Participation In Cervical Cancer Screening Research Articles

Evaluation of culturally sensitive educational video for informed screening decisions among migrants

Abstract Background In the Netherlands, especially Turkish- and Moroccan-Dutch women show low cervical cancer screening participation and limited informed decision-making in this regard. To meet the needs of these women, a culturally sensitive educational video was developed. The objective was to evaluate the effect of the video on informed decision-making regarding cervical cancer screening participation among Turkish and Moroccan women aged 30-60 years in the Netherlands. Methods Initial respondents were recruited via several social media platforms and invited to complete an online questionnaire. Following respondent-driven sampling, respondents were asked to recruit a number of peers from their social network to complete the same questionnaire. Respondents were randomly assigned to the control condition (current information brochure) or intervention condition (brochure and video). We evaluated the added effect of the video on knowledge, attitude, intention, and informed decision-making using intention-to-treat analyses. Results The final sample included 686 Turkish- and 878 Moroccan-Dutch women. Of this sample, 793 were randomised to the control group (350 Turkish and 443 Moroccan) and 771 to the intervention group (336 Turkish and 435 Moroccan). Among Turkish-Dutch women, 33.1% of the control respondents and 40.5% of the intervention respondents consulted the brochure (not statistically significant). Among Moroccan-Dutch women, these percentages were 28.2% and 37.9%, respectively (P = 0.003). Of all intervention respondents, 96.1% (Turkish) and 84.4% (Moroccan) consulted the video. The video resulted in more positive screening attitudes among Moroccan-Dutch women, in comparison to the brochure (74.3% versus 68.4%, P = 0.07). Conclusions Our short, easily implementable video resulted in more positive screening attitudes in Turkish- and Moroccan-Dutch women and can thus contribute to informed cervical cancer screening decisions. Key messages

Relationship Between Income and Husband's Support In Participation With Via Screening Method In Sexual Productive Women

Cervical cancer is the second most common cancer in women worldwide after breast cancer. The high incidence of cervical cancer is due to delays in diagnosis and patients coming in with advanced cancer conditions; it is necessary to have cervical cancer screening so that it is not too late in treatment. One cervical cancer screening that can be done is the visual inspection with the acetic acid (VIA) method. Based on the existing phenomena, not all women of childbearing age want to do the VIA examination because they feel ashamed, lack knowledge regarding the importance of VIA, fear feeling sick during the examination, and lack of husband's support. This study aims to determine the relationship between income level and husband's help with participation in cervical cancer screening using the VIA method in women of childbearing age. This type of research is a quantitative study with a cross-sectional approach. The research sample is women of childbearing age, which meets the sample criteria by using simple random sampling of as many as 120 respondents. The instrument used is a questionnaire and data analysis using Chi-square. The results showed a relationship between the level of income and the husband's support with participation in cervical cancer screening using the VIA method at WUS in Tandun I District, with p-values of 0.010 and 0.028 (p-value <0.05). The conclusion is that an increase in income or the provision of material support and the husband's support can make his wife carry out an IVA examination. Therefore, it is hoped that what should give an increase in income or the provision of materials support and a husband's license to the wives of couples of childbearing age to prevent cervical cancer and reduce cervical cancer mortality

Development of an Algorithm for Cervical High-Grade Squamous Intraepithelial Lesion Based on Breath Print Analysis.

This study was designed to develop an algorithm for the diagnosis of cervical high-grade squamous intraepithelial lesions (HSIL), based on patterns of volatile organic compounds, evaluated using an e-nose. For this pilot study, the study population consisted of a group of 25 patients with histologically confirmed HSIL and a group of 26 controls. Controls consisted of women visiting the outpatient department for gynecological complaints unrelated to cancer. Women had a negative high-risk human papillomavirus and/or normal cytology (negative for intraepithelial lesions of malignancy) of their most recent test performed in the context of participation in routine cervical cancer screening. Breath tests were performed and labeled with the correct diagnosis. Machine-learning techniques were used to develop a model for predicting HSIL. Based on the receiver operating characteristics curve, both sensitivity and specificity were calculated. Individual classifications of all patients with HSIL and controls, as calculated by the model, showed a sensitivity of 0.88 (95% CI = 0.68-0.97) and specificity of 0.92 (95% CI = 0.73-0.99). The positive predictive value and the negative predictive value were 0.92 (95% CI = 0.72-0.99) and 0.89 (95% CI = 0.70-0.97), respectively. The Cohen κ coefficient was 0.80. E-nose can detect distinctive patterns of volatile organic compounds between cervical HSIL patients and controls. Validation of the algorithm in further studies is necessary before possible implementation into daily practice.

Concurrent participation in breast, cervical, and colorectal cancer screening in the Netherlands

BackgroundMany European countries offer organised population-based breast, cervical, and colorectal cancer screening programmes. Around age 55 and 60, Dutch women are invited to all three screening programmes. We examined the extent to which participation concurs and identified factors influencing concurrent participation. Materials and methodsIndividual level data from breast, cervical, and colorectal cancer screening invitations between 2017 and 2019 were extracted from the Dutch screening registry. The percentages of women participating in all three, two, one, or none of the programmes around age 55 and 60, and before subsequent round invitation were determined. Multivariate ordinal regression analyses were performed to estimate whether population density, socio-economic status (SES) per postal code area, and time between the three invitations (<3, 3–6, >6 months) were associated with concurrent participation. ResultsData from 332,484 women were analysed. At age 55, 53.7% participated in all three programmes, 22.1% in two, 11.7% in one, and 12.6% did not participate at all. At age 60, a similar participation pattern was observed. Women living in areas with higher population density were less likely (odds ratios 0.75–0.94) and women in higher SES groups were more likely (odds ratios 1.12–1.60) to participate in more screening programmes, although this positive association was smaller for the highest SES group. No substantial association was found between concurrent participation and timing of invitations. ConclusionsMore than half of Dutch women participated in all three screening programmes and around 12% did not participate in any. Concurrent participation was lower in cities and lower SES groups.

A Family-Centered Sexual Health Intervention to Promote Cervical Cancer Screening Uptake Among Low-Income Rural Women in India: Protocol for a Community-Based Mixed Methods Pilot Study.

BackgroundHuman papillomavirus (HPV) is the primary cause of cervical cancer, which is preventable through screening and early treatment. The Papanicolaou (Pap) test and visual inspection with acetic acid (VIA), which are traditionally performed in clinical settings, have been used effectively to screen for cervical cancer and precancerous changes and reduce cervical cancer mortality in high-income countries for many decades. However, these screening methods are not easily accessible to women living in low- and middle-income countries, especially women living in rural areas.ObjectiveThe project will use HPV self-sampling, which will be supported by a sexual health literacy intervention, to increase rural women’s participation in cervical cancer screening. The objectives are to determine the effectiveness of this program in (1) increasing sexual health literacy, (2) reducing the gendered stigma of HPV and cervical cancer, and (3) promoting cervical cancer screening by using HPV self-sampling.MethodsThe pilot study will use a community-based, family-centered, mixed methods design. We will recruit 120 women aged 30 to 69 years who are underscreened or were never screened for cervical cancer, along with 120 supportive male relatives or friends from 3 low-income rural/tribal villages in Maharashtra, India. Participants will attend gender-specific sexual health education sessions, followed by a movie matinee. Data will be collected through an interviewer-administered questionnaire before and after sexual health education sessions. The questionnaire will include items on social demographics, medical histories, attitudes, sexual health stigma, cervical cancer knowledge, and screening practices. Women will self-select whether to use HPV self-sampling. Those who do not may undergo a Pap test or VIA. Participants’ views regarding barriers and facilitators and their suggestions for improving access and uptake will also be elicited. This protocol was approved by the research ethics boards of Toronto Metropolitan University (formerly known as Ryerson University; reference number: REB 2020-104) and Tata Memorial Center (reference number: OIEC/3786/2021 /00003).ResultsThe Preventing Cervical Cancer in India Through Self-Sampling study was funded in January 2020 for 15 months. Due to the COVID-19 pandemic, the project was extended by 1 year. The study outcome measures will include changes in knowledge and attitudes about cervical cancer screening, the proportion of participants who self-select into each cohort, the proportion of positive test results in each cohort, and the proportion of participants with confirmed cervical cancer. Women’s experiences regarding barriers and facilitators of screening uptake will be captured.ConclusionsOur multifaceted work could lead to reduced cervical cancer mortality and morbidity and increased community capacity in sexual health promotion and cervical cancer prevention. The insights and lessons learned from our project can be used to inform the adaptation and scale-up of HPV self-sampling among women across India and in other countries; promote collective commitment to family-centered wellness; and support women to make healthful, personalized cervical screening decisions.International Registered Report Identifier (IRRID)PRR1-10.2196/35093

Three birds with one stone: a protocol for a randomised intervention study to increase participation in cervical and colorectal cancer screening among women attending breast cancer screening

IntroductionThe participation rate is higher in breast cancer screening than in cervical cancer (CCU) and colorectal cancer (CRC) screening. In this cluster-randomised study, we aim to evaluate an intervention offering...

Factors Affecting the Cervical Cancer Screening Behaviors of Japanese Women in Their 20s and 30s Using a Health Belief Model: A Cross-Sectional Study.

In recent years, the incidence and mortality rates of cervical cancer (CC) have increased among young women. Cervical cancer screening (CCS) is crucial to reducing the incidence and mortality of CC in a country such as Japan, where it is challenging to raise HPV vaccination rates. The purpose of this study was to identify psychological and personal characteristics relating to CCS participation among young people by using the Health Belief Model (HBM). For this cross-sectional study, an internet survey was conducted between February–March 2018. Based on HBM and personal characteristics, χ2 tests and logistic analyses were used to identify factors influencing CCS. Responses obtained from 816 women in their 20s and 30s were used in the analysis. For HBM-based psychological characteristics, the odds ratios were significantly higher for “cues to participation in screening” and “barriers to participation at the time of cancer screening”, while “barriers to participation before cancer screening” showed significantly lower odds ratios. On the other hand, it was found that the presence of children and having regular health checkups affected the attributes of screening that were significant for decision-making. Therefore, it is important to create proactive measures to encourage younger women to undergo medical examinations.

Effectiveness of Artificial Intelligence-Assisted Decision-making to Improve Vulnerable Women's Participation in Cervical Cancer Screening in France: Protocol for a Cluster Randomized Controlled Trial (AppDate-You).

BackgroundThe French organized population-based cervical cancer screening (CCS) program transitioned from a cytology-based to a human papillomavirus (HPV)–based screening strategy in August 2020. HPV testing is offered every 5 years, starting at the age of 30 years. In the new program, women are invited to undergo an HPV test at a gynecologist’s, primary care physician’s, or midwife’s office, a private clinic or health center, family planning center, or hospital. HPV self-sampling (HPVss) was also made available as an additional approach. However, French studies reported that less than 20% of noncompliant women performed vaginal self-sampling when a kit was sent to their home. Women with lower income and educational levels participate less in CCS. Lack of information about the disease and the benefits of CCS were reported as one of the major barriers among noncompliant women. This barrier could be addressed by overcoming disparities in HPV- and cervical cancer–related knowledge and perceptions about CCS.ObjectiveThis study aimed to assess the effectiveness of a chatbot-based decision aid to improve women’s participation in the HPVss detection-based CCS care pathway.MethodsAppDate-You is a 2-arm cluster randomized controlled trial (cRCT) nested within the French organized CCS program. Eligible women are those aged 30-65 years who have not been screened for CC for more than 4 years and live in the disadvantaged clusters in the Occitanie Region, France. In total, 32 clusters will be allocated to the intervention and control arms, 16 in each arm (approximately 4000 women). Eligible women living in randomly selected disadvantaged clusters will be identified using the Regional Cancer Screening Coordinating Centre of Occitanie (CRCDC-OC) database. Women in the experimental group will receive screening reminder letters and HPVss kits, combined with access to a chatbot-based decision aid tailored to women with lower education attainment. Women in the control group will receive the reminder letters and HPVss kits (standard of care). The CRCDC-OC database will be used to check trial progress and assess the intervention’s impact. The trial has 2 primary outcomes: (1) the proportion of screening participation within 12 months among women recalled for CCS and (2) the proportion of HPVss-positive women who are “well-managed” as stipulated in the French guidelines.ResultsTo date, the AppDate-You study group is preparing and developing the chatbot-based decision aid (intervention). The cRCT will be conducted once the decision aid has been completed and validated. Recruitment of women is expected to begin in January 2023.ConclusionsThis study is the first to evaluate the impact of a chatbot-based decision aid to promote the CCS program and increase its performance. The study results will inform policy makers and health professionals as well as the research community.Trial RegistrationClinicalTrials.gov NCT05286034; https://clinicaltrials.gov/ct2/show/NCT05286034International Registered Report Identifier (IRRID)PRR1-10.2196/39288

Disability and Participation in Breast and Cervical Cancer Screening: A Systematic Review and Meta-Analysis.

It is well established that access to preventative care, such as breast or cervical cancer screening, can reduce morbidity and mortality. Certain groups may be missed out of these healthcare services, such as women with disabilities, as they face many access barriers due to underlying inequalities and negative attitudes. However, the data have not been reviewed on whether women with disabilities face inequalities in the uptake of these services. A systematic review and meta-analysis were conducted to compare the uptake of breast and cervical cancer screening in women with and without disabilities. A search was conducted in July 2021 across four databases: PubMed, MEDLINE, Global Health, and CINAHL. Quantitative studies comparing the uptake of breast or cervical cancer screening between women with and without disabilities were eligible. Twenty-nine studies were included, all from high-income settings. One third of the 29 studies (34.5%, n = 10) were deemed to have a high risk of bias, and the remainder a low risk of bias. The pooled estimates showed that women with disabilities have 0.78 (95% CI: 0.72–0.84) lower odds of attending breast cancer screening and have 0.63 (95% CI: 0.45–0.88) lower odds of attending cervical cancer screening, compared to women without disabilities. In conclusion, women with disabilities face disparities in receipt of preventative cancer care. There is consequently an urgent need to evaluate and improve the inclusivity of cancer screening programs and thereby prevent avoidable morbidity and mortality.

Cervical Cancer Disparities in the American Indian/Alaska Native Population: Are Prevention Tools Being Utilized? (108)

Objectives: Our group published data demonstrating that American Indian/Alaska Native (AI/AN) women have had persistently higher incidence and mortality from cervical cancer than Non-Hispanic White women in the Pacific Northwest (WA, ID, OR). Cervical cancer screening is an essential tool for detecting pre-invasive and early-stage, curable disease. We sought to longitudinally evaluate the participation of AI/AN women in the Pacific Northwest in cervical cancer screening. Results: In the PNW, we identified a total of 34,278 patients eligible for cervical cancer screening within the 10-year period. The aggregate up-to-date pap smear rate was 63.5% for the three-state region (Figure 1). Between the two time periods assessed (January 2010 to December 2014 and January 2015 to July 2020), cervical cancer screening rates increased slightly in all three states of interest, with the greatest increase seen in Washington state (4.0%) and least in Idaho (1.3%). Despite these modest increases, cervical cancer screening rates remain below the 2018 calculated national screening average of 80.5% and the Healthy People 2030 target of 84.3%. Conclusions: In order to reduce the invasive cervical cancer disparities faced by AI/ANs, enhanced efforts should be directed toward identifying and reducing barriers to increase participation in cervical cancer screening. Objectives: Our group published data demonstrating that American Indian/Alaska Native (AI/AN) women have had persistently higher incidence and mortality from cervical cancer than Non-Hispanic White women in the Pacific Northwest (WA, ID, OR). Cervical cancer screening is an essential tool for detecting pre-invasive and early-stage, curable disease. We sought to longitudinally evaluate the participation of AI/AN women in the Pacific Northwest in cervical cancer screening. Results: In the PNW, we identified a total of 34,278 patients eligible for cervical cancer screening within the 10-year period. The aggregate up-to-date pap smear rate was 63.5% for the three-state region (Figure 1). Between the two time periods assessed (January 2010 to December 2014 and January 2015 to July 2020), cervical cancer screening rates increased slightly in all three states of interest, with the greatest increase seen in Washington state (4.0%) and least in Idaho (1.3%). Despite these modest increases, cervical cancer screening rates remain below the 2018 calculated national screening average of 80.5% and the Healthy People 2030 target of 84.3%. Conclusions: In order to reduce the invasive cervical cancer disparities faced by AI/ANs, enhanced efforts should be directed toward identifying and reducing barriers to increase participation in cervical cancer screening.

A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression Among Low-Income Women.

Low-income women of color receive fewer cancer screenings and have higher rates of depression, which can interfere with cancer screening participation. This study assessed the comparative effectiveness of two interventions for improving colorectal, breast, and cervical cancer screening participation and reducing depression among underserved women in Bronx, NY, with depression. This comparative effectiveness randomized controlled trial (RCT) with assessments at study entry, 6, and 12 months utilized an intent-to-treat statistical approach. Eligible women were aged 50 to 64, screened positive for depression, and were overdue for ≥ 1 cancer screening (colorectal, breast, and/or cervical). Participants were randomized to a collaborative depression care plus cancer screening intervention (CCI + PCM) or cancer screening intervention alone (PCM). Interventions were telephone-based, available in English or Spanish, delivered over 12 months, and facilitated by a skilled care manager. Cancer screening data were extracted from electronic health records. Depression was measured with a validated self-report instrument (PHQ-9). Seven hundred fifty seven women consented and were randomized (CCI + PCM, n = 378; PCM, n = 379). Analyses revealed statistically significant increases in up-to-date status for all three cancer screenings; depression improved in both intervention groups. There were no statistically significant differences between the interventions in improving cancer screening rates or reducing depression. CCI and PCM both improved breast, cervical, and colorectal cancer screening and depression in clinical settings in underserved communities; however, neither intervention showed an advantage in outcomes. Decisions about which approach to implement may depend on the nature of the practice and alignment of the interventions with other ongoing priorities and resources.

Social Inequalities in Participation in Cervical Cancer Screening in a Metropolitan Area Implementing a Pilot Organised Screening Programme (Paris Region, France).

Objectives: We aimed to examine social inequalities in participation in cervical cancer screening (CCS) in a metropolitan area by implementing a pilot organised screening programme. The pilot programme consisted of sending invitations to women who did not perform a pap smear within the past 3 years, managing interventions to reach vulnerable women, training healthcare professionals, and organising follow-ups of abnormal pap smears. Methods: We studied participation in CCS between January 2014 and December 2016 among 241,257 women aged 25–63 years old. To assess relative inequalities, Odds Ratios were computed using multilevel logistic regression. To assess absolute inequalities, the CCS coverage and the rate difference were calculated. Inequalities were computed by age and neighbourhood characteristics (social deprivation and proportion of single women). Results: Disparities in participation in CCS were observed by age and social deprivation. For overall screening compared to opportunistic screening, disparities by age were larger (OR25-35_vs._55–64 = 2.13 [2.08–2.19] compared to 2.02 [1.96–2.07]), but disparities by social deprivation were decreased (OR10%_most_vs._10%_least_deprived = 2.09 [1.90–2.30] compared to 2.22 [2.02–2.44]). Conclusion: Disparities in CCS participation remain despite the organised programme. To reduce these inequalities, free screening should be proposed and evaluated.

EPH87 Participation in Cervical Cancer Screening in Hungary

The aim of our study was to explore knowledge, habits and motivation to cervical cancer screening among women aged between 25 and 65 years.

Women’s sexual autonomy as a determinant of cervical cancer screening uptake in Addis Ababa, Ethiopia: a case–control study

Cervical cancer (CC) is the fourth most common cancer in women worldwide and the leading cause of cancer deaths in developing countries. CC can be prevented through available preventive interventions. However, most patients in developing countries, such as Ethiopia, present late with advanced stage disease due to low participation in CC screening and require treatment involving multiple modalities. Women’s social, economic and cultural backgrounds have been associated with the level of participation in CC screening programmes. Therefore, this study aimed to assess women’s sexual autonomy as a determinant of lifetime CC screening among women in Addis Ababa, Ethiopia. An institutional-based case–control study was conducted in which controls were women who had received screening services during the last 5 years, and cases were randomly selected from women coming for other services but never screened or aware of the screening service. Accordingly, 294 women were enrolled. Data were collected by using a pre-tested standard questionnaire through interviewing. Bivariate and multivariable logistic regression analyses were performed to assess the women’s sexual autonomy as a determinant of lifetime CC screening. The study revealed higher sexual autonomy led to higher odds for having been screened (adjusted odds ratio (AOR) = 3.128, 95% CI (1.730, 5.658)). Moreover, direct referral to the screening service (AOR = 3.173, 95% CI (1.57, 6.45)) and parity had positively affected the lifetime uptake of CC screening (AOR = 2.844, 95% CI (1.344, 6.014)). We found that women’s own sexual autonomy was associated with the improvement of CC screening uptake. Empowering women could alleviate barriers to CC screening in the community.

Correlates of cervical cancer screening participation, intention and self-efficacy among Muslim women in southern Ghana

BackgroundThe World Health Organisation’s efforts to eliminate cervical cancer by 2030 with a target of 70% screening coverage using a high-performance test demand that women increase participation in screening. Factors that impact uptake of screening must therefore be identified and bottlenecks addressed, especially in lower- and middle-income countries where cervical cancer incidence remains high. This study investigated Muslim women, participation in, intention to engage in and self-efficacy about cervical cancer screening.MethodsAn analytical cross-sectional study was conducted among Muslim women aged 18 years and above in the Cape Coast Metropolis of Ghana using an interviewer-administered questionnaire. Data were analysed using appropriate descriptive statistics, Chi-square test, point biserial correlation and binary logistic regression analysis.ResultsThe mean age of participants was approximately 31 years (M = 30.9, SD = 10.4). Out of the 431 women, 21 (4.9%) had ever participated in cervical cancer screening. Participants demonstrated very low knowledge about cervical cancer and screening, with a mean knowledge score of 3.68 out of 15. Knowledge about cervical cancer was associated with increased odds of participating in cervical cancer screening (aOR = 1.32, 95%CI 1.11, 1.56). Concerns about similarity with health provider in terms of gender and faith was associated with decreased odds of cervical cancer screening self-efficacy (aOR = 0.81, 95% CI 0.67). Islamic modesty (aOR = 0.88, 95%CI 0.81, 0.96) was associated with decreased self-efficacy about seeking cervical cancer screening, whereas attitude (aOR = 1.32, 95%CI 1.14, 1.53) was significantly associated with increased self-efficacy about seeking cervical cancer screening. Again, Islamic modesty (aOR = 0.88, 95%CI 0.80, 0.97) was associated with decreased intention to participate in screening, whereas attitude (aOR = 1.42, 95%CI 1.20, 1.68) was associated with increased intention to participate in screening.ConclusionsThere are gaps in knowledge of cervical cancer among Muslim women in this study as less than 5% had participated in screening. A positive attitude was found to influence intention to screen and actual participation in screening programmes. Islamic modesty and commitment to the Islamic faith decreased intention and self-efficacy regarding screening. Therefore, comprehensive and appropriate socio-cultural and religion-specific interventions aimed at addressing the barriers to screening are important in improving uptake among Muslim women.

The role of primary care Nurse Practitioners in reducing barriers to cervical cancer screening: A literature review.

Nearly all cases of cervical cancer (CC) are caused by persistent infection by human papillomavirus (HPV). CC remains the second most prevalent carcinoma among women and, in 2017, Canada's screening rates were off target by 19%. For example, screening rates as low as 57.6% were observed in low-income neighbourhoods in Ontario, compared to 70% in highest-income neighbourhoods. Complex, multifactorial barriers affect women's participation in cervical cancer screening (CCS). The most common barriers to screening are directly linked to disparities within determinants of health, including belonging to a minority ethnic group, low socioeconomic status, lack of education, and lack of access to healthcare. Nurse Practitioners (NPs) can reduce these barriers by providing innovative, evidence-based, culturally competent women-friendly care while building trusting relationships with patients and, thus, play a greater role in preventing the disease. The objective of this literature review is to summarize barriers to CCS and the role Canadian NPs can have in reducing them.

Women with obesity participate less in cervical cancer screening and are more likely to have unsatisfactory smears: Results from a nationwide Danish cohort study

Some studies found an association between obesity and increased cervical cancer risk, but potential mechanisms are unknown. In this nationwide register-based cohort study, we investigated the association between overweight/obesity and cervical cancer screening participation and risk of unsatisfactory smears. The study population was identified in the Danish Medical Birth Registry. We included 342,526 women aged 23–49 years with pre-pregnancy body mass index (BMI) registered during 2004–2013. Screening participation and unsatisfactory smears during up to four years after child birth were identified in a nationwide pathology register. We used absolute risk regression to estimate the relative absolute risk (RAR) with 95% confidence intervals (CIs) of screening participation according to BMI, adjusted for age, calendar year, sociodemographic characteristics, parity and previous high-grade cervical intraepithelial neoplasia. Among those who were screened (n = 295,482), we used log-binomial regression to investigate the relative risk (RR) of an unsatisfactory smear according to BMI, adjusted for age, year, parity, oral contraceptive use and pathology department. A lower proportion of obese women (79.3%) than women of normal weight (85.8%) were screened, and obese women had lower adjusted probability of being screened than women of normal weight (RARadjusted = 0.94, 95% CI, 0.93–0.95). A higher proportion of obese women (2.4%) than women of normal weight (1.7%) had an unsatisfactory smear, and this association remained after adjustments (RRadjusted = 1.28, 95% CI, 1.19–1.38). In conclusion, women with obesity were less likely to participate in cervical cancer screening and more likely to have an unsatisfactory smear than women of normal weight.

Quality as an Intermediate Goal of the Dutch Healthcare System: Presentation and Evaluation of the Quality of Cancer Care

Cancer care represents a challenge for the healthcare systems of OECD member states. This also applies to the Netherlands, as cancer is the leading cause of death. High quality of care is essential to effectively tackle the burden of disease caused by cancer. According to the WHO health systems framework, quality is an intermediate goal of health systems, alongside safety, access and coverage. This study aimed to assess the quality of cancer care in the Netherlands, especially in terms of effectiveness. To assess the quality of cancer care in the Netherlands, participation rates in screening and 5-year survival rates for breast, cervical and colorectal cancer were used. The Netherlands is interested in ensuring quality healthcare, and quality is one of the three main objectives of the healthcare system. The 5-year survival rates for breast, cervical and colorectal cancer were above the respective OECD averages in 2014, but some countries are better positioned. Participation in screening for cervical cancer was relatively low in the Netherlands in 2017, below the OECD average. It can be concluded that the Netherlands has high-quality, effective cancer care and is striving to continuously improve it. However, there is room for improvement , especially with regard to participation in cervical cancer screening, transparency about the quality of healthcare and regional differences in the quality of care.

Human Papillomavirus Self-Sampling for Primary Cervical Cancer Screening in Under-Screened Women in Hong Kong during the COVID-19 Pandemic.

The aim of this study was to assess the effectiveness of HPV self-sampling for cervical cancer screening and the best means of service delivery, with a specific focus on under-screened women, particularly during the COVID-19 pandemic. Using three arms of service delivery (social media, school outreach and underserved outreach), we recruited under-screened women aged 30–65 years from two population groups: the general public and specific underserved communities, from whom self-sampled specimens and optional clinician-sampled cervical specimens were obtained for HPV testing. A total of 521 self-sampling kits were distributed, of which 321 were returned, giving an overall uptake rate of 61.6%. The response rate was higher in the face-to-face underserved outreach (65.5%) compared to social media (22.8%) and school outreach (18.2%). The concordance for HPV detection between self-sampled and clinician-sampled specimens was 90.2% [95% confidence interval (CI) 85.1–93.8%; Cohen’s kappa 0.59 (95% CI 0.42–0.75)]. Overall, 89.2% of women were willing to have self-sampling again. In conclusion, HPV self-sampling is an effective method for cervical cancer screening and can be considered as an option, particularly in women who are reluctant or unable to attend regular screening. Various service deliveries could be considered to increase participation in cervical cancer screening.

Knowledge of Cervical Cancer Screening in Adult Women: Meta-Analysis

Background: Cervical cancer is the fourth common cancer worldwide and the second most common cancer cases in women. Cervical cancer screening allows detection of abnormal cervical cells. Having knowledge about cervical cancer and its screening can increase the absorption of services for cervical cancer screening. This study was aimed to determine the comparison of participation in cervical cancer screening in adult women with high education with adult women with low education. Subjects and Method: This study was a systematic review and meta-analysis with the following PICO, population: adult women. Intervention: high knowledge. Comparison: low knowledge. Results: cervical cancer screening. The articles used in this study were obtained from two databases, namely Google Scholar and Pubmed. Keywords to search for "Knowledge," "screening" "cervical cancer" "adult women". The articles included are full-text articles with a cross-sectional study design from 2016 to 2022 and report multivariate analysis with Adjusted Odds Ratio (aOR). Articles were analyzed using the Review Manager 5.3 application. Results: Systematic study and meta-analysis of this study A total of 16 articles from 2 African continents (Ethiopia, Nigeria, Southern Ethiopia, South west Ethiopia, Ivory Coast, South Africa, Northwest Ethiopia, Cameroon, eastern Ethiopia, Ghana), and Asia (Thailand and Malaysia). Showed that women with high knowledge had an attitude to cervical cancer screening 3.63 times compared to women with low knowledge and the results were statistically significant (aOR = 3.63; 95% CI = 2.11 to 6.24; p&lt;0.001). Conclusion: A high level of knowledge increases attitudes to cervical cancer screening in adult women. Keywords: screening, cervical cancer, knowledge. Correspondence: I Gusti Agung Ngurah Putra Pradnyantara, Poltekkes Permata Indonesia. Jl. Ringroad Utara No 22 C, Gandok, Condong Catur, Depok, Sleman, Yogyakarta, Indonesia. Email: gustipradnyantara1997@gmail.com. Mobile: +6282146804776.