High Rates Of Cervical Cancer Research Articles

Exploring the Causes of the Low Incidence of Cervical Cancer in Western Asia

Anecdotal epidemiologic observations can provide valuable tools to study various biologic elements in complex diseases such as cancer. Although cervical cancer is one of the most frequent malignancy affecting women in the world, it displays wide geographical variations remnant of socioeconomic, ethnic and genetic predisposing factors. The observed low incidence of cervical cancer in western Asia has triggered scientists to try to delineate the causes of this reduced occurrence. Although this region including Saudi Arabia is known for being conservative societies with low incidence of sexually transmitted infections including human papillomavirus (HPV) and associated cervical cancer, scientific research points out multifaceted biological explanations including host genetic variations. Researchers observed that a protective genetic variant TP53 codon 72 proline allele was more commonly found in this population and appear to be over-transmitted compared to others known for their high rate of cervical cancer. Thus, the combination of relative low rate of HPV infection, over-transmission of protective genetic variant along with societal variables are the rationale behind the low incidence of cervical cancer in women in the region of western Asia. The influence of the genetic makeup of the patients has impact on personalized preventive medicine to gauge the risk of developing cervical cancer.

Abstract SY14-04: Cancer health disparities in American Indian and Alaskan Native populations

Abstract SY14-04: Cancer health disparities in American Indian and Alaskan Native populations

Mexican American College Men's (Mis)Understandings About HPV and Cervical Cancer.

Latinas have disproportionally high rates of cervical cancer in part due to their reliance on Latino partners to make sexual health decisions, their limited knowledge about human papillomavirus (HPV), and inconsistent Pap smear screening behaviors. In this qualitative study, we examined the sexual health beliefs of Latino college men regarding HPV. Participants included 6 Mexican American college students from a large Midwestern university. We conducted 18 in-depth individual interviews about men's beliefs, attitudes, and knowledge about HPV. Through theme analysis, we identified 4 themes suggesting that participants' limited knowledge of HPV places their female partners at risk. Implications for health promotion programming are discussed.

Abstract A46: Understanding the influential factors to human papillomavirus vaccination among youth in Harris County, Texas: A qualitative study

Abstract Introduction: Harris County, Texas is the 3rd largest county in the United States, and home to a large ratio of racial/ethnic minorities and immigrants. It has one of the highest rates of cervical cancer, where nearly all cases are caused by human papillomavirus (HPV), with the incidence rate highest among African Americans and Hispanics/Latinos. A wealth of medical resources exist, yet HPV-related cancers have failed to improve over the past 10 years. Youth are particularly at risk for HPV infection and are more likely to not receive the HPV vaccine. The aim of this research was to better understand the factors influencing HPV vaccination among youth in Harris County and to develop an evidence-based approach to improve vaccine uptake. Methods: A socio-ecological framework was used to identify key stakeholders. Data was collected using a mixed methods approach between October 2014 and October 2015 in Harris County, Texas. One focus group and 31 focused interviews were conducted with parents of 5-18 year old children. Seven key informant interviews were conducted with school nurses; a political leader; and health professionals from adolescent health clinics, pediatric hospitals, health centers, community-based organizations (CBOs), and medical institutions. Three community advisory board (CAB) meetings were held with school nurses and board members; physicians; and health professionals from health departments, CBOs, and educational and advocacy organizations. Results: Parents Most parents lacked knowledge of HPV and the vaccine. Many felt the best way to receive education was from their providers. Others expressed interest in receiving education from schools, the media, seminars, and community involvement. Spanish-speaking parents emphasized the need for more linguistically appropriate literature. Some parents voiced discomfort with vaccinating 9-12 year olds, mainly due to safety concerns and vaccine efficacy. Physicians' recommendations were an influential factor in some parents' decision making regarding vaccination. Other key stakeholders Lack of education about HPV infection and the vaccine was cited as a major barrier to vaccination. CAB participants often felt misinformed by their providers, and stated some physicians lack time to hold discussions and fail to provide confident recommendations. Perceived negative side effects; cultural and religious beliefs; lack of reminders for the 2nd and 3rd doses; and labeling the vaccine as a cervical cancer and sexual vaccine were noted as other barriers. Health clinics felt some providers' recommendation approaches were a barrier. Mistrust of the healthcare system was reported as common in Hispanic/Latino communities, and lack of engagement in preventable activities was described as common in African American and immigrant communities. It was stressed that education targeting parents, use of the opt-out approach for provider recommendations, and promoting the vaccine as a cancer-prevention vaccine are essential to increasing HPV vaccine uptake. Conclusions: Comprehensive educational interventions at the provider-, school-, and community-level are needed to ensure that physicians, parents, patients, and educators receive accurate information. Provider trainings can equip physicians with the accurate knowledge needed to make confident recommendations; emphasize use of the opt-out approach for recommendations; and provide them with multilingual educational materials to share with parents and patients. Collaborative efforts with school board members and parent organizations/associations can encourage inclusion of HPV in the curriculum, and foster discussions among parents and educators. Community-based interventions should focus on innovative, culturally-appropriate ways to disseminate education messages in medically, underserved communities. Citation Format: Aba Coleman, Marva Mallory, Jane Montealegre, Peggy Smith, Ruth Buzi, Michael Scheurer, Maria Daheri, Maria Jibaja-Weiss, Matthew Anderson. Understanding the influential factors to human papillomavirus vaccination among youth in Harris County, Texas: A qualitative study. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A46.

Preventive Mechanisms and Treatment of Cervical Cancer in Ethiopia

Background: Cervical cancer is the second most common cancer in women globally and a leading cause of death in developing countries especially Sub-Saharan Africa. Ethiopia has also been shown to share this high incidence rate of cervical cancer. Since preventive mechanisms are considered as one of the key elements in tackling the issue, this study mainly sought to uncover the status of primary preventive mechanisms and tertiary care in Ethiopia. Methodology: To get an in-depth look at the preventive mechanisms, the study mainly employed a qualitative design. A total of 13 key informant interviews were conducted with staff and officials of relevant institutions. In addition, 10 interviews were held with cervical cancer patients that were attending care in Tikur Anbesa Hospital. A quantitative design has also been implemented in which 198 patients were surveyed. Results: The study found that due to the inefficient attention paid to cervical cancer, prevention mechanisms and treatment were found to be largely inadequate and underdeveloped. The lack of proper data and other competing health care needs have been stated as the main reason behind the lack of attention paid to cervical cancer. Though steps are currently being taken to expand screening, pre-cancer treatment and invasive cancer treatment sites, the study found all the steps being taken to be in preliminary stages. Conclusion: The current focus of Ethiopia on secondary prevention mechanism is not adequate to fully address the challenge cervical cancer poses. As an emerging health care issue, cervical cancer has to be prioritized so that the proper resources, policies and strategies can be put in place to address the issue in a comprehensive manner.

Lesbian and bisexual women's gynaecological conditions: a systematic review and exploratory meta-analysis.

BackgroundLittle is known about the gynaecological health of lesbian and bisexual (LB) women.ObjectivesTo examine differences in incidence and/or prevalence of gynaecological conditions in LB compared with heterosexual women.Search strategyThe systematic review protocol was prospectively registered (PROSPERO‐CRD42015027091) and searches conducted in seven databases.Selection criteriaComparative studies published 2000–2015, reporting any benign (non‐infectious) and/or malignant gynaecological conditions with no language or setting restrictions.Data collection and analysisInclusions, data extraction and quality assessment were conducted in duplicate. Meta‐analyses of condition prevalence rates were conducted where ≥3 studies reported results.Main resultsFrom 567 records, 47 full papers were examined and 11 studies of mixed designs included. No studies directly addressing the question were found. Two chronic pelvic pain studies reported higher rates in bisexual compared with heterosexual women (38.5 versus 28.2% and 18.6 versus 6.4%). Meta‐analyses showed no statistically significant differences in polycystic ovarian syndrome, endometriosis and fibroids. There was a higher rate of cervical cancer in bisexual than heterosexual women [odds ratio (OR) = 1.94; 95% CI 1.46–2.59] but no difference overall (OR = 0.76; 95% CI 0.15–3.92). There was a lower rate of uterine cancer in lesbian than heterosexual women (OR = 0.28; 95% CI 0.11–0.73) and overall (OR = 0.36; 95% CI 0.13–0.97), but no difference in bisexual women (OR = 0.43; 95% CI 0.06–3.07).ConclusionsMore bisexual women may experience chronic pelvic pain and cervical cancer than heterosexual women. There is no information on potential confounders. Better evidence is required, preferably monitoring sexual orientation in research using the existing validated measure and fully reporting results.Tweetable abstractLesbians have less uterine cancer than heterosexual women; bisexuals have more pelvic pain and cervical cancer.

Socio-demographic and reproductive determinants of cervical neoplasia in seven sub-Sahara African countries.

Since most human papilloma virus (HPV) infections regress without any intervention, HPV is a necessary but may not be a solely sufficient cause of cervical intraepithelial neoplasia (CIN) and cervical cancer. Hence, the influence of cofactors on progression from cervical HPV infection to high-grade CIN and invasive cervical cancer has been a subject of intensive research. We assessed the effect of socio-demographic and sexual reproductive factors on the prevalence of invasive cervical cancer and CIN diagnosed in cross-sectional cervical cancer screening projects carried out in seven sites of different sub-Saharan countries. Between January 2000 and August 2007, healthy women aged 25-59 who participated in the screening projects were interviewed for socio-demographic, reproductive, and behavioral characteristics, investigated for disease confirmation with colposcopy, and had biopsies directed from colposcopically abnormal areas by trained local physicians. Odds ratios (ORs) and their 95% confidence intervals (CIs) from logistic regression analyses were used to assess the effect of women characteristics on CIN 1, CIN 2-3, CIN 3, and invasive cancer outcome measures. Among 47,361 women screened and investigated for disease confirmation, CIN 1 was diagnosed in 1,069 (2.3%), CIN 2 in 517 (1.1%), CIN 3 in 175 (0.5%), and invasive cancer in 485 (1.0%). The site-specific prevalence of CIN 2-3 lesions ranged from 0.3 to 5.1% and from 0.2 to 1.9% for invasive cancers. Risk factors for CIN 2-3 were being widowed or separated versus currently married (OR 1.3, 95% CI 1.0-1.7 a); and having had at least four pregnancies versus zero or one pregnancy (OR at least 1.4-fold, 95% CI 1.1-1.8). Risk factors for invasive cancer were being widowed or separated versus currently married (OR 2.0, 95% CI 1.3-3.1); and having had at least three pregnancies versus zero or one pregnancy (OR at least 3.0-fold, 95% CI 2.1-4.2). Additionally, cervical cancer risk increased with increasing age, age at menarche, and age at marriage, while the risk decreased with increasing level of education and in those with some form of employment compared to housewives. The exposure of the exocervix and/or the increased levels of estrogen and progesterone for more prolonged periods during pregnancy in multiparous women and the vulnerability of widowed/separated women in society might result in increased risk of cervical neoplasia more so among women exposed to HPV infection. High parity probably explains the persistently high rates of cervical cancer in sub-Saharan Africa.

Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas.

Latinas have the highest rates of cervical cancer in the United States and the second highest rate of cervical cancer mortality. One factor in the disparity is the relatively low rate of screening for cervical cancer in this population. Eligible women who were out of adherence with cervical cancer screening (>3 years since their last Papanicolaou [Pap] test) were identified via medical record review by a federally qualified local health center. The effects of a low-intensity intervention (video delivered to participants' homes; n = 150) and a high-intensity intervention (video plus a home-based educational session; n = 146) on cervical cancer screening uptake in comparison with a control arm (usual care; n = 147) were investigated. A cost-effectiveness analysis of the interventions was conducted: all intervention costs were calculated, and the incremental cost-effectiveness ratio was computed. Finally, women with positive Pap tests were provided navigation by a community health educator to ensure that they received follow-up care. A total of 443 Latinas participated. Seven months after randomization, significantly more women in the high-intensity arm received a Pap test (53.4%) in comparison with the low-intensity arm (38.7%; P < .001) and the usual-care arm (34.0%; P < .01). The incremental cost-effectiveness ratio for high-intensity women versus the control group amounted to $4.24. Twelve women had positive Pap tests, which encompassed diagnoses ranging from atypical squamous cells of unknown significance to invasive cancer; these women received navigation for follow-up care. A culturally appropriate, in-home, promotora-led educational intervention was successful in increasing cervical cancer screening among Latinas. Cancer 2017;123:666-674. © 2016 American Cancer Society.

Preventable fractions of cervical cancer via effective screening in six Baltic, central, and eastern European countries 2017–40: a population-based study

SummaryBackgroundCervical cancer incidence remains high in several Baltic, central, and eastern European (BCEE) countries, mainly as a result of a historical absence of effective screening programmes. As a catalyst for action, we aimed to estimate the number of women who could be spared from cervical cancer across six countries in the region during the next 25 years, if effective screening interventions were introduced.MethodsIn this population-based study, we applied age–period–cohort models with spline functions within a Bayesian framework to incidence data from six BCEE countries (Estonia, Latvia, Lithuania, Belarus, Bulgaria, and Russia) to develop projections of the future number of new cases of cervical cancer from 2017 to 2040 based on two future scenarios: continued absence of screening (scenario A) versus the introduction of effective screening from 2017 onwards (scenario B). The timespan of available data varied from 16 years in Bulgaria to 40 years in Estonia. Projected rates up to 2040 were obtained in scenario A by extrapolating cohort-specific trends, a marker of changing risk of human papillomavirus (HPV) infection, assuming a continued absence of effective screening in future years. Scenario B added the effect of gradual introduction of screening in each country, under the assumption period effects would be equivalent to the decreasing trend by calendar year seen in Denmark (our comparator country) since the progressive regional introduction of screening from the late 1960s.FindingsAccording to scenario A, projected incidence rates will continue to increase substantially in many BCEE countries. Very high age-standardised rates of cervical cancer are predicted in Lithuania, Latvia, Belarus, and Estonia (up to 88 cases per 100 000). According to scenario B, the beneficial effects of effective screening will increase progressively over time, leading to a 50–60% reduction of the projected incidence rates by around 2040, resulting in the prevention of cervical cancer in 1500 women in Estonia and more than 150 000 women in Russia. The immediate launch of effective screening programmes could prevent almost 180 000 new cervical cancer diagnoses in a 25-year period in the six BCEE countries studied.InterpretationBased on our findings, there is a clear need to begin cervical screening in these six countries as soon as possible to reduce the high and increasing incidence of cervical cancer over the next decades.FundingNone.

Cervical HPV infection in Romanian women infected with HIV during early childhood.

Human papillomavirus (HPV) is the most common cause of cervical cancer worldwide, and Romania has the highest rate of cervical cancer in Europe. Sixty-five young Romanian women infected with HIV during early childhood and 25 control subjects were evaluated for the presence of cervical HPV infection and for cytologic abnormalities. HPV infection was evaluated longitudinally in 42 HIV-infected individuals. Overall 28/65 (43.1%) of HIV-infected and 8/25 (32.0%) of uninfected subjects were infected with HPV, and 21/65 (32.3%) and 6/25 (24%) had high-risk subtypes, respectively. In HIV-infected women, those maintaining or acquiring a new subtype in follow-up were more likely to have a lower nadir (p = 0.04) and current (p = 0.01) CD4 cell counts. The incidence rate for HPV acquisition events was 0.69 per subject per year, and 0.52 for high-risk subtypes. In the HIV-infected group, 9/13 (69.2%) individuals with abnormal cytology progressed at follow-up. Although HPV prevalence was similar to controls, the rate of Pap smear abnormalities was much higher, possibly due to the decreased ability to mount new immune responses. Given the high rate of incident detection of vaccine preventable strains and cytologic progression in this cohort, HPV vaccination may be beneficial at any age in co-infected women.

Influence of HIV/AIDS on Cervical Cancer: A Retrospective Study From Tanzania.

PurposeCervical cancer is the leading cause of cancer-related morbidity and mortality in women in Tanzania. Any impact of the HIV/AIDS epidemic on cervical precancerous lesions and invasive cervical cancer has a significant implication, as for any public health concern, especially in an area such as the Morogoro region in Tanzania, which has one of the highest rates of cervical cancer in the world.MethodsA comparative retrospective study was performed of 536 women screened for cervical cancer by visual inspection methods at the Morogoro Regional Referral Hospital over a period of 3 years; the women were grouped according to their HIV status. The odds ratios (OR) with 95% CIs were estimated using χ2 test and multivariate analysis. The test statistics were evaluated with a significance level of P < .05.ResultsThe prevalence of precancerous lesions was 71.8% in HIV-positive women and 27.3% in HIV-seronegative women. Furthermore, the prevalence of extensive or large precancerous lesions was 40.5% in HIV-positive women and 13.5% in HIV-seronegative women. The prevalence of invasive cervical cancer was 8% in HIV-seronegative women and 11% in HIV-positive women. The risk factors for the cervical lesions were HIV-positive status (OR, 6.8; 95% CI, 4.2 to 11.2; P < .001) and being older than 30 years of age (OR, 11.99; 95% CI, 6.86 to 21.21; P < .001).ConclusionHIV/AIDS has a highly statistically significant association with (P < .001) and a great influence on the development of cervical precancerous lesions in HIV-positive women; however, its direct involvement in the progression to invasive cervical cancer, especially in this era of highly active antiretroviral therapy, is questionable.

Application of a Telecolposcopy Program in Rural Settings.

Individuals in rural areas are often restricted by the amount of physicians' availability, thus limiting access to healthcare in those settings. While Pap smear screening has increased across the United States, the rural South still reports high rates of cervical cancer and mortality. One solution to improve patient outcomes related to cervical cancer in rural settings is telecolposcopy. Women with abnormal Pap results or an abnormal visual examination needing an evaluation by colposcopy were referred to a hospital-based telecolposcopy program. Descriptive data are provided that include patients' access to care based on travel time and transportation costs. Over a 15-month time period, 940 unique patients were seen using telecolposcopy. Telecolposcopy was done at eight spoke sites across Arkansas representing patients from 72 of the 75 counties. Data for risk factors that include smoking, first sexual experience, and number of sexual partners in past 12 months and in a lifetime are discussed. Pap results and impression are provided. In addition, avoided transportation costs and travel time have been calculated and included. Cervical cancer is important public health concern especially for women residing in rural areas. We were able to demonstrate that our telecolposcopy program has provided sustainability statewide since its inception and that patients are willing to participate. In addition to providing increased access to care, the program also reduced travel time and costs associated with a face-to-face visit. Telecolposcopy should be further explored and utilized in rural settings as a way to reduce patient costs and improve cervical cancer outcomes.

PENGETAHUAN PASANGAN USIA SUBUR (PUS) TENTANG KANKER SERVIKS

Background:Cervical cancer is a type of malignancy disease that is often found among women in Indonesia. It has a relatively high frequency until 25.6%. According to the Ministry of Health, there are about 100 cases per 100 thousand population or 200 thousand cases annually, and the cases of cervical cancer in Central Java increase year to year. The high mortality rate of cervical cancer in Indosnesia due to the lack of general knowledge about the dangers of cancer, the early signs of cancer, the risks factors for cancer, the ways to overcome it correctly, as well as to familiarize themselves with a healthy lifestyle. The treatment as early as possible is an important thing by giving counseling and information about Cervical Cancer. It is one of promoted action to prevent and reduce the cervical cancer. The long-term goal of this research is to analyze and explore health issues within the scope of midwifery.&#x0D; Objectif This study has the specific purpose of analyzing the effect of health education on maternal&#x0D; knowledge about Cervical Cancer In the village of Tambakrejo, Tempel, Sleman, Yogyakarta. This study is a part of an effort to deepen the understanding of health knowledge among the community, especially in the obstetrics field.&#x0D; Result : This study is a quasi-experimental approach to one group pre-test to post-test design. The populations in this study are all couples of reproductive age in the village of Tambakrejo, Tempel, Sleman Yogyakarta.&#x0D; Conclusion The statistical test used is paired samples test. The research results show that there are differences in knowledge before and after giving health education about cervical cancer (p = 0.0001 &lt;0.05). The knowledge of cervical cancer when pre-test with a category is 3% increased to 37% at post-test. Health education provides increase the knowledge of cervical cancer among the fertile age couples.&#x0D; Keywords: Health Education, knowledge, Cervical Cancer

Rapid acquisition of HPV around the time of sexual debut in adolescent girls in Tanzania.

Background: No reports exist on genotype-specific human papillomavirus (HPV) acquisition in girls after first sex in sub-Saharan Africa, despite high HPV prevalence and cervical cancer incidence. Methods: We followed 503 HP-unvaccinated girls aged 15-16 years in Mwanza, Tanzania, 3-monthly for 18 months with interviews and self-administered vaginal swabs. Swabs were tested for 13 higHRisk and 24 low-risk HPV genotypes. Incidence, clearance and duration of overall HPV and genotype-specific infections were calculated and associated factors evaluated. Results : A total of 106 participants reported first sex prior to enrolment ( N = 29) or during follow-up (N = 77). One was HIV-positive at the final visit. The remaining 105 girls contributed 323 adequate specimens. Incidence of any new HPV genotype was 225/100 person-years (pys), and incidence of vaccine types HPV-6, -11, -16 and -18 were 12, 2, 2 and 7/100 pys, respectively. Reporting sex in the past 3 months and knowing the most recent sexual partner for a longer period before sex were associated with HPV acquisition. Median time from reported sexual debut to first HPVinfection was 5 months, and infection duration was 6 months. Conclusion: This is the first description of HPV acquisition after first sex in sub-Saharan Africa where the incidence of cervical cancer is amongst the highest in the world. HPV incidence was very high after first sex, including some vaccine genotypes, and infection duration was short. This very high HPV incidence may help explain high cervical cancer rates, and supports recommendations that the HPV vaccine should be given to girls before first sex.

Abstract B11: Viral and host gene methylation in liquid prep: novel molecular screening and triage tools to reduce cervical cancer disparities

Abstract Latino women in the United States have the highest cervical cancer incidence rate, yet the highest death rate from cervical cancer is among Black women. The disproportionate burden of cervical cancer in the United States is primarily due to lack of screening, among the medically underserved, regardless of race or ethnicity. Rural and inner city women living in poverty have lower rates of screening and higher rates of cervical cancer in the US. The advent of molecular diagnostics provides an opportunity to develop novel cervical cancer screening and triage tools that can be packaged as point of care and self-testing solutions. We set out to identify a panel of methylated HPV DNA and human genes that can discriminate between CIN2+ and normal/CIN1 patients in liquid prep samples and in Transrenal DNA (TrDNA) isolated from urine. We used three independent cohorts, from Chile, Baltimore and Puerto Rico, to develop a method that can be used to triage into colposcopy, HPV+ women with abnormal cytology. Participants were women with no cervical intraepithelial lesions or malignancy and women with abnormal cervical biopsies– Cervical Intraepithelial Neoplasia (CIN), carcinoma in-situ and cervical cancer. Using DNA methylation arrays for Discovery and quantitative Methylation Specific PCR (qMSP) for Validation, we found that promoter methylation of ZNF516, FKBP6, and INST1 discriminates samples with CIN2+ lesions from samples with no intraepithelial lesions or malignancy (NILM): 88.3% sensitivity, 88.9% specificity, 93.2 Area Under the Curve (AUC), 86.9% positive predictive value (PPV) and 90.2% negative predictive value (NPV). Using custom sequence capture pools of baits, we pulled down genomic and bisulfite converted high-risk HPV DNA before library prep for NGS in 454 and MiSeq instruments, respectively. Using our NGS results, we optimized a Syber Greeen qPCR assay to detect high risk HPV DNA and a qMSP primer-probe set to detect methylated HPV. We replicated the results in liquid prep samples (n=67), adding HPV16 methylation to the panel: 90.9% sensitivity, 60.9% specificity, 90.1 (AUC), 52.6% positive predictive value (PPV) and 93.3% NPV. These results were verified in plasma DNA (AUC=80.7) and TrDNA (AUC=86.1) isolated from a subset of patients who provided the liquid prep samples. Our results suggest that our panel of viral and host gene methylation markers may be used as a reflex test in liquid prep to triage high risk HPV positive women into colposcopy, or as a screening and triage test in TrDNA, in combination with our high risk HPV test. There are several commercial co-testing options for identification of oncogenic high-risk HPV types (HPV+) in patients with abnormal cytology. However, there are currently no tests that can reliably identify the HPV+ patients with abnormal cytology that need to be referred for colposcopy. Consequently, more than half of the women that are referred to colposcopy either have a negative biopsy, or a grade 1 Cervical Intraepithelial Neoplasia (CIN1) diagnosis, which usually reverts to normal in 12-24 months. A triage test from cytology to colposcopy that can identify in the liquid prep sample those patients with a CIN grade more likely to progress to cervical cancer (CIN2+), would decrease the number of unnecessary cervical mucosa biopsies performed today, decreasing health care cost and improving the quality of health care delivery. These molecular tools can also be packaged as point of care and self-testing solutions to eliminate cervical cancer disparities in medically underserved women. Note: This abstract was not presented at the conference. Citation Format: Rafael Guerrero-Preston, Anne Jedlicka, Blanca L. Valle, Nitesh Turaga, Liliana Florea, Oluwasina Folawiyo, Francesca Pirini, Fahcina Lawson, Angelo Vergura, Maartje Noordhuis, Gabriela Perez, Marisa Renehan, Carolina Guerrero-Díaz, Edgardo De Jesus, Teresa Diaz-Montes, Bruce Trock, Keimari Mendez, Josefina Romaguera, David Sidransky. Viral and host gene methylation in liquid prep: novel molecular screening and triage tools to reduce cervical cancer disparities. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B11.

Abstract IA12: Addressing cervical cancer disparities in Appalachia: From biology to policy

Abstract IA12: Addressing cervical cancer disparities in Appalachia: From biology to policy

Abstract C86: Adapting patient navigation to promote cancer screening in Chicago's Chinatown

Abstract Women in Chicago's Chinatown experience high rates of breast and cervical cancer. Despite the availability of health services in close proximity to Chinatown, breast and cervical cancer screening and follow-up rates are unacceptably low for Chinese women in this area. However, within this community exist complex barriers to care many women are uninsured or publicly insured, culturally isolated, and are limited English speakers. The Chinatown Patient Navigation Program is a joint effort by the Chinese American Service League (CASL), Northwestern University, and Mercy Hospital and Medical Center to evaluate a community-based patient navigation program to promote breast and cervical cancer screening and follow-up among Chinatown women. CASL is a trusted community organization in Chinatown for over 35 years; it is where the Chinatown community goes for comprehensive services and cultural events. Mercy Hospital is a community hospital located adjacent to Chinatown with a Cancer Center and Comprehensive Breast and Women's Health Center. Additionally, Mercy Hospital is the largest provider of screening mammograms and Pap tests for the Illinois Breast and Cervical Cancer Program (IBCCP) for uninsured women. Northwestern University brings patient navigation research expertise. Moreover, a Community Advisory Board (CAB) has been established and has been strengthening relationships with the Chinatown community for over five years through CASL's partnership. In this program, bicultural and multilingual (Cantonese, Mandarin, Toishanese, English speaking) patient navigators guide women through the clinics, specialty referrals, diagnostic/testing sites, and social services necessary for addressing complex barriers to care. Each navigator contributes different strengths to the team and provides cross-training to complement other team member skills with adequate linguistic, cultural, medical, and insurance knowledge. The community navigation program has comprehensively assisted over four-hundred women in the two years since we've launch the program. Outreach takes place in various community settings, and we regularly host workshops on various topics on women's health and health insurance. In the process of obtaining screenings and timely follow-up, we are helping to build women's trust in the health system and in physicians and staff; increase health coverage for the whole family; create a habit of regular exams; improve women's knowledge in patients' rights and standard clinical care experiences; and decrease fears of hospitals. Our program seeks to not only impact women's health and screening rates, but to positively change the health knowledge and healthcare access of patient's families and friends as well. A large part of the navigators' role has become that of a one-on-one educator on insurance, due to the Affordable Care Act (ACA). The complications of health insurance are compounded by language barriers and lack of knowledge of America's health system. Moreover, systems-level challenges persist, including lack of Chinese-speaking primary-care physicians, shrinking local and state budgets, along with limited cancer education, insurance information and resource availability in Chinese. The Chinatown Patient Navigation Program has an important research component. This includes focus groups to explore Chinatown women's experiences with the U.S. health care delivery system and individual survey interviews to understand Chinese women's barriers to accessing health care along with their social support and networks. Detailed patient navigation efforts are tracked for a comprehensive process evaluation that can help us better understand service delivery, as well as women's needs and behaviors for obtaining health services independently. In addition, utilization data and medical records will be used to assess changes in community-wide breast and cervical cancer screening rates. Findings from these research activities will help future activities to develop, implement, and disseminate effective and culturally appropriate community-based health programs to eliminate health disparities for Chinese American women. Future directions are to establish a one-stop shop for healthcare services featuring fully integrated Chinese support and to expand navigation services to other chronic diseases and illnesses. This partnership will also serve as a viable model for other community-academic partnerships in underserved communities seeking to improve local health care systems. Citation Format: Ivy S. Leung. Adapting patient navigation to promote cancer screening in Chicago's Chinatown. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C86.

Mujer Sana, Familia Fuerte: The Effects of a Culturally-Relevant, Community-Based, Promotores Program to Increase Cervical Cancer Screening among Latinas.

Although cervical cancer can be prevented through screening and follow-up, Latinas' rate of Pap tests remains low due to knowledge gaps and cultural and attitudinal factors. This study used a single-group pre-/post-test design to evaluate the effectiveness of Mujer Sana, Familia Fuerte (Healthy Woman, Strong Family), an intervention intended to improve Latinas' cervical cancer prevention knowledge, attitudes, self-efficacy to obtain a Pap test, and intention to get tested. The intervention is delivered through a single session by promotores de salud, who use a culturally competent, linguistically appropriate toolkit. A total of 5,211 Latinas participated in the study. The evaluation indicated that participants had increases in knowledge, positive attitudes, self-efficacy, and intention to test. Latinas have a low rate of cervical cancer screening but a high rate of cervical cancer, and Mujer Sana, Familia Fuerte shows promise as a public health practice for use with this population.

High rates of cervical cancer among HIV-infected women at a referral hospital in Malawi

High rates of cervical cancer among HIV-infected women at a referral hospital in Malawi

Knowledge, Attitude, Practice and Barriers regarding cervical cancer and its screening using Pap smear, in rural women of Ba, Lautoka and Nadi, Fiji.

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Fiji has a high rate of cervical cancer, which is the second most common cause of cancer deaths in women in the country. Less than 10% of women are screened for cervical cancer in Fiji.In this paper we report the result of a study on Knowledge, Attitude, Practice and Barriers (KAPB) to cervical cancer and its screening with Pap smears, conducted on 1505 rural women in Fiji.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives:&lt;/strong&gt; To assess the knowledge, attitudes, practice and barriers to cervical cancer and it’s screening with Pap smears in rural women of Ba, Lautoka and Nadi, in Fiji.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods&lt;/strong&gt;: Structured questionnaires were administered to women presenting to a rural outreach Reproductive Health education and clinics, by trained health educators to ascertain their Knowledge, Attitudes, Practice and Barriers to cervical cancer and its screening with Pap smears.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;: Seventy two percent of rural women had no knowledge of cervical cancer and 80% had no knowledge of the risk factors of cervical cancer. Lack of knowledge was significantly different for age groups (p=0.006), education levels and employment status(p&amp;lt;0.001) and ethnicity (p=0.022). Those groups with lowest knowledge were teenagers (18 to 19 years); those with less education; and iTaukei respondents. Of the respondents who had at least some knowledge of the Pap smear, 75% had had a Pap test. Of those who had no knowledge of the Pap smear, only 45% had had the test (p&amp;lt;0.001). Of those who did not have a Pap smear the commonest barrier was lack of knowledge at 46.3% and fear of procedure was 29.4%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: More education is required to acquaint women in rural Fiji about cervical cancer, its associated risk factors as well as the benefits of cervical cancer screening programs and other prevention strategies. &lt;/p&gt;