Decline In Cervical Cancer Mortality Research Articles

Impact of the universal health insurance benefits on cervical cancer mortality in Colombia

BackgroundCervical cancer patients in Colombia have a lower likelihood of survival compared to breast cancer patients. In 1993, Colombia enrolled citizens in one of two health insurance regimes (contributory-private insurance and subsidized- public insurance) with fewer benefits in the subsidized regime. In 2008, the Constitutional Court required the Colombian government to unify services of both regimes by 2012. This study evaluated the impact of this insurance change on cervical cancer mortality before and after 2012.MethodsWe accessed 24,491 cervical cancer mortality records for 2006–2020 from the vital statistics of Colombia’s National Administrative Department of Statistics (DANE). We calculated crude mortality rates by health insurance type and departments (geopolitical division). Changes by department were analyzed by rate differences between 2006 and 2012 and 2013–2020, for each health insurance type. We analyzed trends using join-point regressions by health insurance and the two time-periods.ResultsThe contributory regime (private insurance) exhibited a significant decline in cervical cancer mortality from 2006 to 2012, characterized by a noteworthy average annual percentage change (AAPC) of -3.27% (P = 0.02; 95% CI [-5.81, -0.65]), followed by a marginal non-significant increase from 2013 to 2020 (AAPC 0.08%; P = 0.92; 95% CI [-1.63, 1.82]). In the subsidized regime (public insurance), there is a non-significant decrease in mortality between 2006 and 2012 (AAPC − 0.29%; P = 0.76; 95% CI [-2.17, 1.62]), followed by a significant increase from 2013 to 2020 (AAPC of 2.28%; P < 0.001; 95% CI [1.21, 3.36]). Examining departments from 2013 to 2020 versus 2006 to 2012, the subsidized regime showed fewer cervical cancer-related deaths in 5 out of 32 departments, while 6 departments had higher mortality. In 21 departments, mortality rates remained similar between both regimes.ConclusionImprovement of health benefits of the subsidized regime did not show a positive impact on cervical cancer mortality in women enrolled in this health insurance scheme, possibly due to unresolved administrative and socioeconomic barriers that hinder access to quality cancer screening and treatment.

The Association of Cervical Cancer Screening With Disability Type Among U.S. Women (Aged 25–64 Years)

Despite a gradual decline in cervical cancer mortality because of greater use of screening, including Pap and human papillomavirus (HPV) tests, disparities in screening among adult women by disability type have not been examined. This study aims to assess the odds of cervical cancer screening using HPV tests by disability type among U.S. women aged 25-64 years. This study was analyzed in 2022 using pooled data from 2018 and the 2020 Behavioral Risk Factor and Surveillance System. The analytic sample included 189,795 women aged 25-64 years. Disability was defined as having any sensory disability, cognitive disability, physical disability, ≥2 disabilities, or no disability adapted from a standardized questionnaire. Descriptive analyses were used to estimate the proportion of HPV tests on the basis of 2020 American Cancer Society guidelines, which recommend testing within five years for all women aged 25-65 years. Multivariable analyses were conducted to estimate AORs of cervical cancer screening by disability type. Overall, 53.8% of women met recommended 2020 American Cancer Society guidelines for cervical cancer screening using HPV tests. The proportion of HPV tests was higher in women with a cognitive disability (55.9%) and lower in those with sensory (49.7%), physical (48.2%), and ≥2 disabilities (47.8%) than in those without disabilities (54.8%). In adjusted analyses, women with any disability (AOR=0.95, 95% CI=0.88, 0.97), physical disability (AOR=0.96, 95% CI=0.80, 0.98), and ≥2 disabilities (AOR=0.88, 95% CI=0.78, 0.97) had lower odds of receiving cervical cancer screening with HPV testing than women without disabilities. Disparities in screening with HPV tests among women with physical and ≥2 disabilities suggest the need for a targeted approach to improve prevention screening awareness, access, and availability in this population.

Overcoming barriers to cervical cancer screening in a developing country like Pakistan.

Cervical cancer is the second most prevalent cancer in Pakistani women of the reproductive age group (15-44 years), while in women of all ages, it ranks as the third most common. It is estimated that around 20 women are found to have cervical cancer per day, ranking Pakistan in the top 10 countries with the highest cancer-related mortality rates. [1] In 2020 alone, cervical cancer took the lives of 341, 831 women, 90% of whom belonged to developing countries including Pakistan. In the same year, it affected 604, 127 women, from which only 12% were from regions like the North America and Europe, while the remaining belonged to the developing world. [2] This startling disparity can be attributed to the introduction of pap smears in the developing world, like the United States and the United Kingdom, which saw &gt;70% decline in cervical cancer mortality since screening through Pap smears was initiated in these countries. [3]. In Pakistan, several studies have shown that women of the reproductive age group lack basic awareness regarding cervical cancer and screening via Pap smears. A survey on 873 women between 18-28 years found 70.1% of the participants were completely unaware of cancer. [4] A more extensive study consisting of 1070 women between ages 21-30 years found that only 2.2% of their study's population was able to identify the symptoms and risk factors for cervical cancer, while Pap smear was recognized as a screening test by only 2.5% of the same. The Pap smear uptake in this population was 2%. [5]. This lack of knowledge regarding screening can be credited to several factors such as the low educational status of developing countries, little information communicated by the healthcare workers, and the insufficient knowledge of preventive measures amongst them. Other screening barriers include misconceptions about testing guidelines, the socioeconomic status of low-income families, lack of access to testing facilities, personal reluctance due to embarrassment, and family trends of not getting tested due to cultural taboos. [5]. It is crucial to overcome the aforementioned obstacles in order to ensure early screening and treatment of precancerous lesions in women. ---Continue

Hysterectomy-corrected cervical cancer mortality rates in Denmark during 2002-2015: A registry-based cohort study.

We aimed to describe the cervical cancer mortality rates after correcting for hysterectomy and to evaluate trends over calendar time and by age. Using data from nationwide registries, we calculated uncorrected and hysterectomy-corrected cervical cancer mortality rates among women age ≥20years in Denmark during 2002-2015. We calculated hysterectomy-corrected rates by subtracting post-hysterectomy person-years from the denominator, unless hysterectomy was performed due to cervical cancer. The age-standardized hysterectomy-corrected cervical cancer mortality rate of 5.8/100000 was 18.4% higher than the corresponding uncorrected rate. The hysterectomy-corrected cervical cancer mortality rate increased significantly with age, particularly in women aged 65+ (annual percent change +4.57), peaking at 26.1/100000 person-years in women aged ≥85. The hysterectomy-corrected cervical cancer mortality declined significantly over calendar time, from 6.3/100000 person-years in 2002 to 4.5/100000 person-years in 2015 (annual percent change -0.22). This was mainly due to a significant decline in women aged 60years and older, from 20.4/100000 person-years in 2003 to 9.3/100000 person-years in 2015 (annual percent change -0.75). The mortality of cervical cancer increased significantly by age, particularly among women aged 65years and older for whom routine cervical cancer screening is not recommended. Understanding reasons for the high mortality rate in older women is critical, as this may help identify interventions needed to ensure a continued decline in cervical cancer mortality in older Danish women.

The end of the decline in cervical cancer mortality in Spain: trends across the period 1981-2012.

BackgroundIn Spain, cervical cancer prevention is based on opportunistic screening, due to the disease’s traditionally low incidence and mortality rates. Changes in sexual behaviour, tourism and migration have, however, modified the probability of exposure to human papilloma virus among Spaniards. This study thus sought to evaluate recent cervical cancer mortality trends in Spain.MethodsWe used annual female population figures and individual records of deaths certified as cancer of cervix, reclassifying deaths recorded as unspecified uterine cancer to correct coding quality problems. Joinpoint models were fitted to estimate change points in trends, as well as the annual (APC) and average annual percentage change. Log-linear Poisson models were also used to study age-period-cohort effects on mortality trends and their change points.Results1981 marked the beginning of a decline in cervical cancer mortality (APC1981–2003: −3.2; 95% CI:-3.4;-3.0) that ended in 2003, with rates reaching a plateau in the last decade (APC2003–2012: 0.1; 95% CI:-0.9; 1.2). This trend, which was observable among women aged 45–46 years (APC2003–2012: 1.4; 95% CI:-0.1;2.9) and over 65 years (APC2003–2012: −0.1; 95% CI:-1.9;1.7), was clearest in Spain’s Mediterranean and Southern regions.ConclusionsThe positive influence of opportunistic screening is not strong enough to further reduce cervical cancer mortality rates in the country. Our results suggest that the Spanish Health Authorities should reform current prevention programmes and surveillance strategies in order to confront the challenges posed by cervical cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1306-x) contains supplementary material, which is available to authorized users.

Disparities in cervical cancer mortality rates as determined by the longitudinal hyperbolastic mixed-effects type II model.

BackgroundThe main purpose of this study was to model and analyze the dynamics of cervical cancer mortality rates for African American (Black) and White women residing in 13 states located in the eastern half of the United States of America from 1975 through 2010.MethodsThe cervical cancer mortality rates of the Surveillance, Epidemiology, and End Results (SEER) were used to model and analyze the dynamics of cervical cancer mortality. A longitudinal hyperbolastic mixed-effects type II model was used to model the cervical cancer mortality data and SAS PROC NLMIXED and Mathematica were utilized to perform the computations.ResultsDespite decreasing trends in cervical cancer mortality rates for both races, racial disparities in mortality rates still exist. In all 13 states, Black women had higher mortality rates at all times. The degree of disparities and pace of decline in mortality rates over time differed among these states. Determining the paces of decline over 36 years showed that Tennessee had the most rapid decline in cervical cancer mortality for Black women, and Mississippi had the most rapid decline for White Women. In contrast, slow declines in cervical cancer mortality were noted for Black women in Florida and for White women in Maryland.ConclusionsIn all 13 states, cervical cancer mortality rates for both racial groups have fallen. Disparities in the pace of decline in mortality rates in these states may be due to differences in the rates of screening for cervical cancers. Of note, the gap in cervical cancer mortality rates between Black women and White women is narrowing.

Abstract PL05-01: Cervical cancer as an example of gender-associated health inequality.

Abstract Latin America has experienced important improvements in socio-economic and health indicators in the last few decades. Between 1960 and 2000, per capita income doubled, life expectancy increased from 57 to 70 years and infant mortality decreased from 97 to 27/1000 children born alive (1). However, the region, together with sub Saharan Africa, is the most unequal in the world (2) and the benefits of the improved indicators are only reaching a subset of the population. In this context, it is no surprise that cervical cancer, that characteristically affects poor women without access to medical care, continues to be one of the leading public health problems in the region as it is in most developing areas. Almost 90% of cervical cancer occurs in developing regions, and remarkable geographical differences are present even in low-incidence countries, where the most disadvantaged segments of the population are still at high risk of this disease. Efforts to control cervical cancer have been largely unsuccessful in developing regions, in part because the preventive interventions of the past were very limited and complex. Programs based on cytology screening, despite their success in cervical cancer control in high income countries, have been very difficult to implement, in part because of the limitations of the technique (low sensitivity, need for quality control) and in part because of the multiple visits required when the test is positive (screening, colposcopy, treatment), which involve ample coordination between multiple instances within the health system, with the corresponding high cost. The new options available for primary and secondary prevention offer an excellent opportunity to intervene more effectively. Vaccination of adolescent women promises significant reduction in the burden of disease within several decades, and the new screening methodologies available represent an improvement in multiple aspects of the process, but require active and decisive efforts of scientists, activists and the health system for their implementation in organized national programs. The production of new knowledge about cervical cancer and the development of new preventive methods have had the unprecedented participation of multiple research centers in Latin America, as well as many thousands of study participants from the region who have generously contributed. The more than 25 years collaboration between the US National Cancer Institute and Costa Rican researchers to investigate multiple aspects of the natural history of HPV and associated neoplasia (3-8) including the evaluation of an HPV vaccine in a large randomized clinical trial, is an example of the potential of multinational collaboration. The extensive technology transfer associated with this effort has likely contributed to an important decline in cervical cancer mortality in Costa Rica HPV vaccination of young women is advancing rapidly in the region, and organized screening programs based on HPV testing and incorporating innovative strategies, are starting with the leadership of Mexico, Argentina and Colombia. Many questions remain unanswered, including how to manage HPV positive women and its associated psychosocial issues, but we are at the threshold of a new era where the terrible suffering imposed by cervical cancer on Latin American families will be a thing of the past.

Too Much of a Good Thing?

Too Much of a Good Thing?

Factors Affecting Uptake of Cervical Cancer Screening among Clinic Attendees in Trelawny, Jamaica

Use of the Pap test has resulted in a decline in cervical cancer mortality in developed countries. Yet, despite established cervical cancer screening programs, a significant portion of Jamaican women are not undergoing screening for cervical cancer. This study was carried out to identify factors that affect Jamaican women's decisions to screen for cervical cancer. A population survey was administered to 367 clinic-attending women 25 to 54 years of age in the Parish of Trelawny from May to July of 2005. An interviewer-administered questionnaire assessed the women's knowledge, attitudes, and practices regarding cervical cancer and cervical cancer screening. Overall, 11% of the women had never had a Pap smear and only 38% had a Pap test within the last year. Annual visits to a health provider have a strong influence on women's decisions to regularly screen for cervical cancer. Provider recommendation also positively affected initial receipt of a Pap smear as well as continued regular screening. Programs that promote annual health checkups, encourage consistent provider recommendations, and emphasize screening as a preventive measure might positively influence women's decisions to screen for cervical cancer.

Trends in cervical cancer mortality in South Africa.

Cervical cancer is an important cause of death throughout the world, especially in less developed countries. Reports of trends in cervical cancer mortality from less developed countries have been limited by poor data quality and inaccurate population estimates. This paper examines trends in cervical cancer mortality in South Africa from 1949 to 1990 and discusses the impact of cytology screening on these trends. Analysis of national mortality statistics and reconstructed population data. The age-standardized mortality rates for Whites declined after the mid 1960s, while that for Coloureds rose, particularly before the 1970s. These trends were affected predominantly by trends among women in the 35-64 age range. The pattern of mortality in successive birth cohorts for Whites is consistent with a reduction in age-specific mortality following the advent of cytological screening. The same pattern is not evident in trends for Coloureds, among whom screening has apparently had a minor impact if any at all. The apparent lack of impact of screening in those groups of women most at risk of cervical cancer lends weight to demands for the implementation of equitable and rational screening programmes for cervical cancer in South Africa and internationally.