Pap Screening Research Articles

P-447. Anal Pap Smear Trends in Patients Living with HIV and History of Malignancy in a Single-Center Retrospective Observational Study

Abstract Background The elevated rates of squamous cell carcinoma of the anus (SCCA) in persons living with HIV (PLWH) have led to greater awareness for screening with anal Pap cytology. While there is a premise that higher states of immunosuppression carry a greater risk of developing SCCA, no current studies describe this in the setting of PLWH with a history of solid or hematologic malignancy. The objective of this study is to review outcomes of anal Pap screenings in PLWH and a history of either solid or hematologic malignancies. With this study, we aim to outline potential risk factors associated with anal dysplasia in PLWH and a history of cancer. Methods This single-center retrospective cohort study included patients ≥ 18 years of age with a history of solid or hematologic malignancy who were followed at a cancer center clinic for HIV care between 2020-2024 and underwent anal Pap screening during this period. Demographics, pathology results, and clinical characteristics were obtained by chart review. Results The study identified 12 patients to date, with a mean age of 51 and male-to-female ratio of 5:1. Abnormal cytology on anal Pap was present in 83.3% (n=10) of patients with 50% (n=5) of these abnormal screenings resulting in either high-grade squamous intraepithelial lesion (HSIL) or atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion (ASC-H). Most with abnormal cytology on anal Pap underwent high-resolution anoscopy (HRA) (n=7/10). High-grade cytology was present on biopsy in 57.1% of patients (n=4/7). Invasive SCCA was found during HRA in 1 patient who had ASC-H on anal Pap screening. Table 1 outlines demographic information and clinical characteristics. Figure 1 demonstrates cytology results. Conclusion Over 75% screened had abnormal cytology, emphasizing the high incidence of anal dysplasia in this set of PLWH and a history of malignancy. The percentages of abnormal cytology in this population with a history of malignancy appeared to be higher than in other studies, implying chronic ongoing immune activation, although future work to expand the cohort is needed for robust estimation. These results should prompt further investigation to understand the potential interplay of HIV and malignancy history on the risk for developing anal dysplasia. Disclosures All Authors: No reported disclosures

Chronic disease prevalence and preventive care among Ontario social housing residents compared with the general population: a population-based cohort study

BackgroundOlder adults living in social housing report poor health and access to healthcare services. This study aimed to estimate the prevalence of chronic diseases, influenza vaccination and cancer screenings among...

Personal Networks and Cervical Cancer Screening among Black Immigrant Women.

Prior research has linked personal network characteristics with cancer screening uptake including Papanicolaou (Pap) screening, but less is known about the experiences of Black immigrant women (BIW) in the USA. We examined the relationship between network characteristics and Pap screening among BIW and explored how their network members influence their cancer related knowledge and prevention behaviors. A mixed methods study of BIW, aged 21-65years, in southeastern US included a cross-sectional survey (N = 204) and in-depth individual interviews (N = 13). We examined whether high-social connectedness, contact frequency, and social support were associated with Pap screening, using multivariable logistic regression models. Thematic analysis further assessed the roles of personal network factors on BIW's cancer preventive behaviors. Pap screening was more likely among BIW with high- versus low-social connectedness (OR: 2.68, CI: 1.12, 6.46). However, the impact of high-social connectedness was attenuated, after adjusting for demographic factors and health insurance. Our qualitative findings revealed that both BIW and their personal networks had limited knowledge on cancer and related prevention measures. Close network members, particularly mother-figures, provided support for BIW's care seeking efforts, including cancer screening, although some participants mentioned a lack of screening support. These findings suggest that Black immigrant communities may benefit from tailored cancer prevention interventions among close network members, to improve knowledge and support for cancer control behaviors.

Detecting the impact of diagnostic procedures in Pap-positive women on anxiety using artificial neural networks.

Women who receive a result of an abnormal Papanicolaou (Pap) smear can fail to participate in follow up procedures, and this is often due to anxiety. This study aimed to apply artificial neural networks (ANN) in prediction of anxiety in women with an abnormal Pap smear test, prior to and following diagnostic procedures. One hundred-seventy two women who received an abnormal Pap screening result took part in this study, completing a questionnaire about socio-demographic characteristics and Hospital Anxiety and Depression Scale (HADS), right before and two to four weeks after diagnostics (i.e. colposcopy/biopsy/endocervical curettage). A feedforward back-propagation multilayer perceptron model was applied in analysis. Prior to diagnostic procedures 50.0% of women experienced anxiety, while after diagnostics anxiety was present in 61.6% of women. The correlation-based feature selection showed that anxiety prior to diagnostic procedures was associated with the use of sedatives, worry score, depression score, and score for concern about health consequences. For anxiety following diagnostics, predictors included rural place of residence, depression score, history of spontaneous abortion, and score for tension and discomfort during colposcopy. The ANN models yielded highly accurate anxiety prediction both prior and after diagnostics, 76.47% and 85.30%, respectively. The presented findings can aid in identification of those women with a positive Pap screening test who could develop anxiety and thus represent the target group for psychological support, which would consequently improve adherence to follow-up diagnostics and enable timely treatment, finally reducing complications and fatal outcome.

Males Have Lower Anal Pap Smear Screening in a Miami Safety-Net HIV Clinic.

Although people with HIV have a markedly higher risk of anal squamous cell carcinoma (ASCC), there are few evaluations of anal Pap screening determinants within safety-net HIV clinics. We conducted an evaluation of anal Pap screening correlates within a safety-net HIV clinic in Miami. Medical records were reviewed for 298 people ages 45 and older receiving HIV primary care. Demographic information and the prevalence of anal Pap screening over 1year (i.e., 2018-2019) were extracted. Between 2018 and 2019, approximately half (46%) of patients completed anal Pap screening although this varied by sex assigned at birth. More than three-fourths of females (77%) compared to one-fourth (23%) of males were screened between 2018 and 2019 (p < 0.0001). Findings underscore the need for multi-level intervention approaches to optimize anal Pap screening among maleswith HIV within the Miami-basedsafety-net clinic.

Pap test recency and HPV vaccination among Brazilian immigrant women in the United States: a cross-sectional study

BackgroundThe United States (U.S.) has a growing population of Brazilian immigrant women. However, limited research has explored Pap tests and human papillomavirus (HPV) vaccination among this population.MethodsParticipants completed an online survey between July—August 2020. Bivariate analyses examined associations between healthcare-related variables (e.g., insurance, having a primary care provider) and demographics (e.g., age, education, income, marital status, years living in the U.S., primary language spoken at home) with 1) Pap test recency (within the past 3 years) and 2) HPV vaccination (0 doses vs. 1 + doses). Variables significant at p < 0.10 in bivariate analyses were included in multivariable logistic regression models examining Pap test recency and HPV vaccination.ResultsThe study found that 83.7% of the sample had a Pap test in the past three years. Women who did not know their household income were less likely to be than women who reported a household income of < $25,000 (adjusted OR [aOR] = 0.34, 95% CI: 0.12, 0.95). Women who had seen a healthcare provider in the past year were more likely to have had a Pap test within the last three years than those who had not seen a provider in the past year ([aOR] = 2.43, 95% CI: 1.32, 4.47). Regarding HPV vaccination, 30.3% of respondents reported receiving one or more doses of the HPV vaccine. The multivariable logic regression models determined that women aged 27 -45 (aOR = 0.35, 95% CI: 0.18, 0.67) were less likely than women aged 18–26 to have been vaccinated against HPV). and that women with a PCP were more likely to be vaccinated than those without a PCP (aOR = 2.47. 95% CI:1.30, 4.59).ConclusionThis study found that Brazilian immigrant women in the youngest age groups (21 – 29) for Pap test, 18- 26 for HPV vaccination) had somewhat better rates of Pap screening and HPV vaccination than the general U.S. population. This study adds new information about cervical cancer prevention and control behaviors among Brazilian immigrant women.

A Review of Abnormal Pap Smear Follow Up in the Resident Clinic

Introduction: The pap smear is a screening tool designed to reduce the incidence of invasive cervical cancer. The incidence of cervical cancer diagnosis has decreased by 50% from 1970 to 2010. This is largely accredited to pap smear screening, follow up colposcopy appropriate surgical treatment. The pap smear was performed annually for many years; however, in 2012 the guidelines changed to spaced screening pap smears. In our resident clinic we serve patients with barriers to health care. These barriers limit follow up for abnormal pap smears. This study aimed to identify the follow up rate after abnormal pap with colposcopy among resident continuity clinic patients. Methods: The patients with annual exams from resident clinic were collected from Jan 1st, 2023 to Jan 1st, 2024. Study Design: The pap smear results and follow up were reviewed. Results: During the year 2023, 402 patients presented to the resident continuity clinic for annual exams. Pap smears were obtained in 82% of our annuals and 12% had an abnormal pap result. Of these patients, only 62% had appropriate follow up colposcopy. Discussion: The results from our study revealed a low rate of follow up from abnormal pap smear. Conclusion: This study allowed us to better understand the abnormal pap smear follow up in our resident clinic population. Future area of study includes how shorter interval follow up after abnormal pap smear screening may affect colposcopy follow up rates.

Cervical Pap screening among women living with HIV in Puerto Rico and the United States – Medical Monitoring Project, 2018–2021

Our objective was to determine the prevalence of cervical Pap screening among women living with HIV (WLWH) in Puerto Rico (P.R.) and other selected United States (U.S.) jurisdictions. Additionally, we sought to compare selected characteristics of WLWH who underwent cervical Pap screening between P.R. and the other U.S. jurisdictions. We analyzed data from the 2018–2021 cycles of CDC’s Medical Monitoring Project (MMP), a national surveillance system among adults with HIV residing in P.R. (n = 218) and 22 other MMP jurisdictions (n = 3,653). Weighted percentages and 95 % confidence intervals (CIs) for selected characteristics were estimated. Prevalence ratios with predicted marginal means were calculated. An estimated 91.6 % and 84.6 % of WLWH underwent cervical Pap screening in P.R. and the other 22 MMP jurisdictions, respectively (Prevalence Ratio = 1.08, 95% CI = 1.03–1.13). Among WLWH who underwent cervical Pap screening, those in P.R. were more likely to be 50+ years of age, have a household annual income below $20,000, engage in binge drinking, never smoke, and have Medicaid/other public insurance than those in the other 22 MMP jurisdictions (p < 0.05). No differences were found between P.R. and the other 22 MMP jurisdictions in the percentage reporting higher than the median HIV-stigma score, experiencing HIV health care discrimination, and having ≥ 1 sexual partner in the past 12 months. Although cervical Pap screening rates among WLWH were higher in P.R. than in the other 22 MMP jurisdictions, both surpass the Healthy People 2030 target. Future research should assess adherence and compliance with updated cervical cancer screening guidelines.

Perceived Barriers to Pap Screening Influence Adherence to Screening Recommendations Among Black Women.

Objectives: The aim of this study was to determine the Health Belief Model (HBM) constructs associated with Pap screening adherence among a sample of African American and sub-Saharan African immigrant women in the United States. Methods: A descriptive cross-sectional study was conducted via an online survey. Participants were recruited from central Kentucky counties. Ninety-one eligible women participated (mean age 38 ± 12 years), 49.5% identified as African American. Twenty-nine percent indicated never being screened or not being up-to-date. Self-reported demographic data, HBM constructs for Pap screening, and Pap screening history were collected. Bivariate and logistic regressions were performed. Results: There was a significant negative association between perceived barriers and being up-to-date. For every one-point increase in perceived barriers, the odds of being up-to-date decreased by 81%, (p = 0.004; CI: 0.06-0.60), findings from further evaluation of the barrier construct showed that barriers significantly associated with screening include items related to lack of knowledge about where to get a Pap screening, lack of time to attend the screening, screening-associated shame and pain, negligence, and age. There were no other significant HBM constructs associated with up-to-date Pap screening status. There was no difference in perceived barriers between African American and sub-Saharan African women. Conclusions: Despite public health efforts to decrease screening barriers, a perception of barriers exists among Black women. Continued efforts to address screening barriers as well as the perception of barriers are warranted among Black women.

Are we ready for human papillomavirus testing? Assessment of patient knowledge of and preferences for cervical cancer screening in Ontario.

To determine patient knowledge and preferences about primary human papillomavirus (HPV) testing. Cross-sectional survey. Two family practice clinics (urban and suburban) and the social media platforms of 2 hospitals in the greater Toronto area between January and February 2023. A total of 413 Ontario residents aged 25 to 69 years, with a cervix, who qualified for Papanicolaou (Pap) screening and could communicate in English. Electronic survey containing questions about knowledge of, and preferences for, cervical cancer screening, including types of screening and screening intervals, and about education related to HPV and screening intervals. Of 441 potential participants, 426 were eligible and consented to participate in the study; ultimately 413 provided completed or partially completed surveys (96.9% response rate). Of those who completed a recent Pap test, 57.8% (208 of 360) knew of HPV testing. Initially, 27.8% thought HPV testing was better than Pap testing for cervical cancer screening. After learning HPV tests exist and have self-sampling options, most participants preferred HPV testing (self-sampling 46.3%, provider sampling 34.1%). Annual cervical cancer screening was preferred by 50.1% of participants despite knowing that, for most people, Pap tests should be conducted every 3 years (74.8%). After learning about HPV testing, participants were more likely to prefer 5-year screening intervals (43.8%); however, those in the family practice group were still more likely to prefer 3-year intervals compared with those in the social media group (P<.01). Participants in this study identified a preference for HPV testing and self-sampling options. Concerns were raised about extended screening intervals and the safety of self-collected samples that need to be addressed in public health education initiatives during rollout of new screening programs.

Evaluation of cervical cytological abnormalities in correlation with clinical findings in Iraqi patients

Abstract Objective: Many articles study the efficiency of pap smears in detecting cervical disease and precancerous lesions; however, in Iraq, only few researches study the clinic-pathological correlation in pap smear results. In this study, we will highlight the correlation of pap smears with the most important and frequent clinical data and findings on cervical examination. Materials and Methods: One hundred and twenty cases are collected from private clinics of gynecology in Al-Kut province during the interval (June 1, 2020, to February 28, 2021). Clinical history was obtained and pap smear test was examined by two pathologists. Data were analyzed using SPSS software program version 26. Results: There were significant statistical association between cytological abnormalities on pap smear test and age of the patient (P-value of 0.01), with low grade squamous intraepithelial lesion (LSIL) result showed the highest mean age of 46.91 as well as significant association with a number of live birth and a number of pregnancies with significant P value (&lt;0.001 and &lt;0.001) in the same order. Atypical squamous cells of undetermined significance were the most common cytological abnormality. Conclusion: Women should not delay their first screening pap test for more than 30 years of age since the mean age for LSIL (the most significant abnormality present in this study) was the age of 46. 91 ± 10.75. awareness about screening for cervical precancerous lesions should be increased especially among multiparous women and those more than 40 years of age.

Abstract C136: Magnetic nanoparticles and quantum dots coupled visual confirmation of cervical cancer cells from cytology samples: A cost-effective, quick and suitable test for rural Indian set-up

Abstract Introduction Screening and management of cervical cancer is a National health priority of developed and developing countries like India. Cervical cancer screening and diagnosis are currently done by cervical pap screening, colposcopy, and nucleic acid hybridization and amplification assays, which are time-consuming and require specialized facilities. These shortcomings pose severe restrictions on the feasibility of the techniques for a country like India.Aim and objectives Bearing this in mind, we aimed to develop a simple, cost-effective, and visual detection of cervical cancer, based on magnetic nanoparticles coupled quantum dots immuno-nano-fluorescence assay (MNCQDINFA).Materials and methods The detection system comprised of magnetic nanoparticles(MNP) and quantum dots (QD) conjugated specific polyclonal antibodies complex generated against recombinantly purified individual domains (domainN and domainC) of HPV-16 oncoprotein E7, which is deregulated and overexpressed to detectable limits by transformed cervical cancer cells only [1-3]. The assay procedure involves incubating processed cervical cytology samples with MNP-Ab (domainN) complex, magnet-induced pelleting, incubation with QD-Ab (domainC) complex, magnet-assisted washing, and final reconstitution in sample buffer and visualization under UV (Figure). Reconstituted sample in the presence of UV gives fluorescence as an indication of the presence of E7 protein thus cervical cancer cells. Results This method produces a visual fluorescence exclusively in the presence of transformed cervical cancer cells under UV light. Analytical assays showed that a minimum of 0.1µg of E7 protein could be detected specifically from a pool of cellular proteins. HPV 16-positive cervical cancer cell lysates showed concordant results. Both the diagnostic sensitivity and specificity of the assay were determined to be 100%. Conclusion The proposed invention is a simple, visual (naked eye), quick (4 hours), and cost-effective (INR 200-300) cervical cancer cells detection method necessary to identify the candidates at risk so that suitable and timely intervention can be provided.

Abstract C106: Association between cancer risk perception and patient-centered communication and cervical cancer screening behavior among African Americans (AA) and Sub-Saharan African immigrant (SAI) women

Abstract Background- Black women in the US have disproportionately higher mortality and shortest survival than any ethnic or racial group for cervical cancer. Many factors contribute to the elevated cancer burden, including cancer risk perceptions and knowledge as well as patient centered communication behaviors that may influence cervical cancer screening uptake. Misperceptions of cancer risk and limited knowledge may decrease the use of preventive cancer screening. In addition, patients who encounter clinicians who practice communication not reflective of patient-centeredness may be less likely to participate in regular cancer screening. The aim of this study was to determine if cervical screening uptake among Black women was associated with cancer risk perceptions and knowledge and clinician communication behavior. Methods- We conducted a cross-sectional survey of Black women (African Americans (AA) and sub-Saharan African (SAI) recruited from Lexington, KY and surrounding towns. Data included sociodemographics, measures of cancer perceptions, and patient-centered communication. The chi-squared test of association and multiple linear regression were used to assess the unadjusted and adjusted associations among cancer risk perceptions and knowledge, patient-centered communication, and receipt of pap test. Data analysis was conducted using SAS, version 9.4 with an alpha of .05. Results- In the sample of 116 Black women who were age appropriate for pap screening (n = 48 SAI; n = 68 AA), nearly two-thirds had received a pap test (63%) in concordance with guidelines. Compared to those who had not had a pap, women who had received a pap test endorsed the statement ‘it seems like everything causes cancer (p=.006),’ while fewer agreed ‘when I think about cancer, I automatically think about death (p&amp;lt;.001)’. Both responses remained significant after adjusting for age, ethnicity, health insurance status and having a primary care provider. A higher proportion of women agreed with the six patient-centered communication items in the bivariate analysis, and remained significant in the adjusted modeling for the responses to the following three items: 1) During the past 12 months, how often did doctors, nurses, or other health professionals give you the chance to ask all the health-related questions you had?; 2) In the past 12 months, how often did you feel you could rely on doctors, nurses, or other health professionals to take care of your health care needs?; and 3) During the past 12 months, how often did doctors, nurses, or other health professionals make sure you understood the things you needed to do to take care of your health? Conclusion- Evaluation of cancer risk perceptions and patient-centered communication provide useful guidance for the development of interventions for Black women. Future research should target Black women that have misperceptions of cancer risk and limited knowledge for cervical cancer awareness. Clinicians should practice communication reflective of patient-centeredness to promote cervical cancer screening behavior. Citation Format: Adebola Adegboyega, Amanda Wiggins, Mark Dignan. Association between cancer risk perception and patient-centered communication and cervical cancer screening behavior among African Americans (AA) and Sub-Saharan African immigrant (SAI) women [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C106.

Spectrum of Pap smear cytology according to The Bethesda System 2014

Carcinoma of cervix is one of the leading cause of mortality in women across the world. Papanicolaou smear is a valuable screening tool for the neoplastic lesions of cervix. Present study was carried out to do clinicocytological correlation of cervical lesions and to find out the spectrum of cervical lesions in study population. An observational study was conducted at Pathology department in Muzaffarnagar Medical College, Muzaffarnagar. Total 1,017 females were enrolled, scrape smears from the cervix were taken and processed using Papanicolaou's method of staining. These stained smears were examined under microscope and classified according to latest The Bethesda System 2014. Out of 1017 cases, 84.9% (863) smears were classified satisfactory according to 2014 The Bethesda System. Majority of cases (350 cases, 40.5%) belonged to age group of 31-40 years. NILM was the most common cytological finding seen in 340 females (39.3%). The epithelial abnormalities including Atypical Squamous Cells (ASCUS, ASC-H), Squamous Intraepithelial Lesion (LSIL, HSIL) and Squamous Cell Carcinoma were seen in 3.2% of total cases. LSIL found in 1.3% cases and HSIL formed 1.0%. Single case of SCC was detected. Cervical epithelial abnormalities are common in Indian females. Pap smear is the most convenient and OPD test to detect epithelial abnormalities in early phase. Awareness regarding the Pap screening should be encouraged to lessen the morbidity and mortality caused by Carcinoma Cervix.

Psychological Distress in Women With Abnormal Pap Smear Results Attending Cervical Cancer Screening.

Women often experience psychological distress upon receipt of an abnormal Pap test result. This study aimed to evaluate psychological distress and its correlates among women who received an abnormal Pap screening test result. A cross-sectional study was performed in a cohort of 172 consecutive women who had attended screening for cervical cancer and who received abnormal Pap smear results and underwent additional diagnostic procedures (colposcopy/biopsy/endocervical curettage). The participants filled out a questionnaire on sociodemographic variables and the Cervical Dysplasia Distress Questionnaire. Multivariate linear regression was used for the analysis of the data. For multiple comparisons, the Bonferroni correction was applied to adjust the level of significance. In women who received an abnormal Pap smear result, the independent correlate of higher psychological distress (by Cervical Dysplasia Distress Questionnaire score) before diagnostic procedures was lower satisfaction with information/support received from other people ( p = .002). Correlates of psychological distress in women older than 40 years with abnormal Pap smear were anxiety ( p = .042) and worry about having cervical cancer, general health and having sex ( p = .044). The authors' findings could enable control of factors predictive of psychological distress in women who received a positive Pap smear screening test before undergoing diagnostic procedures, primarily via active provision of targeted information.

Factors associated with receiving results and attending colposcopy in patients with positive HPV screens in Mexico City

We identified patient and healthcare system factors related to receipt of screening results and attendance to colposcopy among patients with positive screening results in a cervical cancer screening program in Mexico City, Mexico. We analyzed data from 1,351 patients with high-risk human papillomavirus (HPV)-positive results from two screening demonstration studies conducted between 2017 and 2018. Factors associated with receipt of screening results and with adherence to a colposcopy appointment were identified using multivariable logistic regression. Participants had a median age of 40 years (IQR = 32–48), 60% had less than high school education, and 74% had a previous Pap screening in the last 5 years. Fifty-five percent of participants retrieved their screening results at the healthcare facility (HCF) without any reminder. Providing an email address for contact information, attending a HCF with family medicine, and receiving care from experienced nurses were associated with greater adherence to obtaining screening test results. Fifty-seven percent of participants attended their first scheduled colposcopy appointment. Providing a phone number improved adherence to colposcopy, whereas longer travel times between the HCF and the colposcopy clinic was associated with a decrease in colposcopy adherence. Having a Pap test in the last 5 years was positively associated with better compliance with both outcomes. Securing contact information may help to overcome barriers to future follow-up. Additional research is necessary on strategies for obtaining screening test results and scheduling appointments, which may help address barriers to access, such as limited staff availability, distance from the clinic, and travel costs.

Factors associated with shorter-interval cervical cancer screening for young women in three United States healthcare systems

Frequently changing cervical cancer screening guidelines over the past two decades have been inconsistently adopted in the United States. Current guidelines set the recommended screening interval to three years for average-risk women aged 21–29 years. Few studies have evaluated how patient and provider factors are associated with implementation of cervical cancer screening intervals among younger women. This study evaluated multilevel factors associated with screening interval length among 69,939 women aged 21–29 years with an initial negative Pap screen between 2010 and 2015 across three large health systems in the U.S. Shorter-interval screening was defined as a second screening Pap within 2.5 years of an initial negative Pap. Mixed-effects logistic regression was performed for each site to identify provider and patient characteristics associated with shorter-interval screening. The odds of shorter-interval screening decreased over the study period across all sites, though the proportion of patients screened within 2.5 years remained between 7.5% and 20.7% across sites in 2014–2015. Patient factors including insurance, race/ethnicity, and pregnancy were associated with shorter-interval screening, though the patterns differed across sites. At one site, the variation in shorter-interval screening explained by the provider was 10.6%, whereas at the other two sites, the provider accounted for < 2% of the variation in shorter-interval screening. Our results highlight the heterogeneity in factors driving cervical cancer screening interval across health systems and point to the need for tailored approaches targeted to both providers and patients to improve guideline-concordant screening.

Abstract 39: Factors Associated With Receiving Results and Attending Colposcopy in Patients With Positive HPV Screens in Mexico City

Abstract Purpose: Unlike in high-income countries, where cervical cancer (CC) screening programs have resulted in a dramatic decrease in incidence and mortality of this nearly fully preventable disease, in low- and middle-income countries, the impact of these programs has been limited. Poor follow-up to abnormal cancer screening tests lessens the benefit of CC screening. We sought to identify multilevel factors at the level of patient, provider, and healthcare system related to receipt of screening results and attendance to colposcopy among patients with positive screening results in a CC screening program in Mexico. Methods: We studied 1,351 patients who were scheduled for colposcopy after testing positive for high-risk human papillomavirus in two screening demonstration studies conducted in Mexico City’s Tlalpan District (2017-2018). Multilevel factors associated with receipt of screening results and with adherence to a colposcopy appointment were identified using multivariable logistic regression. Results: Participants had a median age of 40 years, 58% had less than high school education, and 74% had a Pap screening recently (i.e., in the last 5 years). Fifty-five percent of participants retrieved their screening results at the healthcare facility before being reminded to do so. Greater adherence to obtaining screening test results was associated with providing an email address as contact information (Odds Ratio 1.35 [95% Confidence Interval 1.03-1.77]), attending a facility with family medicine (1.54 [1.07-2.21]), and receiving care from experienced nurses (1.85 [1.30-2.70]). Fifty-seven percent of participants attended their first scheduled colposcopy appointment. Providing a phone number as contact information was linked to improved adherence to colposcopy (1.27 [1.01-1.59]), whereas longer travel time between the healthcare facility and the colposcopy clinic was associated with a decrease in colposcopy adherence (0.68 [0.49-0.94]). Having a Pap recently was positively associated with better compliance with both outcomes (1.36 [0.96-1.94] for receiving results; 1.59 [1.10-2.29] for colposcopy adherence). Conclusion: We identified multilevel factors associated with abnormal test follow-up in patients in Mexico City. Additional research is necessary to design and test components for a multilevel intervention to address these factors and enable successful implementation of the follow-up process for abnormal screens from screening to diagnosis and treatment. Citation Format: Leith León-Maldonado, Raul U. Hernández-Ramírez, Leticia Torres-Ibarra, Donna Spiegelman, Sangini S Sheth, Eduardo Lazcano-Ponce, José Damián Cadena-Fiscal, Jorge Salmerón. Factors Associated With Receiving Results and Attending Colposcopy in Patients With Positive HPV Screens in Mexico City [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 39.

P002 Results from a clinical performance study of a new neonatal PAP screening ELISA kit for cystic fibrosis-newborn screening

CF has been included in most newborn screening (NBS) programs based on well-recognized, long-term benefits for CF-patients. CF-NBS algorithms worldwide are quite variable, usually starting with IRT determination, with positive results triggering second-tier tests that can be either DNA analysis or PAP determination.

Experiences and Challenges of African American and Sub-Saharan African Immigrant Black Women in Completing Pap Screening: a Mixed Methods Study.

Understanding Black women's Papanicolaou (Pap) screening experiences can inform efforts to reduce cancer disparities. This study examined experiences among both US-born US Black women and Sub-Saharan African immigrant women. Using a convergent parallel mixed methods design, Black women born in the USA and in Sub-Saharan Africa age 21-65 years were recruited to participate in focus groups and complete a 25-item survey about patient-centered communication and perceived racial discrimination. Qualitative and quantitative data were integrated to provide a fuller understanding of results. Of the 37 participants, 14 were US-born and 23 were Sub-Saharan African-born Black women. The mean age was 40.0 ± 11.0, and 83.8% had received at least one Pap test. Five themes regarding factors that impact screening uptake emerged from the focus groups: (1) positive and negative experiences with providers; (2) provider communication and interaction; (3) individual barriers to screening uptake, (4) implicit bias, discrimination, and stereotypical views among providers, and (5)language barrier. Survey and focus group findings diverged on several points. While focus group themes captured both positive and negative experiences with provider communication, survey results indicated that most of both US-born and Sub-Saharan African-born women experienced positive patient-centered communication with health care providers. Additionally, during focus group sessions many participants described experiences of discrimination in health care settings, but less than a third reported this in the survey. Black women's health care experiences affect Pap screening uptake. Poor communication and perceived discrimination during health care encounters highlight areas for needed service improvement to reduce cervical cancer disparities.