Regular Cervical Screening Research Articles

Coverage of cervical cancer prevention interventions among people in Australia who inject drugs

BackgroundThe human papillomavirus (HPV) vaccine and regular (i.e., every five years) cervical screening are essential to prevent cervical cancer. Australia has high overall coverage of both interventions but little is known about coverage among people who inject drugs. and known barriers to preventive care among this population may extend to cervical cancer control measures. MethodsData were obtained from the 2023 Illicit Drug Reporting System interviews, in which people who regularly inject drugs participated. The sample was restricted to people with a cervix, with participants aged 25–74 years eligible for the National Cervical Screening Program and participants born after 1980 eligible for HPV vaccination. Age-standardised prevalence ratios were used to compare coverage among this sample to the Australian general population; other results were summarised descriptively. FindingsAmong participants eligible for screening (n = 243), most (96.7 %) reported lifetime uptake, while 70.2 % had been screened during the past five years, which was similar to the general population (prevalence ratio [PR]: 1.14, 95 % confidence interval [CI]: 0.96–1.31). Among those never or overdue for screening (n = 57), one third (31.7 %) were aware that self-sampling is available and barriers to screening varied, with similar numbers reporting personal (e.g., ‘I didn't know I needed to’), logistical (e.g., ‘I don't have time’), and test-related reasons (e.g., ‘the test is uncomfortable/painful’). Among participants eligible for HPV vaccination (n = 99), coverage was 27.2 %, 38 % lower than the general population (PR: 0.62, 95 % CI: 0.39–0.86). ConclusionsCervical screening coverage among this sample of people who inject drugs was similar to the Australian population. Health promotion messaging that focuses on the availability of self-sampling and the importance of regular screening may improve coverage among those overdue for screening. HPV vaccination was lower than the general population, warranting targeted efforts to offer the vaccine to eligible people who inject drugs.

Correlates of intention-to-attend and confirmed cervical screening attendance during the COVID-19 pandemic in Australia: Findings from Compass-PLUS, a prospective cohort study

ObjectiveThe coronavirus pandemic impacted health-seeking behaviour and access to primary care in Australia. We investigated factors associated with intention-to-attend and attendance of cervical screening during the pandemic, mainly in Victoria, Australia. MethodsWe used questionnaire and attendance data (Aug 2020-Nov 2022) from Compass-PLUS, a sub-study of the Compass randomized-controlled trial of Human Papillomavirus-based vs cytology-based screening. Data was restricted to the HPV-screening arm for comparability to the national program. We investigated associations overall and for younger (25–39 years) and older (≥40 years) cohorts, between intention-to-attend/attendance, and socio-demographics, anxiety-related scores, and agreement with beliefs about screening during the pandemic (e.g. importance of screening, increased workload, working from home, risk of infection). ResultsAmong 2,226 participants, positive intention to attend screening was more likely among those with a family history of cancer (p = 0.030) or living outside major cities (p = 0.024). Increased attendance was associated with increasing age (p < 0.001), prior regular cervical screening history [adjusted relative risk (aRR) for 2 screens in 6 years vs none: 1.23 (95 %CI 1.09,1.40); p < 0.001], and part-time employment or retirement compared to full-time employment [aRR:1.08 (1.02,1.14); aRR:1.12 (1.03, 1.22); respectively]. Lower attendance was related to increased agreement with statements indicating screening de-prioritisation (p-trend < 0.05) and higher recent anxiety, specifically in the older cohort (p-trend = 0.002). ConclusionsReduced priority of screening and heightened recent anxiety may partly explain indications of lower-than-expected cervical screening rates during the pandemic. It is important that catch-up of missed HPV screens is performed to prevent a possible increase in cancer diagnoses in the long term.

Important and Feasible Actions to Address Cervical Screening Participation amongst South Asian Women in Ontario: A Concept Mapping Study with Service Users and Service Providers.

Regular cervical screening can largely prevent the development of cervical cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some of the lowest rates of screening in the province. In this study, we used concept mapping to engage two stakeholder groups-South Asian service users and service providers-to identify and prioritize points of intervention to encourage the uptake of cervical screening. After participants brainstormed a master list of statements, 45 participants rated the statements based off 'importance' and 'ease to address' in relation to encouraging cervical screening. A bivariate plot (X-Y graph) that shows the average rating values for each statement across the two rating variables (a 'go-zone' display) was produced to display priorities for implementation. Statements that were considered high priority to address reflected issues around education and awareness including understanding and communication related to cervical screening and preventative care, as well as the need for trusted sources of information. Statements that were considered high priority but challenging to implement were centered around fear, stigma, discomfort, family and personal priorities. This study highlighted that stigma, norms and social relations that impact the uptake of screening must be addressed in order for education and awareness raising to be effective and to move people from conviction around screening to action.

Cervical cancer screening practices in HIV positive females - a missing link in health care delivery in Pakistan.

To probe cervical cancer screening practices in local women positive for human immunodeficiency virus, and to determine the cervical cytological changes in them. The serial cross-sectional study was conducted at the Jinnah Hospital and Services Hospital, Lahore, Pakistan, from April 2019 to October 2020, and comprised female patients aged 18-45 years who were positive for human immunodeficiency virus or acquired immunodeficiency syndrome and were registered with the relevant programme being run by the provincial government in Punjab. Blood samples of all the patients were collected for the determination of human immunodeficiency virus viral load and cluster of differentiation 4+ count. Cervical smears were taken for cytopathological analysis, while the swabs were analysed for culture sensitivity. The same individuals were subjected to the same testing one year later, and the status of the disease and clinical stability or disease progression was explored. Data was analysed using SPSS 25. There were 150 women with mean age 32.08±7.13 years (range: 21-45 years). Age at marriage/sexual activity was 17.33±4.73 years in 15(10%) subjects. Cytological examination showed atypical squamous cells of undetermined significance in 6(4%) of the cases whereas 3(2%) cases showed atypical squamous cells, which cannot rule out high grade squamous intraepithelial lesion on cytology, while the rest were classified as negative for intraepithelial lesion or malignancy. Cervical microbial changes revealed methicillin-resistant staphylococcus aureus infection in 9(6%) cases, extended-spectrum beta-lactamase in 15(10%) cases, whereas fungal infection and trichomonas vaginalis infection were found in 30(20%) smears. There was a significant association between cluster of differentiation 4+ cell count and stability of high-risk patients (p<0.001). After one year, 84(56%) patients remained clinically stable, while 51(34%) developed some chronic illness. There was a significant association between cluster of differentiation 4+ cell count <200/mm3 and the risk of developing a chronic illness (p<0.001). There was a dire need to educate healthcare workers to offer regular cervical screening to patients with high-risk sexually-transmitted infections to prevent them from the morbidity and mortality related to cervical cancer.

Clinical use of the Onclarity test with extended HPV genotyping and phenotyping in patients with suspected squamous intraepithelial lesions.

Human papillomavirus (HPV) is the most widespread virus with oncogenic potential that infects humans and there is a need to look for the most effective screening method among the population. Understanding the role of HPV in cervical dysplasia and viruses typing increased the usage of HPV-based cervical cancer screening tests using genotyping. We aim to assess the usefulness the Onclarity Test with extended genotyping and phenotyping of HPV in detecting cervical squamous intraepithelial lesions in 695 subjects who registered for regular cervical screening or due to abnormal LBC result or positive HPV results. Incidence of positive HPV depended significantly on biopsy outcome (p < 0.001). It was the highest for patients with HSIL (92.5%), lower for patients with LSIL (57.9%) and with HPV outcome of biopsy (50.0%). The sensitivity of positive HPV for detecting HSIL was equal to 92.50% (95% CI: 79.61%-98.43%), and specificity equalled 55.26% (95% CI: 43.41-66.69%). Sensitivity of HPV positive for any of 16, 18, 31, 45, 51 or 52 genotypes but not belonging to the P1, P2 or P3 group for detecting HSIL equalled 62.50% (95% CI: 45.80-77.27%), specificity equalled 72.37% (95% CI: 60.91-82.01%). The Onclarity test is characterised by high sensitivity and specificity in detecting CIN2+ lesions. Extended genotyping enables the identification of the most common oncogenic HPV types in the population. It can be used as a basic tool for secondary prevention or together with LBC.

Barriers and enablers to participation in the National Cervical Screening Program experienced by young women and people with a cervix aged between 25 and 35.

Cervical screening rates for young women aged between 25 and 35 are lower than older Australian women, however, little research has been conducted to understand why. This study aimed to identify and explore the barriers and enablers faced by young Victorians with a cervix to regular cervical screening. This study used a mixed method exploratory design consisting of qualitative focus groups and a quantitative online survey. Four focus groups were conducted with 24 Victorians with a cervix aged between 25 and 35. Barriers, enablers and knowledge of cervical screening were explored. Focus groups were recorded and transcribed for thematic analysis of common themes. A supporting online survey was completed by 98 respondents. Summary statistics were analysed for differences in age. Focus groups and the online survey revealed four main factors that influence young people's cervical screening behaviour. These include past negative screening experiences, practitioner factors, priority placed on cervical screening, and cervical screening knowledge. These factors differ to the opinions of people older than 35, with young people focusing more on the psychological elements of cervical screening compared with practical factors. This research provides a unique insight into cervical screening barriers faced by women and people with a cervix aged between 25 and 35 as well as what factors motivate them to screen. SO WHAT?: These findings should be utilised to inform the design of public health campaign messaging targeting this age demographic. Findings can also assist practitioners to improve how they communicate with young people in a clinical setting.

Exploring Women’s Challenge to Pap Smear Attendance and Colposcopy Referral: A Qualitative Study

Introduction: The greatest protection against cervical cancer can be achieved through the combination of cervical screening via repeated Pap tests and HPV vaccination before first sexual intercourse. This study aimed to explore women’s perceptions and experiences of Pap test and colposcopy examination to avoid advance stage of cervical cancer. Methods: An exploratory qualitative approach was carried out using face-to face semi-structured interviews with 22 women attending for their Pap test appointment or colposcopy examination in the main hospital in Kirkuk, Iraq. The study took place between October 2019 and March 2020. The collected data were analysed using inductive content analysis. Results: The findings revealed gap in knowledge regarding Pap test and colposcopy investigation among participants. Overall, three main categories emerged during data analyses namely, women’s awareness of Pap test; challenges to access cervical screening and colposcopy services; women’s views and suggestions to improve their access to cervical screening cervices. Conclusion: Currently, women living in Iraq have no access to regular cervical screening due to unavailability of the cervical screening programme in Iraq. This study provides evidence to develop strategies to enhance the existing cervical cancer prevention services. Health policy makers should consider the establishment of regular population based cervical screening. Health promotion efforts and interventions should focus on challenges and barriers influence the screening behavior among women living in Iraq.

Role of cervical cancer screening during prenatal checkups for infectious diseases: A retrospective, descriptive study.

ObjectiveThis study was conducted to evaluate the status and role of cervical cytology affected by human papillomavirus infection and other infectious diseases screened during routine prenatal checkups.MethodsWe retrospectively examined medical records containing the screening results for infectious diseases and cervical cancer in women who delivered neonates in our hospital from 2014 to 2017.ResultsAmong 3393 deliveries, 18.8% of women underwent a regular cervical cancer screening within 1 year of becoming pregnant, and 2641 women underwent a cervical cytology screening during this pregnancy. The cytological diagnostic results showed that 2562 women (97.0%) were negative for intraepithelial lesions or malignancy, whereas 79 (3.0%) had abnormal results. Of those with abnormal cytology results, 70 had abnormal cytology that was newly detected in this pregnancy, and 42 had grade ≥1 cervical intraepithelial neoplasia lesions. Spatulas were the most frequently used cytological sampling instruments, followed by cotton swabs. Cervical cytology revealed no major adverse reactions during these pregnancies.ConclusionsOur results confirm the importance of screening for infectious diseases during pregnancy. Only 20% of the women underwent a regular pre-pregnancy cervical cytology screening. Cervical cytology screening during pregnancy may currently be playing a crucial role in preventing cervical cancer in Japan.

Knowledge of Cervical Cancer Prevention and Screening Uptake Among Female Non-Health Care Providers in Two Selected General Hospitals in Lagos State

Cervical cancer is an abnormal growth of the cells of the cervix which is the lower-most part of the uterus. This cancer can spread to other parts of the body, including the lungs, liver, bladder, vagina, and rectum. Therefore, this research was aimed at assessing the knowledge of cervical cancer prevention and screening uptake among female non-health care providers working in various departments in two general hospitals in Lagos. Annually, in Nigeria 14,943 cases of cervical cancer are reported: out of these 10,403 women die leading to 28 deaths daily from cervical cancer. However, this needless death can be prevented if the cases are diagnosed early through the cervical screening, knowledge and uptake. The research adopted a descriptive cross-sectional survey. The population comprises of 350 female non-health care providers from two selected general hospitals in Lagos Island. The sample size of 165 was determined using Leslie Kish formula. A self-developed and validated questionnaire was used to collect data. Data collected were analysed using descriptive and inferential statistics at 0.05 level of significance. The results showed that 108 (65.5%) of the respondents knew that abnormal vagina bleeding and bleeding after intercourse are symptoms of cervical cancer while 102 (61.8%) showed that having multiple sexual partners is among the factors for acquiring cervical cancer. Furthermore 113 (68.5%) showed that cervical cancer is preventable while 118 (71.5%) believes that regular cervical screening can prevent cervical cancer and 148 (89.7%) were interested in participating in cervical cancer screening. The knowledge and prevention revealed that there was a positive and significant relationship between them. The research concluded that despite the adequate knowledge of cervical cancer screening as reported by the result, the level of screening is still low. It is hereby recommended that female non-health care providers should do cervical cancer screening regularly.

Role of human papillomavirus self-sampling in cervical cancer screening

Cervical cancer screening has successfully reduced the incidence and mortality of cervical cancer in many countries. In Slovenia, the incidence of cervical cancer decreased in 2003–2015 by almost 50%. Participation in screening has reached about 72% over the last 3 years. The main cause of cervical cancer is infection with human papillomaviruses (HPVs). For this reason, in 2010, HPV testing was included in the national screening programme ZORA for triage of low-grade lesions and as a test of cure in 2010. Even though screening is free ofcharge and accessible in Slovenia, about 30% of women still do not respond to invitations and are not screened regularly, especially women aged 50–64 years. HPV self-sampling could improve the detection of precancerous changes among non-attenders of the cervical cancer screening program. By using a validated PCR HPV DNA test, cervical and vaginal HPV sampling have similar accuracy for the detection of CIN 2+, resulting in the same or higher accuracy than the Pap test. Women describe HPV self-sampling as user-friendly, intimate, less embarrassing, and less painful than the Pap smear. About one-quarter to one-third of non-attenders of regular screening responded to the invitation to perform self-sampling. In a Slovenian randomised trial, the overall response rate was more than one-third and was not much higher in an opt-outcompared to opt-in approach. HPV self-sampling could lead to an improvement in the detection of precancerous cervical lesions. European guidelines for quality assurance on cervical cancer screening recommend HPV self-sampling in women who do not attend regular cervical screening programmes.

E7-Targeted Nanotherapeutics for Key HPV Afflicted Cervical Lesions by Employing CRISPR/Cas9 and Poly (Beta-Amino Ester).

IntroductionPersistent HR-HPV (high-risk human papillomavirus) infection is the main cause of cervical cancer. The HPV oncogene E7 plays a key role in HPV tumorigenesis. At present, HPV preventive vaccines are not effective for patients who already have a cervical disease, and implementation of the recommended regular cervical screening is difficult in countries and regions lacking medical resources. Therefore, patients need medications to treat existing HPV infections and thus block the progression of cervical disease.MethodsIn this study, we developed nanoparticles (NPs) composed of the non-viral vector PBAE546 and a CRISPR/Cas9 recombinant plasmid targeting HPV16 E7 as a vaginal treatment for HPV infection and related cervical malignancies.ResultsOur NPs showed low toxicity and high biological safety both in vitro (cell line viability) and in vivo (various important organs of mice). Our NPs significantly inhibited the growth of xenograft tumors derived from cervical cancer cell lines in nude mice and significantly reversed the cervical epithelial malignant phenotype of HPV16 transgenic mice.ConclusionOur NPs have great potential to be developed as a drug for the treatment of HPV-related cervical cancer and precancerous lesions.

Quantitative analysis of abnormalities in gynecologic cytopathology with deep learning

Cervical cancer is one of the most frequent cancers in women worldwide, yet the early detection and treatment of lesions via regular cervical screening have led to a drastic reduction in the mortality rate. However, the routine examination of screening as a regular health checkup of women is characterized as time-consuming and labor-intensive, while there is lack of characteristic phenotypic profile and quantitative analysis. In this research, over the analysis of a privately collected and manually annotated dataset of 130 cytological whole-slide images, the authors proposed a deep-learning diagnostic system to localize, grade, and quantify squamous cell abnormalities. The system can distinguish abnormalities at the morphology level, namely atypical squamous cells of undetermined significance, low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, and squamous cell carcinoma, as well as differential phenotypes of normal cells. The case study covered 51 positive and 79 negative digital gynecologic cytology slides collected from 2016 to 2018. Our automatic diagnostic system demonstrated its sensitivity of 100% at slide-level abnormality prediction, with the confirmation with three pathologists who performed slide-level diagnosis and training sample annotations. In the cellular-level classification, we yielded an accuracy of 94.5% in the binary classification between normality and abnormality, and the AUC was above 85% for each subtype of epithelial abnormality. Although the final confirmation from pathologists is often a must, empirically, computer-aided methods are capable of the effective extraction, interpretation, and quantification of morphological features, while also making it more objective and reproducible.

Cervical Cancer Prediction by Merging Features of Different Colposcopic Images and Using Ensemble Classifier.

Background:Cervical cancer is a significant cause of cancer mortality in women, particularly in low-income countries. In regular cervical screening methods, such as colposcopy, an image is taken from the cervix of a patient. The particular image can be used by computer-aided diagnosis (CAD) systems that are trained using artificial intelligence algorithms to predict the possibility of cervical cancer. Artificial intelligence models had been highlighted in a number of cervical cancer studies. However, there are a limited number of studies that investigate the simultaneous use of three colposcopic screening modalities including Greenlight, Hinselmann, and Schiller.Methods:We propose a cervical cancer predictor model which incorporates the result of different classification algorithms and ensemble classifiers. Our approach merges features of different colposcopic images of a patient. The feature vector of each image includes semantic medical features, subjective judgments, and a consensus. The class label of each sample is calculated using an aggregation function on expert judgments and consensuses.Results:We investigated different aggregation strategies to find the best formula for aggregation function and then we evaluated our method using the quality assessment of digital colposcopies dataset, and our approach performance with 96% of sensitivity and 94% of specificity values yields a significant improvement in the field.Conclusion:Our model can be used as a supportive clinical decision-making strategy by giving more reliable information to the clinical decision makers. Our proposed model also is more applicable in cervical cancer CAD systems compared to the available methods.

Sociodemographic and risk factors of cervical cancer among female staff of Federal Medical Centre, Owerri, Imo State, Nigeria

This study examines the sociodemographic and risk factors for cervical cancer among female staff of Federal Medical Centre, Owerri, Imo State Nigeria. It is a descriptive cross-sectional survey which was conducted among 400 female staff using predesigned semi-structured questionnaires. The sampling technique adopted was systematic sampling technique. Data analyses were done using statistical package for social sciences version 23 software package. Chi square was used to determine the associations between age at marriage and cervical erosion. A total of 77(19.3%) respondents consume alcohol, 78(19.5%) have had sexually transmitted infection and 58(14.5%) had multiple sexual partners. Thirty-nine (7.5%) have had regular Pap test, while 293(73.2%) have never had Pap test. Cervical erosion was found among 114(38.3%) out of which 101(25.3%) occurred in women that were married on or before the age of 21 years. This study shows the association of cervical cancer among female staff of Federal Medical Centre, Owerri and their sociodemographic and other risk factors. Monogamy, late commencement of sexual activity, personal hygiene, use of barrier contraceptive methods, regular cervical screening and early detection efforts will help towards primary prevention.

Cervical cancer screening behaviours and challenges: a sub-Saharan Africa perspective.

Cervical cancer may be fatal to women if not identified and treated early. The importance of organised cervical screening has been felt in many developed countries. However, the majority of women in developing countries may be under-screened or may have never been screened because many developing countries have not developed a national cervical cancer prevention program accessible to all women due to reasons such as competing funding priorities, low prioritization of cervical cancer and cultural practices across Africa. It is important that these factors are adequately addressed to improve access to regular cervical screening services and ultimately help curb the incidence and impact of cervical cancer on women in sub-Saharan Africa.

What is the Retrospective Correlation between High- Grade Squamous Intraepithelial Lesion (HSIL) on Cytology and the Histological Diagnosis of Cervical Intraepithelial Neoplasia 2 (CIN2) or More in AML, Antwerp, Belgium?

Introduction: Cervical cancer is a major worldwide health problem. Therefore, regular cervical screening in order to make an early diagnosis can help to prevent cervical cancer. The aim of this retrospective study is to evaluate the correlation between HSIL on cytology and histological CIN2+ in AML, Antwerp and to compare two liquid-based cytological techniques ThinPrep® LBC (TP) and SurePath™ LBC (SP). Methods: 120 women with a HSIL positive cytological smear from 2014 (ThinPrep® LBC) and another 120 from 2010 (SurePath™ LBC) were anonymously randomised out of the AML database, according to predefined in- and exclusion criteria. The Belgian Cancer Registry (CIB and CHP) and the AML database were consulted for histological and cytological data and the researched variables (doctor’s speciality, age, HPV status, -genotypes and -persistence) of these 240 women. 184 women, with histological follow-up within one year, out of 240 were included. Statistical analysis was performed using Stata 15.1 (StataCorp, USA). P-values and Odds-ratios were calculated. Results: The CIN2+/HSIL ratio of all included 184 subjects was 75.5% (95%CI=69.3-81.8). The found CIN2+ percentages for TP and SP, were 75.8% (95%CI 67.0-84.6) and 75.3% (95%CI 66.5-84.1) respectively. For all included subjects the variables hrHPV infection (p=0,008; OR=6.97) and HPV16 infection (p=0.004; OR=2.79) were statistically significant for having CIN2+ on histology. Conclusions: The found CIN2+/HSIL ratio of 75.5% in AML, Antwerp is similar to the percentages found in worldwide laboratories. HSIL positive women who are HPV16+ or hrHPV+ are at significant higher risk for invasive cervical disease. No statistically significant difference in CIN2+% was found between the two LBC techniques TP and SP.

Awareness and practice regarding cervical cancer screening among women visiting a tertiary hospital of Kathmandu

Background: Cervical cancer is the leading female cancer in Nepal. Fortunately, it is preventable by detectingprecancerous lesions and by various screening tools for early invasive cancers. Screening can be possible if women are aware of the problem. Despite the existence of effective screening using Pap smear, the uptake of screening is poor.Objectives: The objective of this study was to assess the awareness and practice regarding cervical cancer screening among women visiting tertiary hospital.Methodology: A descriptive cross – sectional study was conducted to assess the awareness and practice regarding cervical cancer screening among women attending in gynaecological outpatient department of Kathmandu Medical College Teaching Hospital. A total of one hundred and fifty two women were selected purposively for the study. Structured questionnaire was designed and data collection was done through face to face interview technique during the period of September to November 2018. The collected data were analyzed by using Statistical Package for Social Science version 20.Results: Among 152 respondents, majority of the respondents (59.2%) were aware that multiple sexual partners is one of the risk factors of cervical cancer. 38.8% were aware that cervical cancer can be prevented by regular cervical screening. Majority of the respondents: 152 (44.7%) had given correct response regarding meaning of cervical cancer screening and 42.8% were aware of Pap smear test for cervical screening. Only 31.6% had performed cervical cancer screening at least once. Overall mean percentage knowledge was 3.08 with SD 0.96.There was weak correlation between knowledge and practice.Conclusion: This study concluded that majority of respondents had inadequate knowledge and practice regarding cervical cancer screening. Thus, cervical cancer screening health camps and awareness program should be conducted at community to national level for women, to increase the level of knowledge and practice regarding cervical cancer screening.

Contrast-Enhancing Snapshot Narrow-Band Imaging Method for Real-Time Computer-Aided Cervical Cancer Screening

Composition of cervical precancerous lesions and carcinoma in situ is rich in hemoglobin, unlike healthy tissues. In this study, we aimed to utilize this difference to enhance the contrast between healthy and diseased tissues via snapshot narrow-band imaging (SNBI). Four narrow-band images centered at wavelengths of characteristic absorption/reflection peaks of hemoglobin were captured with zero-time delay in between by a custom-designed SNBI video camera. Then these spectral images were fused in real time into a single combined image to enhance the contrast between normal and abnormal tissues. Finally, a Euclidean distance algorithm was employed to classify the tissue into clinical meaningful tissue types. Two pre-clinical experiments were conducted to validate the proposed method. Experimental results indicate that contrast between different grades of diseased tissues in the SNBI generated image was indeed enhanced, as compared to conventional white light image (WLI). The computer-aided classification accuracy was 100% and 50% as compared to the gold standard histopathological diagnosis results with the SNBI and the conventional WLI methods, respectively. Further, the boundary contour between health tissue, cervical precancerous regions, and carcinoma in situ can be automatically delineated in SNBI. The proposed SNBI method was also fast, and it generated automatic diagnostic results with clear boundary contours at over 11 fps on a Pentium 1.6-GHz laptop. Hence, the proposed SNBI is of great significance to enlarge worldwide the coverage of regular cervical screening program, and to live guide surgeries such as biopsy sample collection and accurate cervical cancer treatment.

Acceptability of self-taken vaginal HPV sample for cervical screening among an under-screened Indigenous population.

Human papillomavirus (HPV), the causative agent of cervical cancer, can be screened for using self-collected vaginal samples (self-testing). This may overcome barriers to screening for Māori women who suffer a greater burden of cervical disease than New Zealand European women. This study aimed to explore the potential acceptability of HPV self-testing for never/under-screened (self-reported no cervical screen in 4+ years, aged 25+) Māori women by Kaupapa Māori (by, with and for Māori) mixed methods, involving hui (focus groups/interviews) and survey. Community-based researchers ran hui with women in four regions (N=106) and supported hui participants to collect survey data (N=397). Healthcare providers (HCPs) were also interviewed (N=17). Hui data were thematically analysed. Survey data were analysed by age group, rural/urban, primary health organisation (PHO) enrolment, and time since last cervical screen. Most survey participants were PHO-enrolled (87.15%) and attended regularly (71.79%), but did not attend regular cervical screening. A desire for bodily autonomy, including whakamā (embarrassment/shyness/reticence), was the most frequently cited barrier. Three in four women reported being likely/very likely to do an HPV self-test. Nine in ten women reported being likely/very likely to attend follow up if they receive a positive HPV test result. Women and HCPs in the hui emphasised the importance of health literacy, cultural competence and empathetic support. The findings indicate that with a culturally competent introduction of HPV self-testing, many currently never/under-screened Māori women would be willing to be screened and followed up if necessary. HPV self-testing has the potential to save lives.

Cognitive predictors of cervical cancer screening's stages of change among sample of Iranian women health volunteers: A path analysis.

IntroductionThe uptake of Pap smear among Iranian women is low, resulting in a high rate of casualties from cervical cancer in Iran. The present study used the Health Belief Model (HBM) and the Stages of Change theory as theoretical frameworks for understanding the predictors of the behaviour of Iranian Women Health Volunteers (WHVs) with respect to cervical cancer screening.MethodsData from the 1,253 WHVs were analyzed using path analysis to assess the effects of cognitive factors (including knowledge, perceived susceptibility to cervical cancer, perceived severity of cervical cancer, Pap smear benefits, Pap smear barriers, and Pap smear self-efficacy) on the stages of change for Pap-smear behaviour.ResultsThe majority of the respondents (71.5%) reported that they had not taken previous Pap smear tests; only 3% had received a regular Pap test. The perceived benefits to cervical cancer screening, the perceived barriers to cervical cancer screening, and the perceived self-efficacy to perform cervical cancer screening emerged as the predictors of cervical cancer screening’s stages of change; perceived threat to cervical cancer, however, did not.DiscussionUptake of regular cervical screening for Iranian WHVs was very low. Different interventions, such as media campaigns and educational interventions could provide an opportunity to improve women's knowledge on cervical cancer and Pap test benefits, address any misconceptions or fears about the procedure of the Pap test, and finally increase the cervical screening uptake by Iranian women.