Organized Screening Research Articles

Impact of organized colorectal cancer screening programs on screening uptake and screening inequalities: A study of systematic- and patient-reliant programs in Canada

BackgroundVarious provincial colorectal cancer screening programs have been implemented in Canada but have yet to be evaluated. ObjectiveWe examined the effects of patient-reliant and systematic organized colorectal screening programs on colorectal cancer screening uptake and on screening inequalities by income, education, rural residence, and access to a primary care physician. MethodsLifetime and recent (< 1, <2 years) stool-based screening uptake were assessed among Canadian Community Health Survey respondents (cycles 2003–2014), aged 50–75 years, with no personal or family history of colorectal cancer. We used a difference-in-differences approach to estimate the effects of two systematic provincial programs (where all eligible residents receive screening kits via mail), and one patient-reliant program (where residents receive screening kits via mail following their request to a physician, phone line or website). ResultsOverall, systematic and patient-reliant programs were associated with a 4- [95 % CI: 1%, 7%] and a 12-percentage point [95 % CI: 2%, 8%] increase in recent (<2 years) stool-based screening, respectively, with effect sizes converging after three years at approximately 10 %. The patient-reliant program was associated with an 11 % [95 % CI: 5%, 17 %] increase in uptake among those with a physician, but no effect among those without—leading to increased inequality in uptake according to physician access. InterpretationBoth program types increase colorectal screening overall. Reliance on patients’ request for screening may increase disparities according to physician access. Exploration of complementary targeted interventions in patient-reliant settings appears warranted.

Knowledge, Attitude and Practices Towards Cervical Cancer and its Screening Among Women from Tribal Population: a Community-Based Study from Southern India

BackgroundCervical cancer continues to be a leading cancer among women in India. Despite availability of various screening techniques, majority of Indian women remain unscreened for cancer cervix. The increasing incidence could be attributed to the lack of awareness regarding cervical cancer screening and paucity of organized screening facilities in the country. This study assessed the knowledge, attitude and practices (KAP) towards cervical cancer screening among tribal women of coastal Karnataka, southern India.MethodsA community-based cross-sectional study was conducted among 1140 women aged 20–65 years from three tribes. Information on their KAP towards cervical cancer screening was collected using a semi-structured questionnaire.ResultsMean age of the participants was 39.8 ± 10.1 years. Although 82.9% of the participants reported to have heard of cervical cancer, 51% were aware that the disease could be prevented, and only 2.3% knew that it can be detected at an early stage. Over 75% of the participants did not have adequate knowledge regarding cervical cancer. However, majority of them (99.9%) had a favourable attitude towards cervical cancer screening. None of them had undergone cervical cancer screening prior to the study. The knowledge scores were significantly associated with age group, marital status, education level, socioeconomic status and tribal community of the participants (p < 0.05).ConclusionOverall knowledge regarding cervical cancer among the surveyed women was poor, though they exhibited a positive attitude. This calls for a sustained health education and screening program to create awareness and improve the uptake of cervical cancer screening among these women.

Screening for oral cancer: Future prospects, research and policy development for Asia.

Although the incidence of oral cavity cancer is high among low and middle income countries in Asia where the risk habits (tobacco smoking, tobacco chewing and betel quid use) are common, the benefits for introducing oral cancer screening for the whole population in these countries still remains controversial. It is disappointing, but not surprising that many of studies, without control arms, could not provide a clear answer as to whether screening is effective in reducing mortality or combating rising incidence trends. Only one Indian study that reported a randomized controlled trial (RCT) elucidated that mass screening for high risk groups could significantly reduce the cancer mortality or down-stage cancers detected by screening. Several professional organizations that considered any potential benefits of oral cancer screening remain unconvinced that the current knowledge on its natural history, available tests and interventions to treat potentially malignant disorders satisfy the desirable criteria to recommend organized screening for oral cancer. In this review we discuss advantages and disadvantages for oral cancer screening particularly with reference to high incidence countries in Asia. If screening is undertaken, we propose that it is targeted to high risk groups and to combine screening with education on risky life-styles so that overall incidence can be reduced in the future. Further research on increasing public awarenes and impact of professional education such as e-learning to reduce diagnostic delays, studies on the natural history of oral potentially malignant disorders and cancer, comprehensive tobacco and areca nut cessation programs, developing tools to identify high-risk individuals and high-risk lesions are proposed.

Elucidating Higher FIT Interval Caners in Proximal than Distal Colon: Population-Based Periodical Screening Cohort Design

Background: The risk of fecal immunological test (FIT) interval cancer (IC) is higher in the proximal colon than the distal colon but the underlying mechanism explaining the disparity remains elusive. Therefore in this study, we aimed to investigate whether the disparity is attributed to FIT accuracy or the fast progression rates from early to late stage (upstaging) within preclinical-detectable phase (PCDP) and from PCDP to clinical phase (CP). Methods: We did a population-based periodical screening cohort study. Data derived from Taiwanese nationwide colorectal cancer (CRC) organized service screening program. A total of 5,417,699 eligible population aged 50-69 with 3,074,538 individuals ever attending until the end of 2014. The incidence rate of entering the PCDP, the upstaging rate within PCDP, the rate of surfacing to CP, and the test sensitivity classified by early (stage 0/I) and late (stage 2+) stage analyzed with the five-state Markov model. Findings: The proportions of ICs (19% vs 16%) and late CRCs (76% vs 67%) were higher in the proximal colon than the distal colon, which was caused by a faster progression rate from PCDP to CP by 19% and a higher likelihood of upstaging in the proximal colon than the distal colon by 1.6-fold, resulting in the corresponding survival difference of IC, but not site-specific FIT accuracy. Interpretation: Faster progression noted in proximal colon not only supports the previous evidence on rapid transition from dysplasia to malignancy for sessile serrated adenomas but also explain the disparity of effectiveness of FIT and provide a new insight into precision medicine for identifying those who are susceptible to the proximal IC of CRC. Funding: None Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study was approved by the Health Promotion Administration, Ministry of Health and Welfare prior to data retrieval and analysis (A1081113) of Taiwanese government and approved by the Research Ethics Committee of National Taiwan University Hospital prior to data collection pursuant to the regulation of the Institutional Review Board (20192023W).

Drivers of cervical cancer screening uptake in Ibadan, Nigeria

Despite the empirical evidence that cervical cancer screening has been a successful public health initiative to secondarily prevent the incidence and mortality from cervical cancer in developed nations, majority of women of sub-Saharan root, Nigeria inclusive, do not utilize this essential health service. This study/article contributes to the empirical literature on the drivers of cervical cancer screening utilization within Nigeria context. The paper investigates the determinants of cervical cancer screening utilization among both working class women and women involved in trading activities in Oyo state, Nigeria. The statistical estimations find strong support for attitudinal correlates, perceived seriousness and family history as drivers of utilization of cervical cancer screening. While only 13.5% of respondents reported to have ever utilized the screening test, majority had positive attitude towards the screening. The screening uptake among the women could improve, if necessary barriers are addressed. The paper highlights policy recommendations for enhancing organized screening guidelines in a developing country.

Health Policy as a Barrier to First Nations Peoples' Access to Cancer Screening.

Background:First Nations peoples in Ontario are facing increasing rates of cancer and have been found to have poorer survival. Cancer screening is an important strategy to improve cancer outcomes; yet, Indigenous people in Canada are less likely to participate in screening. Ontario has established organized breast, cervical and colorectal cancer screening programs; this paper examines the health policy context that informs these programs for First Nations peoples in the province.Method:This paper follows an embedded multiple-case study design, drawing upon a document review to outline the existing policy context and on key informant interviews to explore the aforementioned context from the perspective of stakeholders.Results:Policies created by agencies operating across federal, regional and provincial levels impact First Nations peoples' access to screening. Interviews identified issues of jurisdictional ambiguity, appropriateness of program design for First Nations persons and lack of cultural competency as barriers to participation in screening.Conclusion:Federal, provincial and regional policy makers must work in collaboration with First Nations peoples to overcome barriers to cancer screening created and sustained by existing policies.

Key issues that need to be considered while revising the current annex of the European Council Recommendation (2003) on cancer screening.

The 2003 European Council recommendation urging the Member States to introduce or scale up breast, cervical and colorectal cancer screening through an organized population-based approach has had a remarkable impact. We argue that the recommendation needs to be updated for at least two sets of reasons. First, some of the current clinical guidelines include new tests or protocols that were not available at the time of the Council document. Some have already been adopted by organized screening programs, such as newly defined age ranges for mammography screening, Human Papillomavirus (HPV)-based cervical cancer screening, fecal immunochemical test (FIT) and sigmoidoscopy for colorectal cancer screening. Second, the outcomes of randomized trials evaluating screening for lung and prostate cancer have been published recently and the balance between harms and benefits needs to be pragmatically assessed. In the European Union, research collaboration and networking to exchange and develop best practices should be regularly supported by the European Commission. Integration between primary and secondary preventive strategies through comprehensive approaches is necessary not only to maximize the reduction in cancer burden but also to control the rising trend of other noncommunicable diseases sharing the same risk factors.

Cervical cancer screening coverage, management of squamous intraepithelial lesions and related costs in France.

Until 2018, cervical cancer screening in France was an unorganized individual screening, with the exception of some pilot programs in some territories. We aimed to assess, before the implementation of organized cervical cancer screening and human papillomavirus (HPV) nonavalent vaccine introduction in the vaccination schedule in 2018, (i) the individual cervical cancer screening coverage, (ii) the management of squamous intraepithelial lesions (SIL) and (iii) the related costs. We used the Système National des Données de Santé (SNDS) (Echantillon Généraliste de Bénéficiaires [EGB] and Programme de Médicalisation des systèmes d’information [PMSI]) to assess the cervical screening coverage rate in France between January 1st, 2012 and December 31st, 2014, and to describe diagnostic investigations and therapeutic management of SIL in 2013. After extrapolation to the general population, a total of 10,847,814 women underwent at least one smear test over the 3-year study period, corresponding to a coverage rate of 52.4% of the women aged 25 to 64 included. In 2013, 126,095 women underwent HPV test, 327,444 women underwent colposcopy, and 9,653 underwent endocervical curettage; 31,863 had conization and 12,162 had laser ablation. Besides, 34,067 women experienced hospital stays related to management of SIL; 25,368 (74.5%) had high-grade lesions (HSIL) and 7,388 (21.7%) low-grade lesions (LSIL). Conization was the most frequent in-hospital therapeutic procedure: 89.5% (22,704) of women with an in-hospital procedure for HSIL and 64.7% (4,781) for LSIL. Mean cost of smear test, colposcopy and HPV tests were around 50€. Total cost for hospital stays in 2013 was estimated at M41€, or a mean cost of 1,211€ per woman; 76% were due to stays with HSIL. This study highlights the low coverage rate of individual cervical cancer screening and a high burden related to SIL management.

Cervical cancer prevention among long-term screening non-attendees by vaginal self-collected samples for hr-HPV mRNA detection

BackgroundThe efficacy of cervical cancer screening programs is dependent on the participation rate. To increase participation among women not attending cervical cancer screening, self-collected samples for detection of high-risk human papillomavirus (hr-HPV) may be an option.The aims of this study were: to investigate the response rate to sending a self-collected vaginal sample for hr-HPV mRNA detection to long-term non-attendees; the compliance with follow-up among women positive for HPV in the self-sample; the prevalence of cervical dysplasia (high grade squamous intraepithelial lesion (HSIL), atypical squamous cells that cannot exclude HSIL (ASC-H) or adenocarcinoma in situ (AIS)) or cancer among the responders; as well as to explore reasons for not returning a self-sample.MethodsA vaginal self-sampling kit was sent to 6023 women aged 30–70 years who had not provided a cervical screening sample for ≥7 years in the Region of Skåne, Sweden in November and December 2017. The self-sample was analyzed by Aptima HPV mRNA assay (Hologic). All vaginal self-samples returned no later than May 31, 2018 were included in the study. Follow-up of the results was registered until January 31, 2019 with a follow-up time varying between eight to 14 months. Women positive for hr-HPV mRNA were invited for a follow-up examination. This examination consisted of a cervical sample for cytological analysis and renewed Aptima HPV mRNA testing. Two hundred thirty-five women who had not returned the self-sample were randomly selected for telephone interviews, in order to explore their reasons.ResultsThe response rate for the self-collected vaginal hr-HPV sample was 13.2% [(797/6023), 95% CI 12.4–14.1%] and 9.9% [(79/796), 95% CI 7.9–12.2%] were positive for hr-HPV mRNA. The prevalence of severe dysplasia or cancer in the whole group of responders was 1.3% [(10/796), 95% CI 0.6–2.3%], with a cervical cancer prevalence of 0.4% [(3/796), 95% CI 0.1–1.1%]. Only 27 women participated in the telephone interviews, no particular reason for not returning self-samples was observed.ConclusionsSelf-collected vaginal hr-HPV samples increased participation in the cervical cancer screening among long-term non-attendees. The prevalence of cervical cancer was almost seven times higher for long-term non-attendees than in the organized screening population.

Role of gastrointestinal endoscopy in the screening of digestive tract cancers in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

In Europe at present, but also in 2040, 1 in 3 cancer-related deaths are expected to be caused by digestive cancers. Endoscopic technologies enable diagnosis, with relatively low invasiveness, of precancerous conditions and early cancers, thereby improving patient survival. Overall, endoscopy capacity must be adjusted to facilitate both effective screening programs and rigorous control of the quality assurance and surveillance systems required. 1 : For average-risk populations, ESGE recommends the implementation of organized population-based screening programs FOR COLORECTAL CANCER: , based on fecal immunochemical testing (FIT), targeting individuals, irrespective of gender, aged between 50 and 75 years. Depending on local factors, namely the adherence of the target population and availability of endoscopy services, primary screening by colonoscopy or sigmoidoscopy may also be recommendable. 2 : In high-risk populations, endoscopic screening FOR GASTRIC CANCER: should be considered for individuals aged more than 40 years. Its use in countries/regions with intermediate risk may be considered on the basis of local settings and availability of endoscopic resources. 3 : For esophageal and pancreatic cancer, endoscopic screening may be considered only in high-risk individuals:- FOR SQUAMOUS CELL CARCINOMA: , in those with a personal history of head/neck cancer, achalasia, or previous caustic injury; - FOR BARRETT'S ESOPHAGUS (BE)-ASSOCIATED ADENOCARCINOMA: , in those with long-standing gastroesophageal reflux disease symptoms (i. e., > 5 years) and multiple risk factors (age ≥ 50 years, white race, male sex, obesity, first-degree relative with BE or esophageal adenocarcinoma [EAC]). - FOR PANCREATIC CANCER SCREENING: , endoscopic ultrasound may be used in selected high-risk patients such as those with a strong family history and/or genetic susceptibility.

Predictive factors for the participation of general practitioners in lung cancer screening by low-dose CT scan in the Somme department in northern France

IntroductionA study on lung cancer screening using low-dose computed tomography (DEP KP80) was conducted in the Somme department in northern France between May 2016 and December 2018. We conducted a cross-sectional survey of family physicians in that department to identify potential predictive factors for their participation in this pilot study. MethodsA survey questionnaire was sent to the 545 general practitioners (GPs) of the Somme department. This survey rendered it possible to identify the investigators who were active in the DEP KP80 study. The questionnaire's content was focused on the socio-demographic conditions of GPs, their professional practices, and their medical practice situations. ResultsThe response rate was 38% (206 completed questionnaires). Active investigators in DEP KP80 accounted for 55% (n=113) of the GPs surveyed, and non-investigators for 45% (n=93). Age, gender, or medical practice situation were not related to the active GPs’ participation in DEP KP80. A multivariate analysis revealed that two factors were correlated with active participation in organized screening: (1) prescription of nicotine replacement therapy; (2) smoking history of the GP. ConclusionsSecuring the active involvement of family physicians and of the French regional cancer screening coordination centers seems essential for the future organization of lung cancer screening on a regional or national level. Our results demonstrate that incorporating smoking cessation support structures into the program would maximize the mechanism's potential.

Faecal immunochemical test-based colorectal cancer screening in Mexico: an initial experience.

BackgroundIn middle-income countries, the burden of colorectal cancer (CRC) is increasing in parallel with resources for diagnosis and treatment. There is a potential benefit of CRC screening programs in Mexico.ObjectiveSince there are no organized screening programs in the country, we explored the willingness of individuals to complete a faecal immunochemical testing (FIT) based CRC screening program and its potential benefit in Mexico.MethodsWe conducted a CRC screening program pilot in Veracruz, Mexico, during 2015–16 using FIT. Individuals with FIT results >100 ng of haemoglobin/ml buffer were referred for diagnostic colonoscopy.ResultsOf 473 FIT kits distributed to adults aged 50–75, 85.8% (406) were completed by participants and analysed in the laboratory. Of these, 5.9% (24/406) of test results showed >100 ng haemoglobin/ml. Twenty-one participants completed colonoscopy. The positive predictive value of FIT >100 ng haemoglobin/ml for premalignant lesions was 33%.ConclusionThese results provide preliminary evidence of the willingness of individuals to complete FIT-based CRC screening program in Mexico. However, further evaluation of health systems resources will be needed prior to large-scale implementation of CRC screening programs.

Documents d’information et outils d’aide à la décision pour le dépistage du cancer du sein

In France, breast cancer has been the most commonly diagnosed and the most lethal cancer in women. The risk-benefit ratio of organized breast cancer screening has been the focus of much scientific controversy, especially about overdiagnosis. A citizen conference and some scientific organizations have asked for a better education for women. The aim of this study was to analyze the numerous decision support tools and other information media, both in form and in substance. A review of the existing publications has been done by 4researchers between 2006 and 2016. Original articles included, in French or in English, focused on information media or decision aid tools for organized screening without any restriction on the type of studies. The 69articles included in this review have shown that a better education of the patients was not related to an increase in the will to take part or in the actual participation in screening. The information media (pamphlet, video…) does not appear to have any influence on those ratios. The participants like having a discussion with a trained interviewer. In a third of the studies, the population was included on ethnic and social criteria. 8studies focused on overdiagnosis. This review underlines the importance of repeated interviews, as a support for shared decision making. Specific interactions (such as patient navigator) could help to reduce social health inequalities. The patients should be informed about the current uncertainty regarding the ratio of overdiagnosis.

Participatory democracy and development of a public health policy?

In view of controversies around breast cancer screening, the Ministry of Health asked the French National Cancer Institute to organize this consultation to clarify the benefits and limitations of breast cancer screening, health objectives, organizing and tackling the health inequalities of this program. It has combined the setting up of an independent and multidisciplinary steering committee, a conference of citizens and professionals. It relied on the hearing of experts representing the trends of the controversy, on a technical and prospective report and on the analysis of nearly 500online contributions. At the end of this process, the policy committee produced a report. In the end, two scenarios were presented, leading to a complete overhaul of the current screening process. As a result of this report, the Ministry announced the action plan for the renovation of organized breast cancer screening in 12measures in April2017. The discussion focuses on the consultation methodology as a tool for health democracy and on the levels of arbitration that led to the action plan. The objective is to reflect on the possible interactions between consultation and decision-making and to propose benchmarks for the development and improvement of this consultation.

Ethics of organized cancer screening in France

Cancer screening has been among the priorities of the French Cancer Plans since 2003. However, participation in screening programs remains below expectations. The predominance of the value of autonomy in today's society may compromise the legitimacy of a public health action if it does not gain the adhesion of individuals. The Group of Reflection on the Ethics of Screening (GRED) set up by the French National Cancer Institute has brought together experts from different disciplines around this issue. The aim of the present article is to summarize the work of the group, which successively focused on breast and colorectal cancer screening programs, followed by reflection on the implementation of organized cervical cancer screening. Information and health education appear to be key levers to enable individuals to understand the collective interest of public health policies and thus to be able to adhere to the proposed actions in an informed manner. This should be made possible by providing complete and high quality information, addressing the limits of each screening including benefits and risks. Valuing the collective dimension of public health, which calls for solidarity, must make it possible to raise awareness of the proper use of public services.

Representations of colorectal cancer screening: the GPs point of view

Various studies have shown that general practitioners (GPs) have a strong influence on adherence to organized screening for colorectal cancer. Faced with very low screening rates (29.8%), this study aims to apprehend the context of screening, the representations of GPs and the context of the arrival of new screening test in how to consider medical practice. On the basis of a qualitative methodology, semi-structured interviews were conducted with 17general practitioners in 2014-2015. A thematic content analysis was then performed. The doctors interviewed said that they discussed colorectal cancer screening quickly at the end of the consultation, along with other screening tests (mammography), due to lack of time and management of several reasons for consultation. GPs had very little information about the new test, so they had no specific expectations for the new test. The analysis revealed an inconsistency between the role that GPs feel they should play with patients in prevention and screening and the reality of their practice that leaves them little time to devote to it. A lack of information regarding the arrival of the new test and the difficulties associated with the organization of care has an impact on the representations of screening management. Setting up a consultation dedicated to prevention could be a prospect of improvement.

Participation in organized screening for bowel cancer and screening for prostate cancer

The aim of this work was to identify among the characteristics of screening programs for prostate and bowel cancers those which constituted brakes or, on the contrary, engines to the participation of men in order to try to explain the differences participation between these screenings. 1,008men aged 50-74 were questioned on their preferences for participating in cancers screening using a discrete choice experiment. Responses were analyzed using qualitative regression models with random effects. The results did not show any major differences between the participation processes in these two screenings. They confirmed the central role of information provided by the physician in decision-making. They also revealed a surprising attitude of men with regard to the risk of overdiagnosis which invites to think about the understanding and the perception by the population of this notion of overdiagnosis in the cancer screening.

Can participatory video reduce mental illness stigma? Results from a Canadian action-research study of feasibility and impact

BackgroundEvidence suggests that stigma against people with mental illness remains high. This demands innovative approaches to reduce stigma. One innovative stigma reduction method is participatory video (PV), whereby marginalized people come together to script, film and produce bottom-up educational videos about shared issues. These videos are then shown to target groups. This paper has two objectives (i) to examine the feasibility of using participatory video with people with severe mental illness (SMI); and (ii) to assess viewer impressions of the resultant videos and subsequent subjective impact.MethodsWe conducted a participatory action research study with three workgroups of people with severe mental illness situated in different Canadian cities, who set out to create and disseminate locally-grounded mental-health themed videos. This involved process and outcome evaluation to assess feasibility and impact. Specifically, we (i) observed fidelity to a co-designed action-plan in all three workgroups; (ii) distributed brief purpose-built questionnaires to viewers at organized screenings to assess preliminary impact; and (iii) conducted focus groups with viewers to elicit further impressions of the videos and subsequent subjective impact.ResultsThe three workgroups achieved high-fidelity to the action-plan. They successfully produced a total of 26 videos, over double the targeted number, during an 18-month period. Likewise, the workgroups organized 49 screenings at a range of venues attended by 1542 people, again exceeding the action-plan targets. Results from the viewer questionnaires (N = 1104, response rate 72%) indicated that viewers reported that their understandings had improved after watching the videos. Four themes emerged from six viewer focus groups (N = 30), with participants frequently noting that videos were (i) educational and informative; (ii) real and relatable; (iii) attention-grabbing; and (iv) change-inducing.ConclusionsTo our knowledge, this study is the first large-scale multi-site project examining the feasibility and impact of a participatory video program for people with severe mental illness. The results indicate that participatory video is a feasible method in this population and gives preliminary evidence that resultant videos can reduce viewer stigma. Thus, participatory video should be considered a promising practice in the ongoing effort to reduce mental illness stigma.

The impact of depression on adherence to organized and opportunistic breast cancer screening

One in five women will experience depression over her lifetime, and one out of eight will develop breast cancer. We evaluated the effect of depression on adherence to mammography in Switzerland, where opportunistic and organized screening programs coexist. We analyzed data from 3206 women aged 50-69 who participated in the Swiss Health Survey 2012. We compared mammographic rates among women with no to mild versus moderate to severe depressive symptoms. The effect of the type of screening on the odds of undertaking a mammography was calculated using multivariable logistic regression analysis. Women with moderate to severe major depressive symptoms were more likely to have had a mammography in the previous 2 years than their nondepressed or less-depressed counterparts (51 vs. 39.2%, respectively, P = 0.005). In the multivariable analysis, women with no to mild major depression living in cantons with an organized screening program had an adjusted odds ratio of 2.7 (95% confidence interval: 2.30-3.17, P < 0.001) of having had a mammography within the past 24 months compared with those living in the regions with an opportunistic screening. The adjusted odds ratio for women with moderate to severe major depression was 4.21 (95% confidence interval: 2.13-8.33, P < 0.001). In Switzerland. adherence to mammographic screening among women with moderate to severe major depression is higher than among women with no or minimal major depressive symptoms. This increased adherence is even more pronounced in regions with organized screening.

Prevalence of high-risk human papillomavirus infection and cervical cytology abnormalities among women up to age 40 in the Tuzla Canton, Bosnia and Herzegovina

Cervical cancer is the second leading cause of female cancer in Bosnia and Herzegovina, and it is the most common female cancer in women 15 to 44 years old. Cervical cancer is etiologically associated with high-risk human papillomaviruses (HRHPV). Data on the prevalence of HRHPV in Bosnia and Herzegovina are scant. This study investigates the prevalence of HRHPV infection among women of reproductive age compared with cervical cytology in the Tuzla Canton. We analyzed the results of HRHPV testing and Papanicolaou (Pap) test results in women up to 40 years old diagnosed at the Tuzla University Clinical Center (UCC) from January 2019 to March 2020. Among 880 women tested for HRHPV, 27.2% (n = 239) were ≤ 40 years. In this age group HRHPV was detected in 33.5% (n = 80) of women, and 23.8% (n = 19) were women < 30 years. Out of 239 women tested for HRHPV, 60.2% had an abnormal Pap smear result. Therefore, 40.7% (n = 59) of HRHPV-positive women had an abnormal Pap test result. Women with a normal Pap test result had an HRHPV-positive test in 22.3% (n = 21) of cases. The results obtained contribute to the knowledge about HPV prevalence and the incidence of squamous cell abnormalities in the most populous canton in Bosnia and Herzegovina, possibly reflecting the situation nationally. The high prevalence of HRHPV in women of reproductive age calls for urgent implementation of an organized cervical cancer screening program and HPV vaccination.