Routine Cervical Cancer Screening Research Articles

Abstract 2143: Association between health insurance coverage and stage of diagnosis for cervical cancer among women in Indiana from 2011-2019

Abstract Introduction: Cervical cancer is one of the most common types of cancer among women and it is caused by infection from the human papillomavirus (HPV). The incidence rates of cervical cancer have increased in Indiana from 7.8 in 2008-2012 to 8.4 in 2013-2017. In 2020, the screening rate for cervical cancer among women in Indiana was 76% when compared to a national average of 78%. Women diagnosed at earlier stages for cervical cancer had higher relative survival of 0.98 than those diagnosed at later stages with a relative survival of 0.43. Health insurance status is an important determinant for health outcomes for patients with cancer. This study aims to assess the extent to which health insurance coverage is a contributing factor to the stage of cervical cancer diagnosis. Methods: We examined reported cases of cervical cancer among women (N=2518) using cervical cancer registry data from the Indiana State Department of Health from 2011-2019. Using multinomial logistic regression model, we examined the associations of both race/ethnicity and insurance status with stage of diagnosis after adjusting for age at diagnosis. Results: In this sample, the average age at diagnosis was 48.98 years (SD = 14.98). The largest proportion of the sample was between 45 to 64 years of age (41.7%), Non-Hispanic White (85.5%), had private insurance coverage (41.8%), had cervix uteri, NOS as the primary site of diagnosis (76.5%), lived in a metropolitan area (74.5%) and had squamous cell carcinoma (73.4%). The largest percentage of Non-Hispanic White patients had private insurance (50.9%), whereas the largest percentage of Black patients had Medicaid (39.3%). 20.2% of Hispanic patients were uninsured when compared to 7.7% Non-Hispanic White and 3.6% Black patients. The multivariate analysis shows that women who are uninsured (OR = 2.475) and those who have Medicaid (OR = 2.321) were significantly more likely to be diagnosed at the regional stage than the in-situ stage compared to women with private insurance. Additionally, women who are uninsured (OR = 4.432) and those who have Medicaid (OR = 3.007) were significantly more likely to be diagnosed at the distant stage than in-situ, compared to women with private insurance. Conclusion: The findings show that insurance status is associated with the stage of diagnosis for cervical cancer and detection at regional or distant stages often leads to higher morbidity. Impact - Increased coverage for routine cervical cancer screening and preventive care services is recommended, especially for uninsured women and women with public insurance such as Medicaid or Medicare. Citation Format: Mrithula Suresh Babu, Monica L. Kasting, Natalia M. Rodriguez. Association between health insurance coverage and stage of diagnosis for cervical cancer among women in Indiana from 2011-2019 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2143.

Abstract 2142: Spatial distribution of high-risk human papillomavirus (HR-HPV) across 23 Chicago community areas and correlates

Abstract Background: Despite availability of effective vaccines and screening, cervical cancer claimed 4,280 lives in 2022. We explored the spatial distribution of high-risk human papillomavirus (“HR-HPV”) infection across 23 Chicago Community Areas (CCAs) served by the University of Illinois Health Network (UI Health). Using a modified Warnecke et al Health Disparity Outcomes (HDO) model, we hypothesized that CCAs with higher rates of structural violence, the social, economic, and political systems exposing populations to risks and vulnerabilities, would correlate with increased HR-HPV. Methods: Electronic medical records of patients receiving routine cervical cancer screening between January 1, 2015 and December 31, 2019 were reviewed. As per the 2014 ACS guidelines. HR-HPV test results were captured as HR-HPV positive, HR-HPV-16, HR-HPV-18 and non-16/18 HR-HPV, the latter consisting of 12 HR-HPV subtypes. Structural violence variables were used from Chicago Health Atlas (2015-2019) with percent poverty, hardship index score, easy access to fruit and vegetables, routine checkup, homicide, and primary care provider across CCAS. Univariate Poisson regression was used to compare the associations between selected structural violence factors and HR-HPV prevalence. Univariate multinomial logistic regression evaluated associations between structural violence indicators and HR-HPV subtypes Global p-values were obtained using ANOVA at 0.05 significance. Results: 8,566 women met inclusion criteria out of 13,466 total women. 75% were Black or Hispanic. Overall prevalence of cervical HR-HPV infection was 20.3% (n=1,737), ranging from 8.7% to 27.2% across CCAs. Median age for women was 36. Percent with primary care provider was negatively associated with HPV infection (IRR = 0.99 with 95% CI (0.98, 1.00), adjusted p-value=0.023), indicating women living in CCAs with higher rates of primary care provider were less likely to have HR-HPV. Easy access to fruit and vegetables (adjusted p-value = 0.007) and percent with primary care provider (adjusted p-value = 0.009) were significantly associated with HR-HPV subtypes. Women living in CCAs with easy access to fruit and vegetables (OR = 0.99, with 95% CI (0.98,0.99)) as well as those with higher rates of primary care provider (OR = 0.98, with 95% CI (0.97,0.99)) were less likely to have non-16/18 HR-HPV. Conclusion: HR-HPV is the most common sexually transmitted infection, and most women clear the infection naturally. As the origin of 99% of cervical cancer, understanding the reasons HR-HPV persists and progresses to cancer among certain individuals and groups is critical. Novel interventions like increasing access to fruit and vegetables could compliment widely available and effective vaccines. Citation Format: Gelila Goba, Jiehuan Sun, Quetzal Class, Joel Schwartz, Sage Kim, Karriem Watson, Lisa Tussing-Hummphreys, Yamile Molina, Shannon MacLaughlan, Ziqiao Xu, Benjamin Aldred, Subhash Kumar Kolar Rajanna, Tamika Alexander, Anna-Barbara Moscicki. Spatial distribution of high-risk human papillomavirus (HR-HPV) across 23 Chicago community areas and correlates [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2142.

Prediction of cervical cancer screening: application of the information-motivation-behavioral skills model

IntroductionScreening is an effective method for preventing cervical cancer. The present study aimed to determine the predictability of cervical cancer screening using the information-motivation-behavioral skills (IMB) model, as this model can help understand the factors that influence health-related behaviors.MethodThe present cross-sectional study examined 310 women aged 20 to 60 in Isfahan, Iran, between 2020 and 2021. To this end, comprehensive health centers and gynecology clinics of hospitals were randomly selected by lot. Women who met the study’s inclusion criteria were selected via convenience sampling. An IMB skills questionnaire developed by researchers comprised the data collection tool. The data were analyzed using SPSS 22 software, descriptive and regression tests, and AMOS 24.0 software.FindingsApproximately 18.1% of the participants had never undergone routine cervical cancer screening. The regression model results indicated that the model components accurately predicted regular cervical cancer screening (P < 0.00). Path analysis revealed that information (β = 0.05, P = 0.002), motivation (β = 0.187, P = 0.026), and behavioral skills (β = 0.95, P < 0.001) were directly associated with regular cervical cancer screening. Furthermore, behavioral skills had the greatest direct effect on regular cervical cancer screening.Discussion and conclusionThe results demonstrated that the IMB model accurately predicted cervical cancer screening. Therefore, it is possible to improve cervical cancer screening in women by designing and implementing interventions based on this model’s components, particularly those that improve behavioral skills.

Uptake of Cervical Cancer Screening and Its Barriers Using Health Belief Model Among Health Professionals Working in Public Hospitals in South Gondar Zone, Northcentral Ethiopia: Multicenter Cross-Sectional Study.

Cervical cancer is a malignant neoplasm that originates in the cervix, and it is a leading cause of mortality, with 270,000 deaths every year globally. Of these, 85% occur in developing countries, including Ethiopia. Routine cervical cancer screening and early treatment can prevent up to 80% of cervical cancers. Health professionals are expected to screen for and be screened for cervical cancer. However, there is limited information about the uptake of cervical cancer screening among health professionals in the study area. This study aimed to determine the magnitude of cervical cancer screening uptake and identify its barriers among health professionals. A multicenter cross-sectional study design was conducted among health professionals from December 01 to 30, 2022. A total of 164 respondents were included in the study, and simple random sampling was used to select the respondents. Variables with a p-value of <0.05 at 95% confidence interval (CI) were considered significantly associated with the outcome variable. Of the total respondents, 112 (68.3%) were younger than the age of 30 years, with a mean age of 29.4 years ranging from 21 to 45 years. Seventy-nine of the respondents (48.2%) have work experience of 6-10 years, and 103 (62.8%) are nurses in profession. In this study, the magnitude of cervical cancer screening uptake was 28.1% (95% CI: 27.7%-35.6%). Moreover, attitude (adjusted odds ratio [AOR] = 3.3, 95% CI: 2.1-5.1), age at first sexual intercourse (AOR = 2.1, 95% CI: 1.3-3.4), having history of sexually transmitted infections (STIs; AOR = 3.6, 95% CI: 1.5-11.6), knowing someone who had been screened (AOR = 2.9, 95% CI: 1.8-4.8), and cervical cancer screening training (AOR = 1.6, 95% CI: 1.1-2.9) were significantly associated with cervical cancer screening. Generally, this study reported that the magnitude of cervical cancer screening uptake was low. The study also indicated that attitude, age at first sexual intercourse, history of STIs, knowing someone who had been screened, and training of cervical cancer screening were independent predictors of uptake of cervical cancer screening.

Successful Routine Cervical Cancer Screening Facilitated by Pelvic Floor Physical Therapy for a Woman With Developmental Disability and a History of Trauma: Case Report

Background: Women with intellectual and developmental disabilities (I/DD) are not getting routine cervical cancer screens at the recommended frequency, limiting opportunities for early detection and treatment of cervical cancer. Pelvic floor physical therapy plans of care can be used to successfully address this health care disparity. Case Description: This is the case of a patient who had diagnoses of developmental delay, oppositional defiant disorder, attention-deficit disorder, unilateral hearing loss, and a history of trauma. The patient was referred by her primary care physician after a halted first pelvic examination due to tension of the patient's pelvic floor and her overall discomfort and dissociation from the session. Clinical findings revealed pelvic floor tension. Interventions were employed over the course of 18 sessions. Outcomes: Sessions focused on education, positioning, relaxation, and graded vaginal dilator insertion while keeping the patient engaged to prevent dissociation. The patient showed minimal clinically important differences on the Patient-Specific Functional Scale, met the short- and long-term goals including undergoing a pain-free pelvic examination, and had a significantly decreased pelvic floor resting tone. Discussion: For patients with I/DD, pelvic floor physical therapy can be a valuable tool to help them undergo a successful and pain-free routine cervical cancer screen. It may take longer than typical plans of care, but the outcomes justify the length of the intervention. Practices that promote self-determination are a key to success. Informed consent was obtained and signed by the patient's medical guardian. Video Abstract: Supplemental Digital Content available at: http://links.lww.com/JWHPT/A128

The impact of the COVID-19 pandemic on routine HIV care and cervical cancer screening in North-Central Nigeria

IntroductionCervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria.MethodsLongitudinal healthcare administration data for women who obtained care between January 2018 and December 2021 were abstracted from the AIDS Prevention Initiative Nigeria (APIN) clinic at Jos University Teaching Hospital. Patient demographics, pap smear outcomes, and HIV management indicators such as viral load and treatment regimen were abstracted and assessed using descriptive and regression analyses. All analyses were conducted comparing two years prior to the COVID-19 pandemic, the four quarters in 2020, and the year following COVID-19 restrictions.ResultsWe included 2304 women in the study, most of whom were between 44 and 47 years of age, were married, and had completed secondary education. About 85% of women were treated with first line highly active retroviral therapy (HAART). Additionally, 84% of women screened using pap smear had normal results. The average age of women who sought care at APIN was significantly lower in Quarter 3, 2020 (p = 0.015) compared to the other periods examined in this study. Conversely, the average viral load for women who sought care during that period was significantly higher in adjusted models (p < 0.0001). Finally, we determined that the average viral load at each clinic visit was significantly associated with the period in which women sought care.ConclusionsOverall, we found that COVID-19 pandemic mitigation efforts significantly influenced women’s ability to obtain cervical cancer screening and routine HIV management at APIN clinic. This study buttresses the challenges in accessing routine and preventive care during the COVID-19 pandemic, especially in low-resource settings. Further research is needed to determine how these disruptions to care may influence long-term health in this and similar at-risk populations.

Barriers to Cervical Cancer Screening among Sub-Saharan African Immigrant Women in the United States: A Qualitative Report

Objective: Cervical cancer screening can prevent women across all age groups from developing cervical cancer (CC). However, Sub-Saharan African immigrant women (SAIW) sparsely engage in routine CC screening. Thus, developing prevention strategies to improve SAIW’s adherence to recommended CC screening guidelines is critical. To ensure that such strategies are successful, they must meet the needs of the target population. By conducting qualitative interviews with SAIW (N = 15), we aimed to get a deeper understanding of barriers to CC screening receipt. Methods: We asked SAIW about barriers to CC screening and possible ideas to facilitate their future screening behavior. Results: Our findings revealed that SAIW are especially affected by several major barriers: lack of awareness of CC guidelines, fear/fatalism, lack of resources (eg, a lack of time due to job and family commitment), other resource-related barriers (eg, unreliable mode of transport, and no health insurance), modesty, and overt bias. Participants indicated a preference for female healthcare providers for CC screening and suggested spousal involvement in CC intervention development to foster support. Conclusion: The identification of multi-level barriers indicates that multiple strategies are needed to improve the uptake of CC screening among SAIW.

Primary Human Papillomavirus Testing and Other New Technologies for Cervical Cancer Screening.

Cervical cancer screening has saved the lives of millions in regions where routine gynecologic care is readily accessible. As screening continues to evolve away from cervical cytology to primary human papillomavirus (HPV) testing, robust prospective cohort data have allowed for precise risk stratification and improved our ability to identify those at greatest risk of high-grade dysplasia and decrease unnecessary diagnostic procedures. New technologies such as p16/Ki-67 dual stain testing and HPV methylation panels, which offer comparable performance to co-testing and can be developed into high-throughput workflows, could lead to a fully molecular Pap test. Self-sampling in the United States, where the initial screen can be done in the home, in conjunction with new screening technologies, may decrease the existing hurdles of routine cervical cancer screening. Implementation barriers include issues with workflow, workforce, and cost. These need to be addressed to achieve an improved and more equitable cervical cancer screening program in the United States.

Classification of single‐cell cervical pap smear images using EfficientNet

AbstractCervical cancer is the second leading cause of death in women in developing nations like India. The automated cervical cancer screening systems play a critical role in diagnosing the ailment at an early stage. They can also assist in routine cervical cancer screening and decision‐making processes. The underlying binary classifier for detecting cancerous cells is necessary for building computerized screening systems. Thus, this work aims to develop a robust binary classifier capable of classifying single cervical cells as normal and cancerous. The current work aims to improvise the EfficientNet‐B7 with empirical resolution parameters and skilful consolidation of the outcomes of the inner layers using the global pooling layer to improve the binary classification result. The proposed model is trained and evaluated on three independent pap smear datasets. The class activation heatmap visualizes the classification model for better interpretability. The performance of the autonomous classification tasks indicates that the deep learning‐based binary classifier is robust in classifying cancerous cells as it achieves accuracy of 94% on Herlev Dataset which is 2% higher than the other state‐of‐the‐art methods and comparable accuracy of nearly 99% on other cervical cell datasets using the proposed methodology.

Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018

The United States Preventive Services Task Force (USPSTF) recommends that women with adequate prior screening and average cervical cancer risk discontinue routine cervical cancer screening after age 65. This study's objective was to estimate how the USPSTF recommendation affects Papanicolaou (Pap) test rates among women at age 66 in the United States. We used nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System data for women ages 56–76 (n = 226,031) and a regression discontinuity design to estimate changes in annual Pap test rates at age 66. Among women age 66–76, 22.5% reported receiving a Pap test within the past one year. At age 66, annual Pap rates declined by 5.9 percentage points (p.p.) (95% Confidence Interval [CI]: −7.7, −4.1) off a pre-66 rate of 39%. The change varied by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women (0.8 p.p.; 95% CI: −5.4, 7.1) but did for women from other racial/ethnic groups. The decline was larger for women who graduated college (−9.0 p.p.; 95% CI: −12.0, −5.9) than for women without a college degree and for women who were never married (−9.4 p.p., 95% CI: −17.3, −1.5) than for women who were married/partnered or divorced/separated. The USPSTF recommendation to discontinue cervical cancer screening after age 65 leads to a sharp decline in Pap test rates at age 66 but disparately affects women based on race, education and marital status. Further study is needed to assess the consequences of these changes.

Cervical human papillomavirus prevalence according to socioeconomic and demographic characteristics in a large Danish screening population

The aim of this study was to investigate high-risk human papillomavirus (hrHPV) prevalence according to socioeconomic and demographic characteristics in a Danish screening population. We used data from HPV SCREEN DENMARK, which was an implementation study embedded into the routine cervical cancer screening programme. During 2017-2020, women aged 30-59 years screened in the Region of Southern Denmark were offered HPV testing or cytology. In the HPV group, liquid-based cytology samples were tested for 14 hrHPV types. We obtained registry information on socioeconomic and demographic characteristics and used log-binomial regression to estimate the prevalence ratio (PR) of hrHPV in three age groups (30-39, 40-49, 50-59 years), adjusting for age and marital status. We included 31,124 HPV unvaccinated women. In all age groups, the age-adjusted hrHPV prevalence was higher in women with basic versus higher education (e.g. age 30-39: 11.9% vs. 9.5%; PRage-adjusted=1.24; 95% confidence interval (CI): 1.02-1.50); women who were unemployed vs. employed (e.g. age 30-39: 11.6% vs. 10.4%; PRage-adjusted=1.11; 95% CI: 0.95-1.28); and in women with highest vs. lowest income (e.g. age 30-39: 11.6% vs. 9.5%, PRage-adjusted=1.18, 95% CI: 0.98-1.44). In models adjusted for marital status, these associations largely disappeared. We found slightly higher hrHPV prevalences in women with basic education, low income and unemployment. The differences largely disappeared when taking into account marital status as a potential proxy for sexual behaviour. Our findings support a need for targeted information on safe sexual practices and promoting socioeconomic equality in HPV vaccination and cervical cancer screening participation.

Updated estimate of the annual direct medical cost of screening and treatment for human papillomavirus associated disease in the United States.

The annual direct medical cost attributable to human papillomavirus (HPV) in the United States over the period 2004-2007 was estimated at $9.36 billion in 2012 (updated to 2020 dollars). The purpose of this report was to update that estimate to account for the impact of HPV vaccination on HPV-attributable disease, reductions in the frequency of cervical cancer screening, and new data on the cost per case of treating HPV-attributable cancers. Based primarily on data from the literature, we estimated the annual direct medical cost burden as the sum of the costs of cervical cancer screening and follow-up and the cost of treating HPV-attributable cancers, anogenital warts, and recurrent respiratory papillomatosis (RRP). We estimated the total direct medical cost of HPV to be $9.01 billion annually over the period 2014-2018 (2020 U.S. dollars). Of this total cost, 55.0% was for routine cervical cancer screening and follow-up, 43.8% was for treatment of HPV-attributable cancer, and less than 2% was for treating anogenital warts and RRP. Although our updated estimate of the direct medical cost of HPV is slightly lower than the previous estimate, it would have been substantially lower had we not incorporated more recent, higher cancer treatment costs.

HPV testing for cervical cancer screening: Should reflex cytology be performed after a positive test for HPV 16 and 18?

At Portuguese-organized cervical cancer (CC) screening programs, all women testing positive for human papillomavirus (HPV) 16 and/or 18 are referred for immediate colposcopy. This study aimed to evaluate the utility of reflex cytology in women who test positive for HPV 16 and/or 18 to improve the efficiency of CC screening.A cross-sectional and retrospective study was performed based on data from the routine CC screening protocol in force at Cova da Beira University Hospital Center, Portugal between August 2012 and June 2021. The screening method was the Cobas 4800 HPV test using the liquid medium Surepath. In all the selected cases, the patient's HPV test results and the cytology and histology findings of the biopsies obtained using colposcopy were analyzed.This study included 339 women who first tested positive for HPV 16 and/or 18 and were referred for immediate colposcopy, in whom 40 (11.8%) cases of high-grade squamous intraepithelial lesion (HSIL+) were diagnosed. Of these, 12 (30%) had reflex cytology negative for intraepithelial lesion or malignancy (NILM) and 14 (35%) had HSIL+ cytology. After 3 years, 14 (9.3%) of the 150 women who were still undergoing follow-up were diagnosed with histologic HSIL+ lesions, of which 5 (35.7%) had baseline NILM cytology.Despite the small sample, the results of this study allow us to conclude that reflex cytology is not useful for discrimination to immediate referral for colposcopy in women who test positive for HPV 16 and/or 18, as most women with a histologic diagnosis of an HSIL+ lesion had <HSIL reflex cytology.

Evaluation of chronotype and sleep quality in infertile population and comparison with fertile population: a cross-sectional study

Purpose Infertility is a stressful condition for couples and can affect patients’ circadian rhythm and sleep quality. The goal of this study is to assess differences in chronotype and sleep quality between infertile and fertile people. Methods A cross-sectional study was conducted. The infertile patient population consisted study group. Primiparous patients without any known gynecological disease who presented for routine cervical cancer screening follow-up were included in the control group. The Turkish version of the Morningness-Eveningness Questionnaire (MEQ) and Pittsburg Sleep Quality Index (PSQI) scores were evaluated between groups. Results A total of 227 patients were assessed. There were 110 patients in the study (infertile) group and 117 patients in the control (fertile) group. The evening chronotype proportion (23.6 vs. 0.9%, p < 0.001) was higher in the infertile group. The median of MEQ score was significantly higher in the fertile patients (50, IQR = 43 − 55 vs. 56, IQR = 51 − 59; p < 0.001), and the median of PSQI score was significantly higher in the infertile patients (5, IQR = 4 − 6, vs. 4, IQR = 3 − 5; p < 0.001). Conclusions In this study, we found significantly worse sleep quality, and more evening chronotype in the patients with infertility.

Time trends assessment of cervical cancer characteristics in Guangzhou, 2010–2021: Is the age at diagnosis increasing over time?

Cervical cancer remains a great challenge to global health, especially in low and middle income countries. A study estimated an occurrence of 111,000 cases of cervical cancer and 34,000 related deaths in 2015 in China [ [1] Cao M. Li H. Sun D. Chen W. Cancer burden of major cancers in China: a need for sustainable actions. Cancer Commun (Lond). 2020; 40: 205-210https://doi.org/10.1002/cac2.12025 Crossref Scopus (132) Google Scholar ]. Persistent infection of high-risk subtypes of the human papillomavirus (HPV) is known to be the main cause of cervical cancer. HPV vaccination and cervical screening programs are effective means to eliminate cervical cancer. However, HPV vaccine was only first approved in China in 2017 for women 9–45 years old. Besides that, the current cervical cancer screening program in China targets women between 35 and 64 years old, and cessation of routine cervical cancer screening in adequately screened women at the age of 65 years is recommended by the American Society for Colposcopy and Cervical Pathology (ASCCP) [ [2] Perkins R.B. Guido R.S. Castle P.E. Chelmow D. Einstein M.H. Garcia F. et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020; 24: 102-131https://doi.org/10.1097/LGT.0000000000000525 Crossref PubMed Scopus (320) Google Scholar ]. These conditions leave older women at an unchanged risk of cervical cancer.

Rates of Routine Cancer Screening and Diagnosis Before vs After the COVID-19 Pandemic

This cross-sectional study analyzes patterns in the rates of routine screening and diagnosis for breast, cervical, and colorectal cancer before and after the COVID-19 pandemic.

Correlation Between hr-HPV Genotypes/Negative Cytology with Cervical Histology Findings

Abstract Introduction/Objective It is well established that the persistent of hr-HPV infection is necessary for the development of cervical dysplasia. Currently, routine cervical cancer screening include both high-risk human papilloma virus (hr- HPV) testing and cervical cytology tests. The guidelines for managing HPV-positive/cytology-negative results is cotesting at 1 year, and/or immediate colposcopy if HPV16 and/or HPV18 is positive. We analyzed the correlation between hr-HPV genotypes /negative cytology with cervical histology findings. Methods/Case Report Retrospective chart review was performed to identify all negative pap smears with positive hr-HPV and follow up colposcopy for patients who presented to our institution from January 2018 to December 2019. We calculated the distribution of HPV genotypes within low grade and high-grade cervical lesions among patients with HPV-positive/cytology-negative pap smears. Results (if a Case Study enter NA) 179 patients with HPV-positive/cytology-negative pap smears were included. The age range was 22-69 years old. Among these patients, 6.70% had low-grade squamous intraepithelial lesion (LGSIL) and 6.14% had high-grade squamous intraepithelial lesion (HSIL) on follow up biopsy. The detection rates of HPV genotypes among patients with LGSIL diagnosis were HPV16 (41.66%), HPV18 (16.66%) and other hr-HPV (41.66%). The detection rates of HPV genotypes among patients with HGSIL diagnosis were HPV16 (9.09), HPV18 (0%), other hr-HPV (72.72%), combined HPV16 + other hr-HPV (9.09), combined HPV18+ other hr-HPV (9.09%). Conclusion According to our data, patients with negative cytology and HGSIL on biopsy have higher association with other hr-HPV (not 16 or 18) than HPV 16 and 18. Patients with negative cytology and LGSIL on biopsy have higher association with HPV16 and other hr-HPV subtypes than HPV18. Thus, we recommend follow-up colposcopy even for patients with other hr-HPV infection.

A study protocol for a cluster randomized pragmatic trial for comparing strategies for implementing primary HPV testing for routine cervical cancer screening in a large health care system

BackgroundLimited guidance exists regarding implementation strategies that best facilitate cancer screening practice substitution and achieve optimal stakeholder-centered outcomes. Here we describe the protocol for a randomized pragmatic trial comparing two implementation strategies to facilitate substitution of primary HPV screening for Pap and HPV co-testing to perform routine cervical cancer screening of women aged 30–65 years at Kaiser Permanente Southern California (KPSC). MethodsTwelve service areas within KPSC will be randomized to a “centrally-administered system-wide implementation + local-tailored implementation” strategy or a “centrally-administered system-wide implementation only” strategy. The centrally-administered strategy comprises clinician and staff educational activities. Sites in the local-tailored arm will then conduct a structured local needs assessment followed by site-specific selection and deployment of implementation interventions. Surveys and interviews will be conducted among women and providers from the primary care and ob/gyn departments prior to the system-wide transition, shortly after the transition, and after the completion of local-tailored interventions. A stakeholder advisory committee will assist with study design, defining stakeholder-centered outcomes, and developing data collection tools. ResultsThe primary outcome of interest is uptake of primary HPV screening. Secondary provider-centered outcomes include provider knowledge, delivery of patient education, satisfaction with the practice substitution process, and resistance to primary HPV screening. Secondary patient-centered outcomes include patient knowledge, stigma, and satisfaction with the screening process. Intervention fidelity will also be measured via surveys. ConclusionsFindings from this study will help inform future use of a local-tailored implementation strategy for adopting primary HPV screening at large health care systems. Findings may also be applicable to other types of practice substitution.

RESULTS OF PROSAFE PAP IN CERVICAL CYTOLOGY

Papanicolaou staining is recommended for routine cervical cytology and cervical cancer screening. Our study was conducted by adapting modied staining technique which involves replacement of use of descending grades of alcohol with one step of 80% isopropyl alcohol. Prosafe papanicolaou staining was intended to reduce the staining time and cost of staining without compromising the quality or cytodiagnosis of the smear.

The prevalence of high-risk human papillomavirus genotypes and related risk factors among Iranian women

Human papillomavirus (HPV) infection, which often includes high-risk genotype infection, is one of the leading causes of cervical cancer. This cross-sectional research included 503 Iranian women referred to the gynecology clinic of Kamali Hospital in Karaj, Iran, for routine cervical cancer screening between 2020 and 2021. Cervical specimens were collected from all participants with a special brush and transported to the laboratory for cervical cytology diagnosis. Overall HPV incidence among Iranian women was 39.96%, of which 23.06% had high-risk HPV genotypes and 9.7% had low-risk HPV types. The risk associated with HR-HPV types was considerably associated with employment and marital status.