Excess Cervical Cancer Research Articles

COVID-19 disruption to cervical cancer screening in England.

IntroductionIn England, routine invitations for cervical screening were reduced between April 2020 and June 2020 due to the COVID-19 pandemic. We quantify the impact of COVID-19 disruptions on attendance and excess diagnoses of cervical cancer (CC).MethodsUsing Public Health England CC screening data on laboratory samples received in 2018 as a baseline we quantify the reduction in screening attendances due to the COVID-19 pandemic between April 2020 and March 2021 for women aged 25–64. We model the impact on excess CC diagnoses assuming once invitations resume 87.5% of women attend within 12 months and 12.5% delay screening for 3 or 5 years (depending on age).ResultsThe number of samples received at laboratories was 91% lower than expected during April, 85% during May and 43% during June 2020 compared to the same period in 2018. Although on average laboratories received 12.6% more samples between August 2020 and April 2021 than over the same months in 2018, by April 2021 there was a short fall of 200,949 samples (6.4% fewer than in 2018). An excess of 41 CC (4.0 per 100,000 women with a maximum screening delay of 12 months) are predicted to occur among the estimated 1,024,794 women attending this screening round with a delay. An excess of 60 CC (41.0 per 100,000 women) are predicted to occur among the estimated 146,391 women who do not attend this screening round.ConclusionPrompt restoration of cervical screening services limited the impact on excess CC diagnoses. However, in 2020 a 6.4% shortfall of screening samples was observed. Every effort should be made to reassure these women that services are open and safe to attend.

Reducing Poverty-Related Disparities in Cervical Cancer: The Role of HPV Vaccination.

Near elimination of cervical cancer in the United States is possible in coming decades, yet inequities will delay this achievement for some populations. We sought to explore the effects of human papillomavirus (HPV) vaccination on disparities in cervical cancer incidence between high- and low-poverty U.S. counties. We calibrated a dynamic simulation model of HPV infection to reflect average counties in the highest and lowest quartile of poverty (percent of population below federal poverty level), incorporating data on HPV prevalence, cervical cancer screening, and HPV vaccination. We projected cervical cancer incidence through 2070, estimated absolute and relative disparities in incident cervical cancer for high- versus low-poverty counties, and compared incidence with the near-elimination target (4 cases/100,000 women annually). We estimated that, on average, low-poverty counties will achieve near-elimination targets 14 years earlier than high-poverty counties (2029 vs. 2043). Absolute disparities by county poverty will decrease, but relative differences are estimated to increase. We estimate 21,604 cumulative excess cervical cancer cases in high-poverty counties over the next 50 years. Increasing HPV vaccine coverage nationally to the Healthy People 2020 goal (80%) would reduce excess cancer cases, but not alter estimated time to reach the near-elimination threshold. High-poverty U.S. counties will likely be delayed in achieving near-elimination targets for cervical cancer and as a result will experience thousands of potentially preventable cancers. Alongside vaccination efforts, it is important to address the role of social determinants and health care access in driving persistent inequities by area poverty.

Effect of an Electronic Health Record Decision Support Alert to Decrease Excess Cervical Cancer Screening.

Cervical cancer screening is often conducted in excess of current screening guidelines. The objective of this study was to evaluate the effect of an electronic health record (EHR) clinical decision support alert to decrease guideline-nonadherent cervical cancer screening beyond the age limits of screening or posthysterectomy. The proportion of guideline-nonadherent Pap tests in women younger than 21 years or older than 65 years or posthysterectomy were compared 4 months before and 3 months after implementation of an EHR clinical decision support alert warning providers that a Pap test is not indicated. Providers could cancel the Pap test or override the alert and place the order. Provider characteristics and Pap test indications were summarized by preintervention/postintervention period using descriptive statistics. The proportions of nonindicated Pap tests were compared by intervention period and provider characteristics using generalized estimating equation models. In women beyond the screening age limits or posthysterectomy, a total of 388 Pap tests were ordered before intervention, and 313 tests were ordered after intervention. Proportion of guideline-nonadherent tests was similar before (62%) and after intervention (63%); thus, implementation of the clinical decision support alert did not change the proportion of guideline-nonadherent Pap tests ordered (OR = 1.08, 95% CI = 0.77-1.52). It is notable that 52% of guideline-nonadherent tests were ordered by 11 providers. Even when controlling for providers who ordered more than 1 test during the study period, multivariate analysis showed that male providers were more likely to order guideline-nonadherent Pap tests (OR = 2.30, 95% CI = 1.36-3.89); no other differences by provider characteristics were observed. An EHR clinical decision support alert does not decrease guideline-nonadherent cervical cancer screening. These data suggest efforts to optimize clinical decision support should be focused on other aspects of cervical cancer prevention.

Insurance status and cancer treatment mediate the association between race/ethnicity and cervical cancer survival.

Cervical cancer outcomes remain poor among disadvantaged populations, including ethnic minorities, low-income, and underinsured women. The aim of this study was to evaluate the mechanisms that underlie the observed association between race/ethnicity and cervical cancer survival. We identified 13,698 women, ages 21 to 64 years, diagnosed with stages I-III primary cervical cancer between 2007–2013 in Surveillance, Epidemiology, and End Results (SEER). Multivariable Cox proportional hazards regression models evaluated associations between race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, Other) and cervical cancer-specific mortality. We conducted mediation analysis to calculate the mediation proportion and its 95% confidence interval. Non-Hispanic black women had an increased risk of cervical cancer-specific mortality (HR: 1.23, 95% CI: 1.08–1.39), and Hispanic women a decreased risk of dying from their disease (HR: 0.82, 95% CI: 0.72–0.93), compared with non-Hispanic white. The estimated proportion of excess cervical cancer mortality for non-Hispanic black women relative to non-Hispanic white women that was mediated by insurance was 18.6% and by treatment was 47.2%. Furthermore, non-Hispanic black women were more likely to receive radiation and less likely to receive surgery for early-stage disease. In this population-based study we found that some of the excess cervical cancer-specific mortality for non-Hispanic black women is mediated by factors such as insurance status and treatment. These findings suggest that enhancing existing insurance coverage and ensuring equal and adequate treatment in all women may be a key strategy for improving cervical cancer outcomes.

Excess cervical cancer screening smears: Any benefit? A retrospective cohort in Alsace, France.

Objectives Although cervical cancer screening guidelines in France recommend a smear test every three years, many physicians order more regular screening. We aimed to assess the benefits or harms of shorter intervals between screenings, both for women and public health. Methods For a retrospective cohort of women aged 25-65 who had two normal smears and at least one additional smear, data were sourced from a regionally organized cervical cancer screening programme in France, with follow-up for nine years. Based on the interval between the second and third smear, two groups were formed; the first comprised overscreened women (interval <24 months), and the second of 'correctly' screened women (interval between 24 and 42 months). The primary outcome was cervical intraepithelial neoplasia 2 or worse (CIN2+); secondary outcomes were cervical cancers and CIN1 lesions. Results Among 63,821 women, CIN2+ incidence rate per 10,000 women per year was 14.5 for 40,350 overscreened women, and 11.5 for 23,471 correctly screened women. Age-adjusted relative risk was 1.22[1.02; 1.46]. We found no significant difference for cancer (RR = 1.39; 95%CI = [0.60; 3.61]), but did find additional CIN1 in the overscreened group (RR = 2.09; 95%CI = [1.76; 2.51]). Conclusions A shorter interval between smears has a low benefit for CIN2+ lesion detection, which may not help avoid cancer. The excess number of CIN1 detected by overscreening may cause needless risk and excess costs due to overtreatment.

Abstract B52: Utilizing media to reduce the burden of cervical cancer in Little Haiti: A community-based participatory research (CBPR) approach

Abstract This video project is part of a larger, ongoing Community-based Participatory Research (CBPR) initiative aimed to reduce the burden of cervical cancer among Haitian women living in South Florida. Haitian women in this region, particularly those who reside in Little Haiti, the largest enclave of Haitian settlement in the United States, experience excess cervical cancer incidence and mortality. Since 2004 key community stakeholders, community health workers, and academic investigators from the University of Miami Miller School of Medicine (UMMSM) have worked collaboratively to address this disparity through complementary, community-based primary and secondary prevention efforts. The partnership has also enabled an in-depth exploration of the risk factors and risk conditions that account, in large part, for the high rate of cervical cancer observed in Little Haiti, including socioeconomic marginalization, language barriers, distrust of researchers, humoral conceptions of illness, and immigration status. Successful prevention efforts must address these multiple barriers to ensure timely screening and treatment for cervical cancer among women in Little Haiti. The United States Preventative Services Task Force recommends Pap screening every 3 years for women 21-65 while the Community Preventative Services Task Force recommends the use of small media including videos and printed materials to promote knowledge of and action on cervical cancer screening. Blending these recommendations with the knowledge obtained through nearly ten-years of campus-community collaboration, we created two ten-minute educational films on cervical cancer prevention for a Haitian audience. The films focus on prevention through HPV vaccination and Pap testing. The dialogue is exclusively in Haitian Kreyol with English subtitles. The films were written and produced by a Haitian writer and producer, with significant community input, star Kreyol-speaking actors, and incorporate medical and public health knowledge shared by the UMMSM partners. Reflective of community feedback regarding how to best structure health messages, the films revolve around a storyline of a Haitian family and how they approach a cervical cancer diagnosis and options for screening and prevention. The films address specific issues that have been raised over the course of the CBPR project including clarifying the difference between HPV and HIV, discussing the HPV vaccine and its unfounded association with sexual promiscuity, and the proactive role Haitian men can play in promoting cervical cancer awareness within the community at large. As we enter the dissemination phase of the project, our community advisory board and production team will collaborate to optimize a plan for circulating the videos throughout Little Haiti, including pairing viewing with ongoing screening and vaccination efforts. Via the internet, the videos will be made available to other Haitian audiences throughout the United States and around the world to promote widespread awareness and action on cervical cancer. These videos are a novel approach to cervical cancer prevention among Haitian women that draw on community knowledge to ensure cultural and linguistic relevance. Because Haitian Kreyol is traditionally a spoken language whose orthography was only recently solidified, this video approach shows particular promise in reaching a monolingual Kreyol-speaking audience to better promote cervical cancer prevention efforts in Little Haiti, Haiti, and throughout the Haitian Diaspora. Citation Format: Brigitte Frett, Myra Aquino, Marie Fatil, Michele Fievre, James LaPierre, Dinah Trevil, Olveen Carrasquillo, Erin Kobetz. Utilizing media to reduce the burden of cervical cancer in Little Haiti: A community-based participatory research (CBPR) approach. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B52. doi:10.1158/1538-7755.DISP13-B52

Working to Close the Gap: Identifying Predictors of HPV Vaccine Uptake among Young African American Women

Factors associated with greater likelihood of human papillomavirus (HPV) vaccination among women who experience excess cervical cancer incidence and mortality requires further study. The purpose of this study was to assess factors associated with HPV vaccine uptake among young African American women. Three hundred sixty-three African American women aged 18-26 were recruited from Historically Black Colleges/Universities to complete a questionnaire to assess health beliefs associated with HPV vaccination. One quarter of participants reported uptake of the HPV vaccine. Women who reported uptake had significantly higher HPV knowledge, lower perceived barriers to vaccination, and were younger (all p<.05). Factors significantly associated with HPV vaccine uptake included HPV knowledge (OR=1.22), perceived severity of health outcomes (OR=0.48), perceived barriers to vaccination (OR=0.49), cues to action (OR=1.94), and age (OR=0.68). Findings can be used to inform the development of targeted HPV vaccine promotion programs for African American women to prevent continued cervical cancer disparities.

Abstract B19: Developing HPV educational programs in faith-based settings: Results of a community-based participatory research study

Abstract Purpose: African-American (AA) women in South Carolina experience excess cervical cancer incidence and mortality despite reporting higher rates of screening. The reasons for this observation are complex and not well understood. The faith-based setting is potentially a model setting to address cancer disparities. The purpose was to explore the acceptance of and opportunities for providing HPV vaccine education in faith-based settings. Methods: The research was community-based and participatory and conducted in collaboration with the State Baptist Young Woman's Auxiliary Health Ministry members in Region 6, five churches (Manning Baptist Church, New Hopewell Baptist Church, Little Mt. Zion Baptist Church, Mt. Pisgah Baptist Church, and Majority Baptist Church), and Carolina Community Based Health Supports Networks. Church liaisons and community data collectors were trained to identify, recruit, and collect data from eligible participants using a closed-ended questionnaire and semi-structured guide. Descriptive data were analyzed in SAS. Qualitative data were analyzed and interpreted using constant comparison and content analysis methods. Results: A total of 20 in-depth interviews and 10 focus groups (96 participants) were conducted. All participants (n=116) were AA and the majority of participants were female (92%); were insured (95%); had completed high school or beyond (89%). The mean age of participants was 38.8 years. Less than half (41%) correctly identified HPV as a main cause of cervical cancer, but 75% of participants had heard of HPV. Most participants (77%) supported a school requirement for HPV vaccination. The in-depth interviews and focus groups provided information on the content and nature of cervical cancer prevention and control educational programs, including HPV vaccines, in faith-based settings. Most participants felt that the church was an appropriate setting for HPV education and discussions about the HPV vaccine and emphasized the importance of involving youth and adults in such efforts. While there was support for HPV vaccination, there were several comments regarding the age, safety, and unknown aspects of the HPV vaccine. Findings were presented back to participants and interested others in feedback sessions held in the partnering churches. Conclusion: Participants’ knowledge of HPV and cervical cancer was average. There was general interest and support of the HPV vaccine among participants, but participants want more information, especially regarding safety. According to participants, the church is an ideal place to conduct programs, but programs need buy-in, support, and collaboration from leaders and stakeholders. Youth and adults should be the focus of such a program planned in partnership with church leaders. There was much discussion on the importance of engaging youth. The findings from this study are encouraging and show that this population of southern, AA church members are accepting of the HPV vaccine, feel that HPV education is needed, and are receptive to an HPV and cervical cancer educational program in the church. The findings are being used to inform development of faith-based interventions to increase knowledge about HPV and cervical cancer and promote informed decision making about HPV vaccines, and potentially decrease excess cervical cancer mortality. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B19.

Abstract B35: Working to close the gap: Identifying predictors of HPV vaccine initiation among young African American women

Abstract Background: HPV (human papillomavirus) vaccines are recent innovations that have provided a new avenue for cervical cancer prevention. The role of HPV vaccines among groups of women who experience excess cervical cancer incidence and mortality requires further study. The purpose of this study was to assess health beliefs associated with HPV vaccine initiation among young African American (AA) women. Methods: Three hundred sixty-three African American female college students aged 18-26 were recruited from three Historically Black Colleges/Universities in the southeastern United States. Participants were asked to complete a self-administered, anonymous survey to assess knowledge and beliefs related to HPV and the HPV vaccine. Results: One-quarter (24%) of participants initiated the HPV vaccine. Women who initiated the HPV vaccine had significantly higher HPV knowledge (p=0.01), lower perceived barriers to vaccination (p&amp;lt;0.01), and were younger (p&amp;lt;0.01) compared to women who had not initiated vaccination. Factors significantly associated with HPV vaccine initiation included: HPV knowledge (OR=1.22), perceived severity of HPV health outcomes, (OR=0.48), perceived barriers to vaccination, (OR=0.49), cues to action (OR=1.94), and age (OR=0.68). The model explained 19% of the variance in HPV vaccine initiation. Conclusions: Study findings can be used to inform the development of targeted health education and promotion HPV vaccine programs for AA college-aged women to prevent continued disparities in cervical cancer incidence and mortality. Addressing health beliefs will be central to efforts to promote widespread vaccine uptake and future reduction in disease. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B35.