Cervical Cancer Screening History Research Articles

Characterization of Cervical Cancer Screening History Among Patients with Invasive Cervical Cancer: A Population-Based Approach

•A high proportion of patients with cervical cancer were not up to date on screening at diagnosis.•Histology, age and path to diagnosis were associated with cervical cancer screening history.•Targeted health maintenance and screening guideline adherence are called for.

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

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

Questionnaire survey on cervical cancer screening and HPV awareness among patients at a local cancer center in Japan

BackgroundThe incidence of cervical intraepithelial neoplasia is increasing in Japan. Although human papillomavirus (HPV) vaccination and cancer screening are crucial in preventing cancer-related mortality, the cervical cancer screening rate in Japan was only approximately 43.6% in 2022. This study aimed to conduct an epidemiological analysis of cervical cancer by collecting data from individual patients.MethodsA questionnaire survey was administered to patients who visited our hospital between January 2017 and July 2023 owing to abnormal cervical cytological findings or a cancer diagnosis. Patients answered questions regarding their history of cervical cancer screening as well as their knowledge of HPV and cervical cancer.ResultsDuring the study period, 471 patients participated in the survey, with 35 declining to participate. Patients with Stage 1b1–4b primarily sought medical attention due to self-reported symptoms (P < 0.001); however, they were less likely to have undergone cervical cancer screening (P < 0.001). Additionally, older patients were less likely to be aware of the association of HPV with cervical and other cancers. Notably, 28 of the 129 patients with stage 1b1–4b cancer underwent cervical cancer screening within 2 years. The tumor location within the endocervical canal emerged as a significant factor contributing to the difficulty for an accurate diagnosis of precancerous or cervical cancer during cervical screening. Furthermore, non- squamous cell carcinoma (SCC) histology was another possible factor.ConclusionsOur findings suggest the need to widely disseminate information regarding the significance of cancer screening to increase cancer screening rates. Moreover, establishing strategies for improving the accuracy of detecting lesions during screening for non-SCC and endocervical canal tumors is crucial.

Parental willingness to vaccinate their daughters against human papilloma virus and its associated factors in Woldia town, Northeast Ethiopia.

The cells of the cervical epithelial wall are the source of the malignant tumor caused by the human papilloma virus (HPV) known as cervical cancer. In 2018, Ethiopia implemented the HPV vaccine specifically targeting girls aged 9-14 years. This vaccination initiative serves as an effective preventive measure against cervical cancer, provided that parents express a positive inclination to have their daughters vaccinated as part of the program. The aim of the study was to assess parental willingness to vaccinate their daughters against human papillomavirus and its associated factors in Woldia town, Northeast Ethiopia. A community-based cross-sectional study was conducted among 414 parents of daughters aged 9-14 years between 10 and 25 January 2023. Respondents were selected by a systematic sampling method and a face-to-face interview was conducted to collect data. Data were entered into Epi Data version 4.6 and exported to SPSS version 25 for analysis. Multivariable analyses were used to examine the association between dependent and independent variables. The adjusted odds ratio (AOR), 95% confidence interval (CI), and p-value <0.05 were used to determine statistical significance. A total of 410 study participants with a response rate of 99% were included in the study, and approximately 72.9% (95% CI: 68.3-77.2) of them were willing to vaccinate their daughters. This study found that parents with a family history of cervical cancer screening (AOR = 3.27, 95%; CI = 1.38-7.74), secondary and above educational status (AOR = 2.72, 95% CI = 1.29-5.73), good knowledge of the human papilloma virus vaccination (AOR = 3.00, 95% CI = 1.70-5.28), and favorable attitude toward the human papilloma virus vaccine (AOR = 4.40, 95% CI = 2.45-7.88) were significantly associated with parental willingness to vaccinate their daughters against human papilloma virus. In this study, most parents were willing to vaccinate their daughters against human papilloma virus. The significant determinants of parental willingness to their daughter's human papilloma virus vaccination were family history of cervical cancer screening, level of education, and knowledge and attitude toward the human papilloma virus vaccine. Therefore, health information regarding the human papillomavirus vaccination with an emphasis on raising community awareness should be designed.

The levels of women’s awareness, experience, acceptability and preference for Vaginal Human Papillomavirus (HPV) self-sampling in three provinces of China: a cross-sectional study

BackgroundThe primary screening technique for precancerous lesions and cervical cancer is human papillomavirus (HPV) testing, and HPV self-sampling has been shown to be consistent with clinician sampling in terms of the accuracy of the results and may improve cervical cancer screening rates. The aim of this study was to understand the level of awareness, experience, acceptability, and preference for vaginal HPV self-sampling among women in Jiangsu, Zhejiang, and Shanghai, China, and to analyze the possible influencing factors to determine the feasibility of implementing self-sampling.MethodsOverall, 1793 women were included in the data analysis. A self-administered questionnaire was utilized. In addition to descriptive analysis, univariate and multivariate analyses were used to explore the associations between sociodemographic features, history of cervical cancer screening, and the level of awareness, experience, acceptability, and preference for HPV self-samples.ResultsThe participants’ level of awareness of and experience with HPV self-sampling were moderate. A total of 88.8% of participants rated the acceptability as “high”, and self-sampling was preferred by 64.2% of them for cervical cancer screening. People aged 45 to 54 years showed a preference for both clinician sampling(OR = 1.762 (1.116–2.163)) and self-sampling (OR = 1.823 (1.233–2.697)). Those who had graduated from high school or above (OR = 2.305 (1.517–3.503), OR = 2.432 (1.570–3.768), OR = 3.258 (2.024–5.244)) preferred clinician-sampling, and those with a bachelor’s degree or above (OR = 1.664 (1.042–2.657)) preferred self-sampling. Middle- and high-income individuals showed no preference for either sampling method (OR < 1).ConclusionsHPV self-sampling is widely accepted, but awareness, experience and preferences need to be improved. These results may help to adjust public health strategies for the early inclusion of HPV self-sampling as a screening method in national initiatives to prevent cervical cancer.

Exploring the Correlation Between Health Literacy and Knowledge of Cervical Cancer and Radiotherapy Among Japanese Women: A Web-Based Survey.

Health literacy (HL) plays a vital role in an individual's ability to make informed health decisions. Japan faces several challenges in cervical cancer control, including low human papillomavirus (HPV) vaccination and screening rates, underutilization of radiotherapy, and limited HL. This study explored the association between HL and knowledge of cervical cancer and radiotherapy, particularly among young Japanese women. We conducted a web-based survey among users of LunaLuna, a popular women's healthcare application, to assess their HL and knowledge about cervical cancer and radiotherapy through a 46-question survey. We compared three groups in terms of HL (inadequate, problematic, and sufficient & excellent). Multiple regression analysis was used to identify factors associated with knowledge. In total, 1468 respondents were included in this study. HL was positively correlated with knowledge scores (inadequate: 51.8%; problematic: 56.3%; sufficient & excellent: 60%). Participants displayed relatively low accuracy for treatment-related questions. Higher HL (β = 0.15, p < 0.01), education (β = - 0.11, p < 0.01), cervical cancer screening (β = - 0.11, p < 0.01), income (β = 0.09, p < 0.01), and employment (β = - 0.06, p = 0.04) were significant factors affecting knowledge of cervical cancer and radiotherapy. Our findings underscore the pivotal role of HL in promoting cervical cancer prevention and providing a better understanding of radiotherapy. Despite factors such as age, education, and history of cervical cancer screening, HL showed the strongest association with knowledge of cervical cancer and radiotherapy. The enhancement of HL and knowledge dissemination may be critical for promoting cervical cancer prevention and radiotherapy in Japan.

Correlates of intention to screen for cervical cancer among adult women in Kyotera District, Central Uganda: a community based cross-sectional study

IntroductionCervical cancer continues to pose a major public health challenge in low-income countries. Cervical cancer screening programs enable early detection and effectively reduce the incidence of cervical cancer as well as late-stage diagnosis and mortality. However, screening uptake remains suboptimal in Uganda. This study assessed correlates of intention to screen for cervical cancer among women in the Kyotera district of Central Uganda.MethodsWe analyzed cross-sectional data collected to determine the effectiveness of community audio towers (CATs) as a modality of health communication to support cervical cancer prevention. Women (n = 430) aged 21–60 years without a prior history of cervical cancer screening were surveyed about demographics, sources of health information and cervical cancer screening intentions in 2020. We used generalized linear modelling with modified Poisson regression and backwards variable elimination to identify adjusted prevalence ratios and 95% confidence intervals (CI) to determine factors associated with intention to screen for cervical cancer.ResultsHalf (50.2%) of the participants had intentions to screen for cervical cancer within twelve months and 26.5% had moderate knowledge about cervical cancer. Nearly half (46.0%) considered themselves at risk of cervical cancer. Compared to residents who primarily received their health information from social media and radio, participants who received health information primarily from CATs (aPR:0.64, 95% CI:0.52–0.80, p < 0.001) and TV (aPR:0.52, 95% CI:0.34–0.82, p = 0.005) had a lower prevalence of intention to screen for cervical cancer. The prevalence of intentions to screen for cervical cancer in twelve months was higher among those resided in town councils (aPR:1.44, 95% CI:1.12–1.86, p = 0.004) compared to rural areas, and higher among those who considered themselves to be at risk of cervical cancer (aPR:1.74, 95% CI:1.28–2.36, p < 0.001) compared to those who did not.ConclusionsWe found suboptimal prevalence of intentions to screen for cervical cancer among women in central Uganda. Additional research and implementation projects are needed to increase cervical cancer screening. Targeting risk perceptions and behavioral approaches to increase intentions could be effective in future intervention work. Based on urban-rural differences, additional work is needed to support equitable sharing of information to support cancer prevention messaging; CATs and TV may best help reach those with lower intentions to screen based on our research.

Prevalence and predictors of cervical cancer screening among HIV-positive women in rural western Uganda: insights from the health-belief model

BackgroundWomen living with HIV are at increased risk of developing cervical cancer (CC). Screening for cancer is an important preventive strategy for the early detection of precancerous lesions and its management. There has been inadequate evidence on cervical cancer screening (CCS) practices among HIV-positive women in rural western Uganda. This study aimed to assess the prevalence and predictors of CCS among HIV-positive women, as well as knowledge and practices regarding cervical cancer screening.MethodsA cross-sectional, analytical study was conducted among HIV-positive women attending HIV care facilities located in rural settings of western Uganda. A validated and interview-based data collection form was used to capture statistics regarding demographics, HIV care, obstetric profile, health belief constructs, and knowledge and history of CCS from the participants. Bivariate and multivariate logistic regression analyses were used to correlate women’s characteristics and health beliefs toward CCS practices.ResultsThe prevalence of CCS among HIV-positive women was found to be 39.1% (95%CI: 14.0–71.7). A multivariate logistic regression analysis showed that post-secondary education attainment (AOR = 3.21; 95%CI = 2.12–7.28), four years or more lapsing after being diagnosed as HIV-positive (AOR = 2.87; 95%CI = 1.34–6.13), having more than one child (AOR = 1.87; 95%CI = 1.04–3.35), antenatal care attendance (AOR = 1.74; 95%CI = 1.02–3.43), post-natal care attendance (AOR = 3.75; 95%CI = 1.68–5.89), and having good knowledge regarding CC (AOR = 1.26; 95%CI = 1.98–3.02) were positively associated with adherence to CCS among HIV-positive women in western Uganda. Health Belief Model (HBM) constructs like the perceived risk of developing CC (AOR = 1.82; 95%CI = 1.16–2.01), worries about developing CC (AOR = 5.01; 95%CI = 4.26–8.32), believing that CC leads to death (AOR = 2.56; 95%CI = 1.64–3.56), that screening assists in early identification (AOR = 2.12; 95%CI = 1.84–3.74) and treatment (AOR = 4.63; 95%CI = 2.78–6.43) of precancerous lesions, reducing the risk of mortality (AOR = 1.84; 95%CI = 1.12–2.75), and the reassurance provided by negative test results (AOR = 2.08; 95%CI = 1.33–4.22) were positively associated with adhering to CCS. A female doctor performing the screening (AOR = 2.02; 95%CI = 1.57–3.98) as well as offering a free screening service (AOR = 3.23; 95%CI = 1.99–4.38) were significantly associated with CCS. Meanwhile, screening being painful (AOR = 0.28; 95%CI = 0.12–0.45), expensive (AOR = 0.36; 95%CI = 0.24–0.53), time-consuming (AOR = 0.30; 95%CI = 0.19–0.41), embarrassing (AOR = 0.02; 95%CI = 0.01–0.06), and the fear of positive results (AOR = 0.04; 95%CI = 0.02–0.10) were found to have a significant negative association with adhering to CCS.ConclusionsOnly one-third of HIV-positive women had undergone CCS. Variables including secondary education attainment, four years or more lapsing after being diagnosed as HIV-positive, having more than one child, antenatal care attendance, post-natal care attendance, and knowledge about CC were positively associated with CCS adherence. Educational programs should be geared towards the risk of CC, severity of cases, benefits of screening, and reducing barriers associated with screening, which can significantly improve cervical CCS among HIV-positive women. The study proposes the incorporation of free screening services and the inclusion of trained female staff in CC prevention policies to improve CCS.

Strategies to Increase Cervical Cancer Screening With Mailed Human Papillomavirus Self-Sampling Kits

Optimal strategies for increasing cervical cancer screening may differ by patient screening history and health care setting. Mailing human papillomavirus (HPV) self-sampling kits to individuals who are overdue for screening increases adherence; however, offering self-sampling kits to screening-adherent individuals has not been evaluated in the US. To evaluate the effectiveness of direct-mail and opt-in approaches for offering HPV self-sampling kits to individuals by cervical cancer screening history (screening-adherent and currently due, overdue, or unknown). Randomized clinical trial conducted in Kaiser Permanente Washington, a US integrated health care delivery system. Individuals aged 30 to 64 years with female sex, a primary care clinician, and no hysterectomy were identified through electronic health records (EHRs) and enrolled between November 20, 2020, and January 28, 2022, with follow-up through July 29, 2022. Individuals stratified as due (eg, at the time of randomization, these individuals have been previously screened and are due for their next screening in ≤3 months) were randomized to receive usual care (patient reminders and clinician EHR alerts [n = 3671]), education (usual care plus educational materials about screening [n = 3960]), direct mail (usual care plus educational materials and a mailed self-sampling kit [n = 1482]), or to opt in (usual care plus educational materials and the option to request a kit [n = 3956]). Individuals who were overdue for screening were randomized to receive usual care (n = 5488), education (n = 1408), or direct mail (n = 1415). Individuals with unknown history for screening were randomized to receive usual care (n = 2983), education (n = 3486), or to opt in (n = 3506). The primary outcome was screening completion within 6 months. Primary analyses compared direct-mail or opt-in participants with individuals randomized to the education group. The intention-to-treat analyses included 31 355 randomized individuals (mean [SD] age, 45.9 [10.4] years). Among those who were due for screening, compared with receiving education alone (1885 [47.6%]), screening completion was 14.1% (95% CI, 11.2%-16.9%) higher in the direct-mail group (914 [61.7%]) and 3.5% (95% CI, 1.2%-5.7%) higher in the opt-in group (2020 [51.1%]). Among individuals who were overdue, screening completion was 16.9% (95% CI, 13.8%-20.0%) higher in the direct-mail group (505 [35.7%]) compared with education alone (264 [18.8%]). Among those with unknown history, screening was 2.2% (95% CI, 0.5%-3.9%) higher in the opt-in group (634 [18.1%]) compared with education alone (555 [15.9%]). Within a US health care system, direct-mail self-sampling increased cervical cancer screening by more than 14% in individuals who were due or overdue for cervical cancer screening. The opt-in approach minimally increased screening. To increase screening adherence, systems implementing HPV self-sampling should prioritize direct-mail outreach for individuals who are due or overdue for screening. For individuals with unknown screening history, testing alternative outreach approaches and additional efforts to document screening history are warranted. ClinicalTrials.gov Identifier: NCT04679675.

The barriers to cervical cancer screening for urban and rural populations in Rwanda

BackgroundCervical cancer is the leading cause of cancer mortality in Rwandan women. There is a limited understanding of the barriers that women face to obtain cervical cancer screening in Rwanda. It is important to understand the barriers in order to implement effective screening programs. The goal of this study is to describe the barriers to cervical cancer screening among women in Rwanda and how they differ among women in rural and urban areas.MethodsThis cross-sectional study recruited women from June 1 to 9, 2022, at Muhima and Nyamata District Hospitals in Rwanda. Women were eligible for the study if they were ≥ 18 years and spoke Kinyarwanda or English. Women completed a 15-min survey which included questions on the participants’ demographics, knowledge of cervical cancer, cervical cancer screening history, and barriers to healthcare. Women were stratified by survey location (urban vs rural). Descriptive statistics were reported.ResultsA total of 374 women completed the survey with 169 participants from Muhima and 205 from Nyamata. Most women were in a relationship and had a primary school or less education. The most common barriers to accessing general healthcare services were long wait times at the facility (Muhima 26%; Nyamata 30%), low quality of care (Muhima 15%; Nyamata 12%), and transportation costs (Muhima 13%; Nyamata 9.3%). However, women from Nyamata were significantly more likely to report distance to the health center as a barrier (p-value < 0.001), and women from Muhima were significantly more likely to report transportation method as a barrier (p-value = 0.004). The primary reason reported for not obtaining cervical cancer screening was that women did not know how or where to get tested (Muhima 57%; Nyamata 51%).ConclusionsThe most common barriers to cervical cancer screening in Rwanda were the quality of clinical care and issues with traveling to the clinic. Implementing a cervical cancer self-collection program could help eliminate many barriers that women face to obtain health services in Rwanda. More research is needed to better understand the acceptability of cervical cancer screening in Rwanda and how it could be integrated into the healthcare system.

Knowledge, attitudes, and practices of HPV vaccination among pharmacy students and other health science students

AbstractBackgroundHuman papillomavirus (HPV) vaccination is an effective way to prevent cervical cancer. In Vietnam, there has been a lack of research specifically targeting the student population in the field of health sciences.ObjectivesThis study aimed to assess HPV vaccination knowledge, attitudes, and practices among health science students in Vietnam, focusing on differences between pharmacy students and other health science students.MethodsThe study used a cross‐sectional descriptive design, conducted at a medical university in southern Vietnam. This survey was managed by Google Form which was distributed online to students via posts on Facebook and student chat groups on health science courses on Message, Zalo.ResultsOut of the 1010 students surveyed, 213 (21.1%) were pharmacy students. There was no difference between pharmacy and non‐pharmacy students in terms of knowledge scores about HPV, cervical cancer (median = 7 vs. median = 7, p = 0.301), and vaccine knowledge (median = 8 vs. median = 7, p = 0.273). Pharmacy students had a less positive attitude toward HPV, cervical cancer, and HPV vaccines than non‐pharmacy students (median = 36 vs. median = 37, p = 0.014). Parents' education level, history of cervical cancer screening, HPV vaccine knowledge, and attitudes toward HPV, cervical cancer, and HPV vaccine were identified as significant factors influencing HPV vaccination in the women population.ConclusionPharmacy and non‐pharmacy students differ significantly in their attitudes toward HPV, cervical cancer, and HPV vaccines. These findings can help develop educational programs and counseling to improve students' understanding, awareness, and vaccination decisions.

Socio-Demographic Factors and Other Predictors of Pap Test Uptake Among Women: A Retrospective Study in Ghana.

The World Health Organization has reported a rise in cervical cancer in Ghana. Ghanaian women predominantly undergo opportunistic Pap smear screening for cervical cancer. Numerous studies have documented differences in the sociodemographic traits of participants undergoing Pap smear testing or screening, which correlates with their screening habits. This study aims to assess sociodemographic variables, including others that determine Pap test utilization at a single center in Ghana. A single-center survey was conducted by extracting data from the records of women who walked in for Pap smear testing. A telephone survey was also conducted among these women to document their barriers to utilizing the center. For data analysis, descriptive statistics and chi-square were utilized. A total of 197 participants' records were retrieved for the study. Most participants were market women (69.4%) and uneducated (71.4%). Their Pap smear screening records indicate that the majority (86%) had no history of cervical cancer screening, and only 3% tested positive for Pap smear test. Educational level, occupation and family history of cancer significantly correlated with participants' Pap smear history (p<0.05). However, most sociodemographic factors were not significant with the Pap test results of the participants (p>0.05). The perceived barrier identified by most participants was the need for more information (67.40%) on the test. This study revealed that sociodemographic and gynaecological factors do not correlate with Pap test results. However, education level, occupation, and family history of cancer were significantly associated with the history of Pap smear uptake. The most significant barrier hindering Pap smear services was the need for more information.

Confusion and anxiety in between abnormal cervical cancer screening results and colposcopy: “The land of the unknown”

ObjectiveAttendance to colposcopy after abnormal cervical cancer screening is essential to cervical cancer prevention. This qualitative study explored patients' understanding of screening results, their experiences of the time leading up to the colposcopy appointment, and colposcopy. MethodsWe recruited women referred for colposcopy from two urban practices in an academic health system. Individual interviews (N = 15) with participants were conducted after colposcopy appointments about their cervical cancer screening histories, current results, and colposcopy experiences. A team analyzed and summarized interviews and coded transcripts in Atlas.ti. ResultsWe found that most women were confused about their screening results, did not know what a colposcopy was before being referred for one, and experienced anxiety in the interval between receiving their results and having their colposcopy. Most women searched for information online, but found “misinformation,” “worst-case scenarios” and generic information that did not resolve their confusion. ConclusionWomen had little understanding of their cervical cancer risk and experienced anxiety looking for information and waiting for the colposcopy. Educating patients about cervical precancer and colposcopy, providing tailored information about their abnormal screening test results and potential next steps, and helping women manage distress may alleviate uncertainty while waiting for follow-up appointments. Practice implicationsInterventions to manage uncertainty and distress in the interval between receiving an abnormal screening test result and attending colposcopy are needed, even among highly adherent patients.

What is the role of attitudinal barriers on cervical cancer screening non-attendance? Findings from a cross-sectional study with migrant women in Portugal

BackgroundCervical cancer is a common disease which can be effectively and timely detected by cervical cancer screening. However, access to cervical cancer screening is unequal, and it is known that migrant women have a lower attendance to cervical cancer screening. These inequalities are associated with several factors, including attitudes and beliefs of the women regarding screening practices, which prevents them from participating. This study aims to explore the attitudinal barriers to cervical cancer screening among migrant women in Portugal.MethodsA web-based cross-sectional survey was conducted with 1100 migrant women residing in Portugal. Women were recruited through social media platforms. The survey included items on socioeconomic characteristics, cervical cancer screening history and an 11-item attitudinal questionnaire to assess attitudinal barriers. Logistic regression models were used for statistical analysis.ResultsThe attitudinal barriers to CCS most often reported by participants were fear of the test result (25.3%), worry about seeing a male health professional (23.8%), perceiving the test as painful (23.1%), embarrassment (18.5%), difficulties scheduling the test (14.3%), and having a negative experience in screening (12.4%). Low perceived need in absence of symptoms and lack of motivation to be screened were reported by less than 5% of the women. However, the results suggest that most of the attitudinal barriers with higher agreement percentage have no association with cervical cancer screening attendance. Among all the attitudinal barriers, low perceived need of screening and lack of motivation were associated with CCS non-attendance.ConclusionsBased on the findings, out of all the factors analyzed, low perceived need of screening and lack of motivation are the most relevant factors associated with non-attendance among migrants in Portugal. Promoting health literacy and empowering women with knowledge about benefits of screening may help overcoming these barriers. Therefore, this study provides a foundation for stakeholders on which areas should be prioritized when developing strategies aiming to reduced cervical cancer screening non-attendance among migrant women.

Cervical cancer screening history among women diagnosed with cervical cancer in Estonia 2017-18.

Despite the national cervical cancer screening programme launched in 2006, Estonia has one of the highest cervical cancer incidence rates in Europe. While the overall coverage of cervical cytology is high, the factors related to cancer screening history prior to cancer diagnosis need to be studied. In this study, we aimed to examine the 10-year screening history of women diagnosed with cervical cancer in Estonia in 2017-18, using data collected from laboratory reports from 2007 to 2018. From each report, we extracted information on the date and result of cytology and on the laboratory where the sample was assessed. We analysed these data across cancer histology, the time interval between the last test result and cancer diagnosis and the laboratory type (local or regional). Among 319 women with cervical cancer, 181 (56.7%) did not have any cytology reports available. Among 138 women with at least one cytology, 60% had 1-3, 24% 4-6 and 16% ≥7 tests (mean 3.7) before cancer. In 78% of women, the last test was performed less than 5 years before cancer diagnosis and 62% of these tests did not report any abnormalities. The last cytology results differed significantly between the regional and local laboratories (P = 0.028). Women received the cervical cancer diagnosis in Estonia despite having several screening tests 10 years prior to the diagnosis. The proportion of cytology tests without any abnormalities less than 5 years before the diagnosis was worryingly high and needs further investigation together with the difference between laboratory types.

Matrix factorization for the reconstruction of cervical cancer screening histories and prediction of future screening results

BackgroundMass screening programs for cervical cancer prevention in the Nordic countries have strongly reduced cancer incidence and mortality at the population level. An alternative to the current mass screening is a more personalised screening strategy adapting the recommendations to each individual. However, this necessitates reliable risk prediction models accounting for disease dynamics and individual data. Herein we propose a novel matrix factorisation framework to classify females by the time-varying risk of being diagnosed with cervical cancer. We cast the problem as a time-series prediction model where the data from females in the Norwegian screening population are represented as sparse vectors in time and then combined into a single matrix. Using novel temporal regularisation and discrepancy terms for the cervical cancer screening context, we reconstruct complete screening profiles from this scarce matrix and use these to predict the next exam results indicating the risk of cervical cancer. The algorithm is validated on both synthetic and registry screening data by measuring the probability of agreement (PoA) between Kaplan-Meier estimates.ResultsIn numerical experiments on synthetic data, we demonstrate that the novel regularisation and discrepancy term can improve the data reconstruction ability as well as prediction performance over varying data scarcity. Using a hold-out set of screening data, we compare several numerical models and find that the proposed framework attains the strongest PoA. We observe strong correlations between the empirical survival curves from our method and the hold-out data, and evaluate the ability of our framework to predict the females’ next results for up to five years ahead in time using only their current screening histories as input.ConclusionsWe have proposed a matrix factorization model for predicting future screening results and evaluated its performance in a female cohort to demonstrate the potential for developing prediction models for more personalized cervical cancer screening.

Patient delay and related influencing factors in Chinese women under 35 years diagnosed with cervical cancer: A cross-sectional study

ObjectivePatient delay was defined as an interval between the discovery of the initial symptoms and diagnosis, which was longer than 90 days. This study aimed to determine the patient delay rate and related factors in women with cervical cancer in Hunan province, South-Central China. MethodsA cross-sectional study was conducted among 140 women with cervical cancer aged < 35 years from October, 2019 to March, 2021. Assumptions in Andersen Behavioral Model of Health Services Utilization were used to measure the factors influencing patient delay. Logistic regression models were used to identify factors associated with patient delay. A P-value of < 5% was considered significant. ResultsA total of 57 (40.71%) young women with cervical cancer had patient delay, and the median delay time was 134 (90-375) days. Predisposing factors, such as religion, unemployment, health beliefs related to cancer screening, and a history of cervical cancer screening within 2 years or more (P ​< ​0.05), were associated with patient delay. Enabling factors, such as distance to the nearest medical facility and type of the nearest medical facility, were associated with a reduced likelihood of patient delay. With the need-for-care factor, young women who experienced vaginal pain after or during intercourse had a higher risk (adjusted odds ratio, 33.48; 95% confidence interval, 3.22–348.68, P ​= ​0.003) of patient delay. ConclusionsThese findings reinforce the need for programs to enhance knowledge and awareness about cervical cancer screening and the importance of early diagnosis in women to help eliminate cervical cancer in China by 2050.

Predicting the factors related to cervical cancer screening in secondary school female teachers in Shahrekord: Application of PEN-3 model factors about cervical cancer screening in female teachers

Background and aims: Cervical cancer is one of the most common cancers in women. Cervical cancer screening is one of the essential measures for preventing this disease, and its purpose is to detect lesions in the premalignant stage and reduce the risk of death from this cancer. This study aimed to predict the factors related to cervical cancer screening in secondary school teachers using the PEN-3 model in Shahrekord, southwest Iran. Methods: This descriptive-analytical study was conducted on secondary school female teachers in the academic year 2019-2020. The samples were 228 individuals who were selected by convenience random sampling. The research tools were a demographic information checklist, uterine screening performance information, and a questionnaire based on PEN-3 model constructs (perceptual, enabling, and reinforcing factors). Data analysis was done using SPSS version 22. Results: Regarding cervical cancer screening (Pap smear test), 59.82% of the teachers had a history of undergoing Pap smear tests, of which 35.43% had performed the test regularly. Pearson’s correlation coefficient showed a direct and significant correlation between PEN-3 model constructs (perceptual, enabling, and reinforcing factors) and a history of cervical cancer screening (P&lt;0.001). In the regression analysis of demographic variables and PEN-3 model constructs, the predictive value of these variables for cervical cancer screening was obtained at 0.57%. Conclusion: Based on the findings of the study and given the role of PEN-3 model constructs (perceptual factors, enabling factors, and reinforcing elements) in predicting cervical cancer screening behavior, comprehensive planning for intervention and use of this educational model and gaining knowledge about the cultural and socioeconomic factors for cervical cancer screening seems useful.

Feasibility of human papillomavirus self-sampling to combat COVID-19-related disruptions to cervical cancer screening: a cross-sectional survey

BackgroundThe prevalence of human papillomavirus (HPV) infection among Chinese women in Hong Kong has been reported to range between 7% and 11%, and high-risk HPV genotypes accounted for about 90% of cases of cervical cancer. The COVID-19 pandemic has had a major impact on a wide range of health outcomes because of limitations to the functioning of health services, including cervical cancer screening. The aim of this study was to assess HPV self-sampling as an alternative option for cervical cancer screening during the COVID-19 pandemic.MethodsA cross-sectional household survey was conducted with a residential mailing sampling approach. Under the sampling frame, addresses would be geographically randomly selected in each group and mailing invitation letters were sent to selected households. All sexually active adult household members would be eligible to join the survey. The study comprises two parts: first, a self-administrated standardised web-based questionnaire; and second, laboratory testing of HPV in self-collected cervical samples. In part one of the study, a survey link was included in the invitation letter and a telephone survey was also offered to those who were unable to complete the web-based questionnaire. Participants were asked about their lifestyle and sexual behaviour, history of cervical cancer screening and infections, acceptability of HPV self-sampling, COVID-19-related health-care disruption, and sociodemographic factors. Interested participants who completed part one study were then invited to join part two of the study by taking a self-sample to be tested for sexually transmitted infections (namely HPV, Neisseria gonorrhoeae, and Chlamydia trachomatis) for estimation of the prevalence of sexually transmitted infections among the Hong Kong population.Findings39 815 invitation letters were sent to selected households between May 1, 2021, and Dec 31, 2021. The response rate was 924 (2%) respondents who completed the web-based survey. 557 (60%) of 924 respondents were women aged 19–76 years (median 39 IQR 32–51). The overall willingness to undergo self-sampling was 364 (65%) of 557 participants, with a response rate of 166 (30%) of 557 who successfully completed part two of the study (self-sampling procedure). The overall HPV infection rate was 10% (17 of 166 self-tested participants), three (18%) of whom had never been screened. Among the 557 respondents, 144 (26%) who had never been screened for cervical cancer accepted HPV self-sampling. Among the 413 women who had ever been screened, 328 (80%) reported previously attending regular screenings. 129 (39%) of these 328 respondents indicated that their screening behaviour was affected by the health-care disruptions caused by the COVID-19 pandemic, and 93 (72%) of these 129 were willing to receive the self-sampling kit for testing, with a response rate of 34% (44 of 129) successfully completing the self-sampling procedure.InterpretationOur findings show that most women were willing to uptake self-sampling, both among those who had never been screened and especially those who previously adhered to regular screening but were affected by the COVID-19 pandemic. HPV self-sampling not only can help to tackle the barriers to cervical screening, but can also a feasible and acceptable option as an alternative cervical cancer screening during the pandemic.FundingThis study was supported by the Commissioned Health and Medical Research Fund of Food and Health Bureau of HKSAR Government (reference number CID-CUHK-E).

Abstract PO-065: Increasing breast and cervical cancer knowledge during COVID-19 pandemic in collaboration with Cooperative Extension Program

Abstract Introduction: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) reported that in April 2020, screening tests for breast cancer decreased by 87% and 84% for cervical cancer, compared to the averages of the previous 5-year for the same month. In response to this finding, the Puerto Rico Breast and Cervical Cancer Prevention and Early Detection Program (PR-BCCPEDP), in collaboration with the Cooperative Extension Program (CEP), implemented an educational intervention of breast and cervical cancer in the northeast region of the island. The intervention aimed to reinforce knowledge in the early detection of breast and cervical cancer, increase screening tests, and reach out to women without health insurance who may qualify for the Program. Methodology: Since 2017, the PR-BCCPEDP agreed with the CEP to implement educational interventions for breast and cervical cancer in 4 of CEP's regions throughout the island. From February to May 2021, seven CEP Family and Consumer Educators (EFC) carried out 8 educational activities with 182 participants in the island's northeast region. We collected age, town of residence, level of education, health insurance, breast and cervical cancer screening history, and the reasons for not having performed screening tests according to the recommended guidelines. The educational activities were performed virtually through an educational PowerPoint and face-to-face using flip charts. The topics included breast and cervical cancer statistics, risk factors, symptoms, early detection guidelines, myths and facts, and barriers to not having screening tests. Participants that didn't have the screening tests according to the recommended guidelines had follow-up calls. Results: A total of 182 women participated in the intervention, with an average age of 47 years; most participants had a high school degree (42%), and 59% had the government's health plan. Regarding screening tests, 35.1% reported that they had not had a mammogram in the last two years, 73.4% authorized to be contacted after the intervention. Similarly, Pap tests, 30.7% reported that they had not had a Pap test in the last three years, of which 87.5% authorized to be contacted. Of the participants who had not had a mammogram (35.1%) or Pap test (30.7%), the main reason was the COVID-19 Pandemic (22.9% and 21.8%, respectively). Regarding the participants referred to the PR-BCCPEDP, 3.6% of the women without health insurance were referred to the Program and of these, 50% were recruited. Conclusion: Despite security, restrictions from the Pandemic, collaborations with community-based programs helped to reach a greater number of women to provide education and awareness about breast and cervical cancer. In terms of breast and cervical cancer screening, more than a third of the participants had not had their mammogram or Pap done due to the Pandemic. Women were recruited for the Program; however, additional efforts are necessary in order to reach a higher number of uninsured women. Citation Format: Omayra Salgado, Ircha Martinez, Nelybeth Santiago, Mirza Rivera, Taina De La Torre, Guillermo Tortolero. Increasing breast and cervical cancer knowledge during COVID-19 pandemic in collaboration with Cooperative Extension Program [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-065.