Cervical Cancer Screening Tests Research Articles

Do immigrants know less than natives about cancer screening tests? – the case of Netherlands

IntroductionThe Netherlands was one of the first countries in Europe to offer breast, colorectal and cervical cancer screening tests free of charge. Yet, a significant share of migrants in the Netherlands forgo the use of these preventive screenings. Qualitative research suggests, that lack of system knowledge on how the healthcare system operates (e.g. age eligibility of cancer screenings), is one factor contributing to this underuse among migrants. However, little is known about the extent to which migrants differ from natives in their system knowledge and about potential causes of this ethnic gap. The contribution of this study is therefore twofold: First, we examine whether migrants in the Netherlands have lower system knowledge regarding cancer screenings than the natives. Second, we examine which factors explain potential ethnic differences in system knowledge between migrants and non-migrants. MethodUsing the Longitudinal Internet Study for Social Sciences (LISS), we matched newly collected data on system knowledge about healthcare with Health module (wave 14). To assess the difference in system knowledge among migrants and non-migrants, while taking into account potential selection bias, we applied propensity score matching, one-to-one matching procedure with no replacement. We compared first generation non - Western migrants (FNWM) and second-generation non-western migrants (SNWM) with their most similar non-migrants group regarding their knowledge about breast, colorectal, and cervical screening. A Blinder-Oaxaca decomposition with non-matched samples was used to examine which factors can explain the differences in system knowledge among migrants and non-migrants. ResultsOur results show that first generation migrants have lower system knowledge about all three screening tests, while second generation migrants differ from non-migrants only with regard to knowledge about breast and colorectal cancer screenings. The ethnic differences found are not caused by personal or social factors such as education or income. ConclusionWe recommend Dutch healthcare policy makes to focus in the strengthen of cancer screening system knowledge among migrant populations in order to increase their participation in these screening programs.

Examining Prevalence and Influential Factors of Cervical Cancer Screening Among Women of Reproductive Age at Fort Portal Regional Referral Hospital in Fort Portal City

Globally, cervical cancer stands as a pressing health issue for women, ranking as the second most common cancer type among females worldwide. A study conducted at Fort Portal Regional Referral Hospital in Fort Portal City aimed to assess the prevalence and factors impacting the participation of women of reproductive age in cervical cancer screening tests. Employing a cross-sectional descriptive design with quantitative methods, the study utilized a consecutive sampling technique, surveying 96 respondents through self-administered questionnaires. Data analysis involved coding and entry via SPSS 20.1, with findings presented through tables, graphs, and pie charts. Results indicated that only a quarter of respondents (25%) had undergone cervical cancer screening, predominantly opting for Visual Inspection with Acetic Acid (VIA) (58.3%). Notably, a significant proportion of screened individuals (66.7%) hailed from rural areas, and the majority (66.7%) had a parity of 3 or fewer children. Moreover, 58.3% of those screened reported earning more than 400,000 shs per month. Unexpectedly, reluctance accounted for 44.8% of respondents' reasons for not undergoing screening. In summary, despite free accessibility to the service, there's a notably low prevalence of cervical cancer screening. Reluctance and fear associated with the procedure emerged as significant barriers hindering the uptake of cervical cancer screening among the surveyed population. Keywords: Cervical cancer, Reproductive age, Mothers, Women, Human papillomavirus.

External quality assessment program for human papillomaviruses DNA testing in Thailand

BackgroundSince 2020, the National Health Security Office includes the human papillomavirus DNA testing for cervical cancer screening in the government's healthcare schemes. HPV DNA testing has become primary screening in many laboratories in Thailand. External quality assurance scheme is crucial for assessment of laboratory performance. ObjectivesThe aim of this study was to develop a pilot program using LBC samples for the EQA of molecular methods and to review the methods used by participants to detect the presence of high risk HPV genotypes. Study designFour pilot distributions were shipped between December 2021 and May 2023, six months apart of two panels, each consisting of five different specimens. ResultsAll participants achieved 100 % accuracy in correctly identifying the presence or absence of high-risk genotypes in all 5 EQA samples. The most used HPV DNA test for detecting the presence of high-risk HPV DNA was the two specific high-risk genotypes and 12 other high-risk HPV genotypes. There was an observed increase in the use of assays that could detect 14 HPV HR genotypes. It suggests expanding testing methods to include a broader range of high-risk HPV genotypes, which could improve the comprehensiveness of the testing. ConclusionsThe HPV DNA testing scheme provides a standardised, homogeneous and characterised clinical specimen. These results indicate that the LBC samples are suitable for utilisation in an EQA scheme. EQA of HPV molecular screening programme is essential for monitoring the performance of laboratory networks.

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.

OP81 Cost Effectiveness Of Human Papillomavirus Extended Genotyping For Cervical Cancer Screening In Singapore

IntroductionThe World Health Organization recommends the human papillomavirus (HPV) test for cervical cancer screening. HPV partial genotyping (PGT) identifies HPV16 and HPV18 individually and the 12 other high-risk HPV genotypes (hrHPV) collectively. In contrast, HPV extended genotyping (XGT) identifies six hrHPV individually (HPV16,18,31,45,51, and 52) and the other eight in three groups (HPV33/58, HPV56/59/66, and HPV35/39/68). XGT allows better risk stratification for patient management and monitoring of persistent same-genotype infections (PSGI), which convey a higher risk for cervical cancer. This study compared the cost, quality-adjusted life-years (QALYs), and resource use of XGT with PGT when used as the primary cervical cancer screening method in Singapore.MethodsA discretely integrated condition event simulation was developed for screening 500,122 women aged 30 to 69 years over five years from the health system perspective, using a three percent annual discount. For XGT, women with HPV35/39/51/56/59/66/68 and reflex cytology of atypical squamous cells of undetermined significance were recalled for a repeat screening in one year, instead of the immediate colposcopy referral that occurs with PGT. At repeat screening, colposcopy was only provided for women with PSGI on XGT. Published data from Singapore were used for inputs and supplemented with data from international literature. Deterministic and probabilistic uncertainty analyses were conducted. Scenario analysis was conducted to simulate various HPV burdens among women. XGT was cost effective when the incremental cost-effectiveness ratio (ICER) relative to PGT was below SGD100,000 (USD118,906) (gross domestic product per capita in 2021).ResultsXGT was cost effective relative to PGT (ICER SGD16,370 [USD19,465]), with fewer colposcopies (n=7,130; 19%), liquid-based cytology tests (n=6,027; 7%), and clinic consultations (n=9,787; 2%) but more HPV tests (n=2,446; 0.5%). The ICER was most sensitive to the relative cost of XGT and the cost of PGT. XGT remained cost effective in one-way sensitivity analysis in all 1,000 probabilistic uncertainty simulations and in scenario analysis with various HPV burdens.ConclusionsXGT can provide a cost effective, risk-based approach to primary cervical cancer screening, with lower resource utilization than PGT.

Abstract PR020: Predictors of cancer screening in federally qualified health centers in the United States: A cross sectional study

Abstract Background: Patients from medically underserved populations are less likely to have access to cancer screening. Federally Qualified Health Centers (FQHCs) provide primary care services for medically under-served communities on a sliding-fee scale and are well-positioned to increase equity in cancer screening access. However, there is limited data about predictors and patterns of cancer screening among FQHC patients. The purpose of our study was to evaluate predictors and patterns of breast, colorectal, and cervical cancer screening in FQHCs across the United States. Methods: Data on the FQHCs was obtained from publicly available data sets from the Health Resources and Services Administration and included locations across the United States. Primary outcomes included breast, colorectal, and cervical cancer screening percentages. Primary exposures included the number of patients; percentages of patients by race/ethnicity, primary language, poverty threshold, and insurance status. Descriptive statistics (median and IQR) were obtained for all continuous variables. Spearman’s correlation coefficients were estimated to evaluate the association between cancer screening percentages and primary exposures. Results: We analyzed data from 1,375 FQHCs. The median population size served was 12,404 (IQR 6,084-24,757) patients, with 12% (IQR 2-38) Black/African American, 18% (IQR 5-48) Hispanic/Latino, 1% (IQR 1-3) Asian, and 1% (IQR 0-2) American Indian/Alaska Native patients. The median percentage of patients below the 100% poverty line was 66% (IQR 52-78), the percentage of uninsured patients was 19% (IQR 11-31), and the percentage of patients with Medicaid was 42% (IQR 28-57). 13% of patients preferred receiving care in a language other than English (IQR 3-32). Median percentage of mammography screening was 44% (IQR 31-56). Percentage of uninsured patients was negatively correlated with mammography screening percentages (r = -0.23, p &amp;lt; 0.001). Median percentage of colorectal cancer screening was 39% (IQR 27-51). Percentage of uninsured patients (r = -0.29, p &amp;lt; 0.001) and percentage of patients below 100% of the poverty line (r = -0.24, p &amp;lt; 0.001) were negatively correlated with colorectal cancer screening percentages. Median percentage of cervical cancer screening 48% (IQR 37-59). Percentage of Hispanic patients (r = +0.22, p &amp;lt; 0.001) and percentage of patients for whom English is not their first language (r = +0.29, p &amp;lt; 0.001) were positively correlated with cervical cancer screening percentages. Conclusions: Compared with national averages, patients who are served by FQHCs are less likely to receive recommended breast, colorectal, and cervical cancer screening tests, likely driven by social determinants of health. FQHCs represent trusted healthcare providers who serve high proportions of uninsured, Medicaid, low-income, diverse patients. Health care researchers and practitioners interested in reducing cancer disparities should consider working with FQHCs to conduct targeted outreach initiatives. Citation Format: Ashley M. Stuckwisch, Anand K. Narayan. Predictors of cancer screening in federally qualified health centers in the United States: A cross sectional study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR020.

Evaluating the economic screening of cervical cancer using IVA, HPV DNA, and histology methods: Systematic review

Background: Cervical cancer is a common malignancy causing cancer-related deaths worldwide. Evidence suggests that adequate screening can reduce cervical cancer-related deaths. Screening for cervical cancer can be done using Visual Inspection of Acetic Acid (VIA), HPV DNA and cytology. The economic burden of cancer patients is substantial ranging from US$8,066 to 22,888 per patient. Health cost effectiveness was comparative in the analysis of costs and consequences for the three screening methods. VIA is the most cost-effective primary screening test for cervical cancer. Purpose: To review the research results of a full economic evaluation to encourage the specific cervical cancer screening methods used to enhance the detection of precancerous lesions in women's cervix. Method: This systematic review used the PRISMA ScR framework with a literature search using 3 databases, namely Pubmed, Wiley, and Google Scholar, with years of publication from 2009 – 2023. The data that has been obtained is carried out by critical appraisal using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Results: Based on the search for 3,973 selected articles, 7 match the inclusion criteria. This systematic review discovered three major themes: the utility value of health status, cost and analysis. Conclusion: The most cost-effective cervical cancer screening is by VIA. HPV DNA and pap smear based cytology techniques have been reported to show high sensitivity and specificity respectively including being expensive and resource intensive. In contrast the VIA technique has moderate sensitivity and specificity but is less expensive Various developed countries have used Pap or HPV DNA cytology tests as the main screening method, which can lead to a 50-70% reduction in cervical cancer incidence, while in developing countries using VIA tests as a cervical cancer screening method.

Health Counseling and Cervical Cancer Screening Test for Reproductive Age Women in Bojong Gede District

In Indonesia, 75% of women have experienced vaginal discharge at least once in their lives and half of them have experienced vaginal discharge twice or more. Vaginal discharge is a classic problem for most women. Ironically, most women do not know about vaginal discharge and the causes of vaginal discharge. If not handled properly, vaginal discharge can be fatal, infertility and ectopic pregnancy (pregnancy outside the womb) can be one of the consequences of vaginal discharge. The early symptoms of uterine cancer usually start with vaginal discharge. The betel leaf (Piper betle linn) used in this study belongs to the Peiperaceae family. The part used is the leaves. Betel leaf contains essential oils that contain compounds that have strong antibacterial properties, which are referred to as "kavikol" and "kavibetol". Anti-bacterial is also found in boiled betel in water. Betel leaf in traditional medicine is usually used for first aid in first-line treatment in daily medicine, especially as an antiseptic. This activity aims to increase the knowledge of adolescent girls about the dangers of vaginal discharge and provide an intervention in the form of betel leaf boiled water to reduce physiological vaginal discharge. The results of the activity showed benefits for adolescents as evidenced by the decrease in the incidence of physiological vaginal discharge after being given counseling and betel leaf water.

Women's perceptions and preferences for cervical cancer screening in light of updated guidelines.

Updated risk-based guidelines for cervical cancer screening (CCS) allow for individualized screening that minimizes unnecessary testing. However, these guidelines are complex and may not be easily understandable to patients. To describe women's perceptions and preferences about CCS in light of recent guideline changes. This qualitative study conducted in February 2020 used online, text-based focus groups with a sample of US women (n = 49) ages 27-45. After participants completed a short demographic survey, an experienced moderator used a semistructured guide to solicit participants' perceptions of routine gynecologic care and CCS. We summarized survey data using descriptive statistics. Two authors analyzed transcripts using conventional content analysis and met with other team members to resolve discrepancies and determine final themes. Most participants were non-Hispanic White (65%), had health insurance (90%), and reported having a routine gynecologic examination in the past year (70%). We identified four common themes: (1) low perceived risk of human papillomavirus (HPV) coupled with low knowledge about HPV as a causative factor for cervical cancer, (2) confusion about-and mistrust of-recent individual risk-based guidelines that determine the indicated timing and type of CCS test (Pap or HPV testing), (3) mixed opinions about performing a self-swab for HPV testing, and (4) conflicting perceptions of trust toward providers and the health care industry. Findings highlight women's uncertainty and hesitancy about updated CCS guidelines. Provider-patient communication strategies should consider women's gaps in knowledge about HPV, include the rationale for guidelines and types of tests, and build trust between patients and providers.

Use of Spiritually Framed Information Messages to Improve Cancer Screening

This study aimed to determine the effect of spiritually framed information messages on breast and cervical cancer screening tests participation plans and self-efficacy levels in Turkish Muslim women. This study was conducted as a randomized controlled trial with 3 treatment groups. Each group consisted of 335 women. Study findings suggest that spiritually framed information messages on breast and cervical cancer screening tests can elicit positive thoughts on cancer self-efficacy and participation in breast and cervical cancer early screening tests.

Up-to-Date Breast, Cervical, and Colorectal Cancer Screening Test Use in the United States, 2021.

We examined national estimates of breast, cervical, and colorectal cancer (CRC) screening test use and compared them with Healthy People 2030 national targets. Test use in 2021 was compared with prepandemic estimates. In 2022, we used 2021 National Health Interview Survey (NHIS) data to estimate proportions of adults up to date with US Preventive Services Task Force recommendations for breast (women aged 50-74 y), cervical (women aged 21-65 y), and CRC screening (adults aged 50-75 y) across sociodemographic and health care access variables. We compared age-standardized estimates from the 2021 and 2019 NHIS. Percentages of adults up to date in 2021 were 75.7% (95% CI, 74.4%-76.9%), 75.2% (95% CI, 73.9%-76.4%), and 72.2% (95% CI, 71.2%-73.2%) for breast, cervical, and CRC screening, respectively. Estimates were below 50% among those without a wellness check in 3 years (all screening types), among those without a usual source of care or insurance (aged <65 y) (breast and CRC screening), and among those residing in the US for less than 10 years (CRC screening). Percentages of adults who were up to date with breast and cervical cancer screening and colonoscopy were similar in 2019 and 2021. Fecal occult blood/fecal immunochemical test (FOBT/FIT) use was modestly higher in 2021 (P < .001). In 2021, approximately 1 in 4 adults of screening age were not up to date with breast, cervical, and CRC screening recommendations, and Healthy People 2030 national targets were not met. Disparities existed across several characteristics, particularly those related to health care access. Breast, cervical, and colonoscopy test use within recommended screening intervals approximated prepandemic levels. FOBT/FIT estimates were modestly higher in 2021.

Prevalence of precancerous gynecological lesions and gynecological cancer in patients undergoing vaginal hysterectomy for pelvic organ prolapse

Objectives This retrospective cohort study aimed to determine the prevalence of precancerous or malignant lesions of the cervix and/or endometrium among patients who underwent vaginal hysterectomy. Materials and methods Medical record of patients who had been diagnosed with pelvic organ prolapse (POP) and undergone vaginal hysterectomy from January 2009 to September 2018 in tertiary hospital was reviewed. The exclusion criteria included individuals who had previously received a diagnosis of gynecologic precancerous lesions or cancer, had abnormal preoperative findings, presented abnormal cervical cancer screening test results or abnormal results from preoperative endometrial biopsy, and had incomplete operative notes or pathological results. Results The electronic medical records of 530 patients were reviewed and included in the analysis. Nine of the 530 patients (1.7%) had precancerous or malignant lesions of the cervix and/or endometrium. The prevalence of atypical endometrial hyperplasia and endometrial carcinoma were 0.19% and 0.57%, respectively. All of the patients with endometrial cancer subsequently underwent complete surgical staging. Precancerous cervical lesions were found in five patients (0.95%): CIN II 0.38% and CIN III 0.57%. No cases of cervical cancer were identified. Conclusions It is possible to detect a minor prevalence of precancerous and malignant lesions following post-operative procedures in POP. The assessment of the elderly through the use of risk-based evaluation merits attention for the purpose of early identification. This study offers valuable insights that can be utilized in preoperative counseling and enhancing the preoperative evaluation process.

Approach of Female Patients to Screening Tests in the Prevention of HPV-Related Cervical Cancer and the Effect of Physician's Recommendation

The aim of our study was to evaluate the cervical cancer screening test status of female patients between the ages of 30-65 who applied to the family medicine outpatient clinic for any reason. If they have not had the screening test, it is aimed to provide information and relevant education to the patients about the test, and then to include the patient in the national cervical cancer screening program by improving the patient's knowledge and awareness and also to contribute to preventive health care, which is our principle of family medicine specialty. Our study was prospective observational research in which evaluating the status of having a cervical cancer screening test after appropriate information. Patients were asked about their cervical cancer screening test status, and all participants were informed about this issue, and the patients who did not get tested were contacted again by phone one month later to evaluate the status of taking the test. A unique structured questionnaire form was used for the study. A total of 146 women who agree to participate voluntarily were included in the study. The mean age of the patients was 44.39±9.26 years and 64.4% had not gone through menopause. Of the patients, 87% were married, 48.6% were university graduates, and 49.3% were not employed. 66.4% of patients had had a cervical cancer screening test at least once, while 28.9% of them had been tested more than five years ago, 2.1% did not remember when they had the test. Of those who had the screening test, 57.7% had the test for health check-up, 73.5% of those who did not get tested they did not have a test because they did not need or had any complaints. 73.3% of the patients had not received training on the screening tests. 51.3% of those receiving training stated that they received training from the hospital and 28.2% from the family health center. After being informed about the cervical cancer screening test, 58.9% (n=86) of the patients considered having the test. It was determined that 26.6% of the patients (n=79) who did not have the screening test in accordance with the screening program and who never tested, had the screening test done after being informed. Consider the average age of the patients, it was determined that their participation in the cervical cancer screening program was quite low. The fact that more than half of the participants considered having a screening test after the physician's recommendation and training, and the fact that one quarter of the participants who were due to have the screening test after one month had the screening test, shows the importance of the physician's recommendation and education.

Triage Strategies for Non-16/Non-18 HPV-Positive Women in Primary HPV-Based Cervical Cancer Screening: p16/Ki67 Dual Stain vs. Cytology.

In the context of primary HPV cervical cancer screening, the identification of minor screening abnormalities necessitates triage tests to optimize management and mitigate overtreatment. Currently, reflex cytology and reflex p16/Ki67 dual-stain (DS) are under scrutiny for their applicability in primary HPV-based screening. However, there remains a dearth of comprehensive data for comparing their performance. Among 30,066 results from liquid-based cervical cancer screening tests, a cohort of 332 cases was meticulously selected based on available high-risk human papillomavirus (HPV) test results, limited genotyping for HPV 16 and 18, liquid-based cytology, DS, and histology outcomes from standardized colposcopy with biopsy. For cases positive for 12 other high-risk HPV genotypes, three retrospective triage approaches were analyzed. We computed the positive predictive value (PPV) for the detection of high-grade squamous intraepithelial lesions or worse (HSIL+). Both triage models employing DS (reflex cytology followed by DS and reflex DS alone in all cases) exhibited significantly higher PPV for HSIL+ compared to the strategy with reflex cytology alone (35.9%/33.3% vs. 18.8%; p < 0.0001). Additionally, these DS-based models showed higher negative predictive values (NPV) (100%/96.2% vs. 69.2%; p = 0.0024/0.0079). In the DS-inclusive models, fewer colposcopies were necessitated (103/102 vs. 154), and fewer cases of HSIL+ were overlooked (0/3 vs. 8). Our findings suggest that p16/Ki67 dual-stain, either as a standalone or combined triage test, holds promise for the effective detection of HSIL+ in patients with minor screening abnormalities in primary HPV-based cervical cancer screening.

Abnormal cervical cancer screening results among US Veteran and non-Veteran participants in the National Health Interview Survey (NHIS)

Female Veterans report cervical cancer risk factors at higher rates than non-Veterans. Using data from the National Health Interview Survey (NHIS), we tested whether Veterans with a recent cervical cancer screening test were more likely than non-Veterans to have received an abnormal result. NHIS is a population-based cross-sectional household survey with a stratified, multistage sampling design. We pooled screening data from 2010, 2015, and 2018, and restricted the sample to female participants without a hysterectomy who had a cervical cancer screening test in the prior 3 years. The primary outcome was self-reported abnormal result on a Pap and/or HPV test in the prior 3 years. Our main predictor was Veteran status. We used survey-weighted multivariable logistic regression to estimate odds of an abnormal screening result in the prior 3 years as a function of Veteran status, controlling first for age and survey year, then adding sociodemographic and health factors in subsequent models. The sample included 380 Veterans and 25,102 non-Veterans (weighted total population 104.9 million). Overall, 19.0% of Veterans and 13.7% of non-Veterans reported an abnormal cervical cancer screening test result in the prior 3 years (unadjusted p = 0.03). In the adjusted regression model, the previously observed association between Veteran status and abnormal screening result was explained by differences in sociodemographic and health factors between Veterans and non-Veterans (aOR 1.21, 95%CI 0.78–1.87). Nearly 1 in 5 Veterans with a recent cervical cancer screening test received an abnormal result. Clinicians should address modifiable risk factors and provide evidence-based follow-up for abnormal results.

Knowledge level about HPV infection and cervical cancer screening tests

Introduction: Understanding HPV and cervical cancer is vital for prevention, early diagnosis, and treatment. Nurses play a crucial role in implementing screening and are also at risk. This study examines nurses' knowledge and practices regarding HPV and cervical cancer screening in a tertiary center.&#x0D; Materials and Methods: It is a prospective survey study conducted with nurses. A total of 191 nurses participated in the three-part and 53-item survey that evaluated demographic data, HPV knowledge levels and cervical cancer screening awareness.&#x0D; Results: A total of 2895 nurses work at the hospital. The rate of participation in the research was 6.6% with 191 participants. The average age of the participants is 27.1. Majority of the participants are female (n: 171, 89.5%), only 20 (10.5%) are male. While 81.9% of the respondents had knowledge about sexually transmitted diseases, only 13.5% had gone to regular gynecological examinations. Despite 98.4% of the participants who had knowledge about cervical cancer and screening practices, only 11% (n:19) had undergone cervical cancer screening and 94.2% (n:180) had not received HPV vaccine. The most mis-answered question about HPV was whether current vaccines protect against both genital warts and cervical cancer. &#x0D; Conclusion: In conclusion, nurses' knowledge level and screening practices about HPV and cervical cancer need to be improved. It is also important to increase awareness of the HPV vaccine and encourage more people to receive it. This effort could positively impact health outcomes related to cervical cancer and HPV.

Automated Assessment of Digital Images of Uterine Cervix Captured Using Transvaginal Device-A Pilot Study.

In low-resource settings, a point-of-care test for cervical cancer screening that can give an immediate result to guide management is urgently needed. A transvaginal digital device, "Smart Scope®" (SS), with an artificial intelligence-enabled auto-image-assessment (SS-AI) feature, was developed. In a single-arm observational study, eligible consenting women underwent a Smart Scope®-aided VIA-VILI test. Images of the cervix were captured using SS and categorized by SS-AI in four groups (green, amber, high-risk amber (HRA), red) based on risk assessment. Green and amber were classified as SS-AI negative while HRA and red were classified as SS-AI positive. The SS-AI-positive women were advised colposcopy and guided biopsy. The cervix images of SS-AI-negative cases were evaluated by an expert colposcopist (SS-M); those suspected of being positive were also recommended colposcopy and guided biopsy. Histopathology was considered a gold standard. Data on 877 SS-AI, 485 colposcopy, and 213 histopathology were available for analysis. The SS-AI showed high sensitivity (90.3%), specificity (75.3%), accuracy (84.04%), and correlation coefficient (0.670, p = 0.0) in comparison with histology at the CINI+ cutoff. In conclusion, the AI-enabled Smart Scope® test is a good alternative to the existing screening tests as it gives a real-time accurate assessment of cervical health and an opportunity for immediate triaging with visual evidence.

Training health care providers to administer VIA as a screening test for cervical cancer: a systematic review of essential training components

BackgroundTraining health care providers to administer visual inspection after application of acetic acid (VIA) is paramount in improving cervical cancer screening services for women in low- and middle-income countries. The objective of this systematic review was to create a framework of essential VIA training components and provide illustrating examples of how VIA training programs can be carried out in different clinical settings.MethodsA systematic review of PubMed, Embase, and Web of Science (from 2006 to 2021) was undertaken. Our inclusion criteria comprised articles reporting on implemented cervical cancer screening programs using VIA in a screen-and-treat approach. Trained health care providers with any level of health education were included, and the outcome of interest was the reporting of training components. Data were extracted by two reviewers, and a narrative synthesis of the training programs was performed. We developed a framework of seven essential training components and applied it to assess how training courses were conducted in different settings.Results13 primary studies were eligible for inclusion, including 2,722 trained health care providers and 342,889 screened women. Most training courses lasted 5–7 days and included theoretical education, practical skill development, and competence assessment. It was unclear how visual aids and training in client counselling and quality assessment were integrated in the training courses. After the training course, nearly all the VIA training programs made provisions for on-job training at the providers’ own clinical settings through supervision, feedback, and refresher training.ConclusionsThis study demonstrates the feasibility of implementing international training recommendations for cervical cancer screening in real-world settings and provides valuable examples of training program implementation across various clinical settings. The diverse reporting practices of quality indicators in different studies hinder the establishment of direct links between these data and training program effectiveness. To enhance future reporting, authors should emphasize specific training components, delivery methods, and contextual factors. Standardized reporting of quality indicators for effective evaluation of VIA training programs is recommended, fostering comparability, facilitating research, and enhancing reporting quality in this field.

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.

Combined influence of immigration status and income on cervical cancer screening uptake

The regular performance of Pap tests for cervical cancer screening reduces this disease's incidence and mortality. Income inequalities have been reported for this screening, partly because in some countries women must advance or even pay out-of-pocket costs. Because immigrant status is also associated with low Pap test uptake, we aimed to analyze the combined impact of immigrant status and low income on cervical cancer underscreening. This study, based on the French CONSTANCES cohort, uses data from the cohort questionnaires and linked health insurance fund data about Pap test reimbursement. To measure income inequalities in screening, we calculated a Slope Index of Inequality (SII) by linear regression, taking into account the migration status of participants. The majority of the 70,614 women included in the analysis were not immigrants (80.2%), while 12.9% were second-generation immigrants, and 6.9% first-generation immigrants. The proportion of underscreening increased with immigrant status, from 19.5% among nonimmigrants to 23.6% among the second generation, and 26.5% among the first (P < 0.01). The proportion of underscreening also increased as income level decreased. The income gradient rose significantly from 14% among nonimmigrants to 21% in second-generation immigrants and 19% in the first generation (P < 0.01). Among first-generation migrants, the shorter the duration of residence, the higher the SII. Women who are first- or second-generation immigrants are simultaneously underscreened and subject to a more unfavorable economic gradient than native French women born to native French parents. The accumulation of several negative factors could be particularly unfavorable to screening uptake.