Non-attendance was associated with young age, immigrant background, lower education level and having never been married. We showed that a total attendance of well over 80% can be achieved within an organized program when the invitational protocol is carefully arranged.

What Women Want: Patient Recommendations for Improving Access to Breast and Cervical Cancer Screening and Follow-up

BackgroundThe patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net. MethodsSemi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers, free clinics, or an academic cancer center in the Chicago metropolitan area. FindingsOf the 138 women interviewed in the parent study, 52 women provided recommendations for improving access to screening and follow-up care. Most were between 41 and 65 years old (62%) and African American (60%) or White (25%). Recommendations included strengthening community-based health education with more urgent messaging, strategic partnerships, and active learning experiences to increase patient engagement, which women regarded as a key driver of access. Women also suggested increasing access by way of changes to health care delivery systems and policy, including more direct patient–provider and patient–clinic communications, addressing delays caused by high patient volume, combining preventive services, expanding insurance coverage, and adjusting screening guidelines. ConclusionsThis exploratory study demonstrates important insights from the patient lens that may help to increase the acceptability and efficacy of community and clinical interventions aimed at improving access to breast and cervical cancer screening and follow-up. Further research is needed to identify appropriate integration of patient input into interventions, practice, and policy change.

Nonrandom Return: Lessons from Women Returning for Follow-Up Results of Cervical Cancer Screening in Rural Haiti

Purpose: Few studies have evaluated approaches to improve patient follow-up in screening programs within resource-limited areas. This study investigated the patterns of return among women presenting for results from a cervical cancer screening program implemented in a resource-poor region to highlight areas for future research and potential interventions. Methods: In the development of a cervical cancer screening program in rural Haiti, women aged 18-45 years were recruited from local churches to undergo cervical cancer screening and follow-up for results. A dot plot was used to analyze the distribution of women returning during the results phase compared to the random return rates based on the screening phase. Results: Of the 250 women tested, 121 (48%) returned for follow-up. On the 2 result days with the most returnees, 46 and 63% of the women had been tested during only 3 of the 11 testing days which themselves accounted for 41% of the total number of women who returned. The highest volume return days, a Monday and a Friday, gave results to women tested on Monday, Wednesday and Friday, and on Monday, Tuesday and Thursday, respectively. The 2 result days with the lowest return numbers had 80% (8/10) of those who returned coming as the only returnee from their day of testing. Conclusion: Result days corresponding with the highest return rates had increased clustering of women from the screening phase, and the result days with fewer women returning had less clustering. These findings are among the first to implicate the importance of defining these patterns of return and the potential for recruitment techniques that exploit such groupings, potentially described by social connections, in limited-resource settings to improve follow-up for screening programs.

The Role of Acculturation and Collectivism in Cancer Screening for Vietnamese American Women

The aim of this study was to examine the influence of demographic variables and the interplay between collectivism and acculturation on breast and cervical cancer screening outcomes among Vietnamese American women. Convenience sampling was used to recruit 111 Vietnamese women from the Richmond, VA, metropolitan area, who participated in a larger cancer screening intervention. All participants completed measures on demographic variables, collectivism, acculturation, and cancer-screening-related variables (i.e., attitudes, self-efficacy, and screening behavior). Findings indicated that collectivism predicted both positive attitudes and higher levels of self-efficacy with regard to breast and cervical cancer screening. Collectivism also moderated the relationship between acculturation and attitudes toward breast cancer screening such that for women with low levels of collectivistic orientation, increasing acculturation predicted less positive attitudes towards breast cancer screening. This relationship was not found for women with high levels of collectivistic orientation. The current findings highlight the important roles that sociodemographic and cultural variables play in affecting health attitudes, self-efficacy, and behavior among Vietnamese women. The findings potentially inform screening programs that rely on culturally relevant values in helping increase Vietnamese women's motivation to screen.

Cervical Cancer Screening Outcomes in a Refugee Population

Cervical cancer is the second most common cause of female cancer mortality worldwide, accounting for approximately 274,000 deaths annually (Parikh, Brennan, & Boffetta, 2003; World Health Organization, 2002). Of the estimated 500,000 new cases of cervical cancer diagnosed each year, 80% of these occur in developing countries, with the highest rates occurring in Africa, Asia, and Central and South America (de Sanjose et al., 2010; Ferlay et al., 2010; Lipson et al., 1995; Parikh et al., 2003; World Health Organization, 2002, 2011). Human papillomavirus (HPV) has been detected in 99% of cervical cancer cases, and infection with HPV is a prerequisite to the development of invasive cervical cancer (de Sanjose et al., 2010; Dunne et al., 2007; Ferlay et al., 2010; Lipson et al., 1995; Parikh et al., 2003; World Health Organization, 2002, 2011). Seventy percent of cervical cancers are due to high-risk (HR) HPV types 16 and 18, and although there is some geographic variation in the prevalence of HPV, global data suggests that the eight most common high-risk oncogenic HPV genotypes (16, 18, 21, 33, 35, 45, and 52) contribute to over 90% of the cervical cancer in all world regions [de Sanjose, 2010; Dunne, 2007; World Health Organization, 2011].

Gender roles and acculturation: Relationships with cancer screening among Vietnamese American women.

The aim of this study was to examine the influence of demographic variables and the interplay between gender roles and acculturation on breast and cervical cancer screening outcomes among Vietnamese American women. Convenience sampling was used to recruit 100 Vietnamese women from the Richmond, VA, metropolitan area. Women were recruited to participate in a larger cancer screening intervention. All participants completed measures on demographic variables, gender roles, acculturation, and cancer screening variables. Findings indicated that traditional masculine gender roles were associated with increased self-efficacy for breast and cervical cancer screening. Higher levels of acculturation were associated with higher probability of having had a Papanicolaou test. In addition, acculturation moderated the relationship between traditional female gender roles and cancer screening variables. For highly acculturated women, higher levels of feminine gender roles predicted higher probability of having had a previous clinical breast exam and higher levels of self-efficacy for cervical cancer screening, while the opposite was true for lower acculturated women. The findings of this study indicate the important roles that sociodemographic variables, gender roles, and acculturation play in affecting health attitudes and behaviors among Vietnamese women. These findings also help to identify a potentially high-risk subgroup and existing gaps that need to be targeted by preventive interventions.

PIH7 - Budget Impact of HPV16/18 Genotyping Tests for the Management of Non-concordant Cotesting Cervical Cancer Screening Results: A United States Payer Perspective

PIH7 - Budget Impact of HPV16/18 Genotyping Tests for the Management of Non-concordant Cotesting Cervical Cancer Screening Results: A United States Payer Perspective