Cervical Cancer Screening In Women Research Articles

Health-care providers' perceptions, attitudes towards and recommendation practice of cervical cancer screening.

In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women.

The role of pre-invasive disease in overdiagnosis: A microsimulation study comparing mass screening for breast cancer and cervical cancer.

Although early detection of cancer through screening can prevent cancer deaths, a drawback of screening is overdiagnosis. Overdiagnosis has been much debated in breast cancer screening, but less so in cervical cancer screening. We examined the impact of overdiagnosis by comparing two screening programmes in the Netherlands. We estimated overdiagnosis rates by microsimulation for breast cancer screening and cervical cancer screening, using a cohort of women born in 1982 with lifelong follow-up. Overdiagnosis estimates were made analogous to two definitions formed by the UK 2012 breast screening review. Pre-invasive disease was included in both definitions. Screening prevented 921 cervical cancers (-55%) and 378 cervical cancer deaths (-59%), and 169 (-1.3%) breast cancer cases and 970 breast cancer deaths (-21%). The cervical cancer overdiagnosis rate was 74.8% (including pre-invasive disease). Breast cancer overdiagnosis was estimated at 2.5% (including pre-invasive disease). For women of all ages in breast cancer screening, an excess of 207 diagnoses/100,000 women was found, compared with an excess of 3999 diagnoses/100,000 women in cervical cancer screening. For breast cancer, the frequency of overdiagnosis in screening is relatively low, but consequences are evident. For cervical cancer, the frequency of overdiagnosis in screening is high, because of detection of pre-invasive disease, but the consequences per case are relatively small due to less invasive treatment. This illustrates that it is necessary to present overdiagnosis in relation to disease stage and consequences.

Breast and Cervical Cancer Screening in Women Referred to Urban Healthcare Centers in Kerman, Iran, 2015

Breast and cervical cancers are among leading causes of morbidity and mortality in women worldwide. Regular screening is very important for early detection of these cancers, but studies indicate low rates of screening participation. In this survey we studied the rate of screening participation among women 18-64 years old referred to urban health centers in Kerman, Iran in 2015. A cross-sectional study was carried out on 240 women who were selected using a multistage sampling method. Data collected using a questionnaire covered demographics and questions about common cancer screening status in women. Analysis was by SPSS 19. The mean age of participants was 31.7± 7. Most (97.1%) were married, housewives (83.3%), had high school diploma (43.8%) and a monthly income more than ten million Rls. The frequency of the Pap test performance was higher in women who were employed and with a university degree (p<0.05). The frequency of mammography performance in women over 40 years was also higher in women with university degree (p<0.05). There was no statistically significant difference in the frequency of pelvic examination, and self and clinical breast examinations based on education, household income and employment (p>0.05). Our study found that the rate of screening participation among women is low. Investigation of the barriers, increasing the awareness of women about the importance and advantages of screening and also more incentives for health personnel especially family physicians to pay more attention to preventive programs could be effective.

Cost-Effectiveness of Screening and Treatment for Cervical Cancer in Tanzania: Implications for other Sub-Saharan African Countries

ObjectivesTo compare the institutional cost per person of screening and treatment between two groups of patients—those screened and those not screened before treatment for cervical cancer at Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania—and to perform a cost-effectiveness analysis of the ORCI cervical cancer screening program. MethodsThe study included 721 screened and 333 unscreened patients treated at ORCI for cervical cancer from 2002 to 2011. We compared the cost of cervical cancer treatment per patient with life-years gained for patients screened at ORCI versus not screened. ResultsPatients with cancer were diagnosed at an earlier stage after participating in screening compared with nonparticipants. For example, 14.0% of stage I cancer patients had received screening by ORCI compared with 7.8% of unscreened cases. For stage IV cancer, these percentages were 1.4% and 6.9%, respectively. Average screening and treatment cost for patients receiving cancer screening ($2526) was higher than that for unscreened patients ($2482). However, we calculated an incremental cost-effectiveness ratio of $219 per life-year gained from receiving cervical cancer screening compared with not being screened, and thus the ORCI screening program was highly cost-effective. Furthermore, the screening program was associated with averting 1.3 deaths from cervical cancer each year resulting from earlier diagnoses of cancer cases, with the incremental cost-effectiveness ratio of $4597 per life saved. ConclusionsAlthough Sub-Saharan Africa faces substantial challenges in population health management, our study highlights the potential benefits from expanding access to regular cervical cancer screening for women in this region.

Prevalence and genotype distribution of human papillomavirus: implications for cancer screening and vaccination in Henan province, China.

To provide information for cervical cancer screening and vaccination in Henan province, China, the distribution of human papillomavirus (HPV) was analyzed. The HPV genotypes were detected using gene array and flow-through hybridization. Overall, 38.1% (1,536/4,033) of the women were human papillomavirus deoxyribonucleic acid (HPV DNA) positive. The prevalence of high-risk HPV types was 32.4%. HPV 16 was the most prevalent genotype (8.9%), followed by HPV 52 (5.8%) and HPV 58 (4.4%). The data support close surveillance of women for cervical cancer screening, and HPV prophylactic vaccines including HPV16, HPV 52, and HPV 58 might offer greater protection in this area.

The influence of the social support about 20s women's cervical cancer screening who are doing physical activities on the screening attitude

This research observes the influence of the social support about cervical cancer screening on the screening attitude to provide necessary implications by drawing the method for preventing young women's cervical cancer. The research targets were extracted conveniently from Seoul and Gyeonggi‐do area, it was total 281 people and the average age was 22.94 years old. The question for measuring the social support was used by Multidimensional Scale of Perceived Social Support: MSPSS which was developed by G. D. Zimet, N. M. Dahlem, S. G. Zimet and G. K. Farley(1988). The ‘social support’ question was composed of total 12 questions with 3 factors(family support, friend support, doctor/nurse support) and was evaluated as 5‐point Likert Scale which means 1 point as ‘Not at all’ and 5 points as ‘Absolutely’. The question for measuring the cervical cancer screening intention used the question which was used by E. C. Jung and C. H. Jin(2011). The questions for measuring the cervical cancer screening attitude used the questions which was used by [ G. U. Ko, D. H. Lee, Y. H. Lee, H. S. Son, (2002); J. A. Lee, M. D. Park, J. H. Shin, A. S. Sohn, M. O. Kim(2000)]. The cervical cancer screening attitude question is consisted of 8 questions with single factors which are the necessity of cervical cancer screening, the financial burdens, the dangerousness, the early detection and the health and these are evaluated by 5‐point Likert scale which means 1 point as ‘Not at all’ and 5 points as ‘Absolutely’. In this research, having higher average means that the attitude for the cervical cancer screening is positive. After examining how the social support effects on the cervical cancer screening attitude, the family support(β=.55, t=10.72, p&lt;.001) and the friend support(β=.16, t=10.72, p&lt;.01) except doctor/nurse support(β=.02, t=.49, p&gt;.05) presents that these two silently effects on the cervical cancer screening attitude. Therefore, it seems that the family support and the friend support positively effects on the cervical cancer screening attitude. Social support is not only the source of unofficial treatment but also the advice about the health and the physical care and it supplies the psychological support. The health is the one of the social compositions in the perspective of the contextual construction, and the process of having diseases and treating them is effected by social contexts and the influence of social relations like family, friends etc. Eventually, when people sick or want some consolations or when they want to get some information related to health, they want to get social support from family or friend who supports them, and these supports can be evaluated positively to the formation of individual attitude. Moreover, the social relation which is also called the source of social support supports the result of this research by producing emotional, informative support with the points that it reduces the uncertainty related to health, enhances the sense of control and works as the motive to effectively handle the specific situation about health. If we reflect the result of this research, to enhance the screening intention as the preventive behavior for young women's cervical cancer, the social support about cervical cancer screening has to be improved, and by through this, it is important to have the positive attitude.Support or Funding Informationsocial support, women, cervical cancer, screening attitude

Cervical and breast cancer screening participation for women with chronic conditions in France: results from a national health survey.

BackgroundComorbidity at the time of diagnosis is an independent prognostic factor for survival among women suffering from cervical or breast cancer. Although cancer screening practices have proven their efficacy for mortality reduction, little is known about adherence to screening recommendations for women suffering from chronic conditions. We investigated the association between eleven chronic conditions and adherence to cervical and breast cancer screening recommendations in France.MethodUsing data from a cross-sectional national health survey conducted in 2008, we analyzed screening participation taking into account self-reported: inflammatory systemic disease, cancer, cardiovascular disease, chronic respiratory disease, depression, diabetes, dyslipidemia, hypertension, obesity, osteoarthritis and thyroid disorders. We first computed age-standardized screening rates among women who reported each condition. We then estimated the effect of having reported each condition on adherence to screening recommendations in logistic regression models, with adjustment for sociodemographic characteristics, socioeconomic position, health behaviours, healthcare access and healthcare use. Finally, we investigated the association between chronic conditions and opportunistic versus organized breast cancer screening using multinomial logistic regression.ResultsThe analyses were conducted among 4226 women for cervical cancer screening and 2056 women for breast cancer screening. Most conditions studied were not associated with screening participation. Adherence to cervical cancer screening recommendations was higher for cancer survivors (OR = 1.73 [0.98–3.05]) and lower for obese women (OR = 0.73 [0.57–0.93]), when accounting for our complete range of screening determinants. Women reporting chronic respiratory disease or diabetes participated less in cervical cancer screening, except when adjusting for socioeconomic characteristics. Adherence to breast cancer screening recommendations was lower for obese women and women reporting diabetes, even after accounting for our complete range of screening determinants (OR = 0.71 [0.52–0.96] and OR = 0.55 [0.36–0.83] respectively). The lower breast cancer screening participation for obese women was more pronounced for opportunistic than for organized screening.ConclusionWe identified conditions associated with participation in cervical and breast cancer screening, even when accounting for major determinants of cancer screening. Obese women participated less in cervical cancer screening. Obese women and women with diabetes participated less in mammographic screening and organized breast cancer screening seemed to insufficiently address barriers to participation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2295-0) contains supplementary material, which is available to authorized users.

Adherence to US Preventive Services Task Force recommendations for breast and cervical cancer screening for women who have a spinal cord injury

Context: Women with spinal cord injury (SCI) may face barriers that result in disparities in receipt of recommended mammography and Papanicolaou testing.Setting: South Carolina.Participants: South Carolina women with SCI were identified using International Classification of Diseases codes in 2000–2010 Medicaid and Medicare billing data.Outcome measures: Receipt of mammography and Pap testing was determined using procedure billing codes. Partial proportional odds models were estimated to examine the association between SCI and adherence with screening recommendations from the United States Preventive Services Task Force. Each individual's screening experience was classified as full adherence, partial adherence, or no screening.Results: The cohort for mammography consisted of 3,173 women with SCI and 6,433 comparison women without SCI. The cohort for Pap testing consisted 5,025 women with SCI and 9,538 comparison women. Women with SCI were less likely to have full adherence with mammography recommendations (aOR = 0.69, 95% CI 0.64, 0.76) and Pap test recommendations (aOR = 0.53, 95% CI 0.49, 0.57). They were more likely to have no mammography screening (aOR = 1.44, 95% CI 1.33, 1.57) and no Pap testing (aOR = 1.89, 95% CI 1.77, 2.03) than women without SCI.Conclusion: Using longitudinal data with multiple outcome levels, women with SCI were less likely to be fully adherent with receipt of recommended breast and cervical cancer screenings and more likely to have no screenings during the eligible years when compared to women without SCI.

Cervical Cancer and Screening Test (PAP Test): Knowledge and Beliefs of Egyptian Women

Cervical cancer is the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases in 2012. In Egypt the incidence of cervical cancer is 866 per year where mortality rate is 373 per year. The current study aims to determine women’s beliefs and knowledge towards cervical cancer and Pap smear. The study was conducted at the outpatient obstetrics clinics of two hospitals namely El- Mainshawy health insurance Hospital, and El – Aiada El- Shamela at Tanta governorate. The study subjects comprised 1000 women attending the above mentioned settings two tools were used: An interview assessment sheet and the Health Believe Model (HBM). Results of the current study illustrated that Out of the 1,000 women interviewed, (68.0%) could know the definition of cervical cancer and related to a virus as its causative agent. About 95% of the women did not have an idea of the risk factors for cervical cancer, the knowledge about Pap test is quite poor, only 13.3% identify Pap smear test while 86.7% had no idea at all. In terms of the perceived benefits of Pap test, about 50.3% of the participants believed that Pap tests are the best way to detect cervical cancer, 42.9% believed that cervical cancer can be cured easily if detected early, and 62% disagree that a Pap test is important for save their health. The present study concluded that inefficient utilization of cervical cancer and its screening test would be affected by poor knowledge and negative beliefs related to cervical cancer screening in women. It was recommended that development of effective intervention programs strategies for Egyptian women and identify those women who are most at risk for cervical cancer and would benefit from intervention programs to increase cervical cancer screening rates.

Use of Cytology, E6/E7 mRNA, and p16INK4a-Ki-67 to Define the Management of Human Papillomavirus (HPV)-Positive Women in Cervical Cancer Screening.

We measured the accuracy of p16(INK4a)-Ki67 (CINtec PLUS, Roche, Mannheim, Germany), and E6/E7mRNA (types 16/18/31/33/45 NucliSENS easyQ, bioMérieux, Boxtel, The Netherlands) as triage test, alone and combined with cytology. Six thousand two hundred and seventy two women were recruited in a population-based screening using HPV DNA as primary test; 396 were positive and were tested for cytology and biomarkers. All tests were performed on the same sample. Cytology-positive women were referred to colposcopy; cytology-negative women were referred to one-year HPV re-testing. The endpoint was CIN2+ at baseline or follow up. Sensitivity was 77.6% (95% confidence interval (CI) 65.3-86.7) and 53.2% (95%CI: 40.3-65.4) for cytology at atypical squamous cells of undetermined significance (ASC-US) and high-grade threshold, and 87.6% (95%CI:75.7-93.6), and 80.8% (95%CI: 67.6-89.8) for p16INK4a-Ki67, and E6/E7mRNA, respectively. Colposcopy referral was 36% (95%CI: 31.2-40.9) and 11.2% (95%CI: 7.8-14.1) for cytology at ASC-US and high-grade threshold, respectively, and 36.0% (95%CI: 29.9-29.6), and 47.5% (95%CI: 32.5-42.4) for p16(INK4a)-Ki67, and E6/E7mRNA, respectively. Strategies referring high-grade cytology or biomarker positive women to colposcopy reached sensitivity close to 100%, with modest increase in colposcopy referral. The high sensitivity of combined strategies probably allows longer intervals in HPV-positive, triage-negative women.

Discontent and Confusion: Primary Care Providers' Opinions and Understanding of Current Cervical Cancer Screening Recommendations.

In 2012, new cervical cancer screening guidelines were published by three widely recognized entities which advocate delayed onset of testing, fewer screenings, selective use of human papilloma virus co-testing, and no further screening in women over age 65 years. Early observations report that these recommendations are not being followed and overscreening is common. This study seeks to understand why primary care providers might not adhere to these new 'best practice' health policy protocols. A total of 4,909 randomly selected primary care providers (physicians, nurse practitioners, and physician assistants) practicing in California were mailed a study questionnaire. Participants were asked if they consider current published screening guidelines to be authoritative, reliable, and/or clinically appropriate. Clinical vignettes captured individual provider beliefs on timing and method of cervical cancer screening in women within the four key age groups embedded in current screening guidelines. Of the 4,909 surveys mailed, 1,268 (25.8%) qualified responses were received. Fundamentally, 35.0% of all primary care providers do not believe current guidelines are clinically appropriate, with 58.6% of obstetrician/gynecologist physicians having this same skepticism. Even among those who affirmatively believe current guidelines are authoritative, reliable, and clinically appropriate, only 15.3% recommend screening intervals and methodology of testing in women of four differing ages consistent with that of current policy guidelines. Among the primary care providers surveyed, distrust and confusion likely limit adherence to current evidence-based cervical cancer screening health policy recommendations, and contribute to the current high rates of overscreening that have been observed.

Women with Cervical Cancer: Perceptions about the Papanicolau Test

Objective: Examine perceptions about the Papanicolaou (Pap) test from the perspectives of Chilean women with cervical cancer. Design: A descriptive, cross-sectional study conducted in Santiago, Chile. Participants: 127 Chilean women. Results: The principal reasons for not having had a PAP test were procrastination and barriers related to fear, embarrassment, discomfort, not caring, lack of time, and lack of knowledge. Conclusion: All the reasons given by the Chilean women who took part in the study must be considered by health care professionals who are in a position to advocate for education and cervical cancer screening for women, especially in countries where the disease is still prevalent. These results can serve as a guide for education programs and can be applied in intervention research.

Brief report: cervical cancer screening in women with intellectual and developmental disabilities who have had a pregnancy

Women with intellectual and developmental disabilities (IDD) have lower cervical cancer screening rates than women without IDD. Key barriers to screening uptake include physician or caregiver assumptions that screening is unnecessary because women with IDD are not sexually active. Our objective was to compare cervical cancer screening rates in women with and without IDD who had had a pregnancy. We conducted a population-based retrospective cohort study using linked Ontario (Canada) health and social services administrative data. We identified 20- to 64-year-old women with (N = 5033) and without (N = 527 437) IDD who had had a pregnancy. We examined the occurrence of cervical cancer screening between April 1, 2007 and March 31, 2010. We compared screening rates in women with and without IDD using logistic regression, controlling for age, region of residence, neighbourhood income quintile and morbidity level. Women with IDD who had had a pregnancy were more likely than those without IDD to be young, to live in the lowest neighbourhood income quintile, to live in rural areas and to have high or very high morbidity. Even after controlling for these factors, women with IDD were less likely than women without IDD to be screened (67.7% vs. 77.0%; adjusted odds ratio 0.61; 95% confidence interval 0.58-0.65). Even among women who have had a pregnancy and are therefore known to have been sexually active, women with IDD face significant disparities in cervical cancer screening. Strategies to promote equitable uptake of cervical cancer screening for women with IDD need to be implemented.

Abstract PL02-04: Drastically reducing HPV-associated cancers through etiologically-based primary and secondary prevention

Abstract HPV infection causes more than 25,000 anogenital and oropharyngeal cancers annually in US men and women and is responsible for about 10% of all female cancers worldwide. In the developing world, where cervical cancer is the main HPV-associated cancer, a woman's lifetime risk of dying from this cancer is estimated to be about 1%. Persistent infection by more than 10 HPV types can lead to cervical cancer; HPV16 and HPV18 account for about 70% of these tumors. These two HPV types account for more than &amp;gt;90% of the HPV-positive non-cervical cancers. Primary prevention by the FDA-approved HPV vaccines has the potential to reduce the incidence and mortality attributable to the HPV-positive anogenital and oropharyngeal cancers, while secondary prevention through HPV-based screening for cervical cancer can lower the incidence and mortality for this cancer. The first generation virus-like particle HPV vaccines, which target HPV16 and HPV18, can prevent more than 90% of new persistent infections attributable to these HPV types. These vaccines are already having an impact on HPV-induced early disease markers in vaccinated populations, including evidence of herd immunity. The high immunogenicity of these vaccines suggests that it should be possible to safely reduce the number of recommended vaccine doses from three to two - and perhaps eventually even to one dose - in young adolescents, who represent the main target group for the vaccine. A second generation vaccine, which targets the seven most oncogenic HPV types and has the potential to prevent ∼90% of cervical cancer, was recently approved by the FDA. HPV-based testing was recently approved by the FDA for primary cervical cancer screening in women 25 or older. Compared to cytology-based screening, HPV-based testing has higher sensitivity for detecting infections that may lead to squamous cell carcinoma and adenocarcinoma. It is predicted that the greater sensitivity of HPV-based testing will be even more important for cervical cancer screening of vaccinated women. Citation Format: Douglas R. Lowy. Drastically reducing HPV-associated cancers through etiologically-based primary and secondary prevention. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr PL02-04. doi:10.1158/1538-7445.AM2015-PL02-04

Colonial legacy and the experience of First Nations women in cervical cancer screening: a Canadian multi-community study

Regular Papanicolaou (Pap) screening has dramatically reduced cervical cancer incidence in Canada since the 1950s. However, Indigenous women’s rates of cervical cancer remain disproportionately high, a factor which is not acknowledged in national media or in educational materials reporting Canada’s new cervical cancer screening guidelines. Here, we present findings from a cervical cancer screening initiative in Northwestern Ontario. Based on participatory action research, we worked with 10 First Nations communities in the Robinson Superior Treaty area to increase awareness of cervical cancer risk, develop culturally sensitive tools for screening and education and test the efficacy of human papillomavirus (HPV) self-sampling as an alternative to Pap cytology. We conducted 16 interviews with health care professionals and 9 focus groups with 69 women from the communities. A central theme for both health care providers (HCPs) and community members was the colonial legacy and its influence on women’s experiences of cervical cancer screening. This was evidenced by a strong sense of body shyness, including shame related to sexuality and sexually transmitted infections, concerns about confidentiality in clinical encounters and distrust or caution around HCPs. Reaffirming women’s traditional caregiving and educational roles, enhancing mother and daughter communication, improving cultural sensitivity in health care and education and adoption of HPV self-sampling to increase women’s privacy and control of the cervical cancer screening experience were endorsed. We argue that education and screening initiatives must reflect the cultural preferences of Indigenous women, empowering them to take control of their experiences of health and body in cervical cancer screening.

Awareness and participation of cervical cancer screening in Uighur female cleaning workers in Urumqi

Objective To understand the awareness and participation of cervical cancer screening, and the human pappillomavirus (HPV) infection rate and the cervical lesions prevalence status in Uighur female cleaning workers in Urumqi, in order to provide the reference basis for the prevention and treatment of cervical cancer. Methods A total of 144 Uighur female cleaning workers aged from 25 to 59 years was selected by multi-level cluster random sampling method from two cleaning company in Urumqi city. Cervical cancer screening questionnaire and HC-2 HPV-DNA test was executed. Electronic colposcopy and cervical biopsy was applied to the HPV positive one. Results There were 69.44% participants having no knowledge of cervical cancer screening, only 26.39% participants knowing a little; 88.19% participants never having a cervical smear, only 2.78% having a cervical smear in 3years; the reason of no cervical cancer screening among participants showed that 57.64% of them declared the screening fees too expensive or difficult economic, 23.61% of the women having fears of cervical cancer detection. A total of 144 cases of Uighur women in cervical cancer screening, 44 cases were HPV positive with positive rate 29.17% and in which 4 of them refused to colposcopy. A total of 140 cases of HPV positive women underwent vaginal endoscopy and cervical biopsy, and pathological biopsy results presented that CINI were 4 cases, CIN Ⅱ-Ⅲ 6 cases, SCC 1 case, and 129 cases with inflammation. Conclusions Generally low income crowd of Uighur women have low rate of knowledge about the prevention and treatment of cervical cancer, but HPV infection rate is high in the crowd. To provide some funding or take various forms of health education are benefit to the improvement of cervical cancer screening participation rate for this crow of Uighur. Key words: Cervical cancer; Screening; Low income crowd; Awareness; Infection rate of human pappillomavirus

Point-Counterpoint: Cervical Cancer Screening Should Be Done by Primary Human Papillomavirus Testing with Genotyping and Reflex Cytology for Women over the Age of 25 Years.

Screening for cervical cancer with cytology testing has been very effective in reducing cervical cancer in the United States. For decades, the approach was an annual Pap test. In 2000, the Hybrid Capture 2 human papillomavirus (HPV) test was approved by the U.S. Food and Drug Administration (FDA) for screening women who have atypical squamous cells of underdetermined significance (ASCUS) detected by Pap test to determine the need for colposcopy. In 2003, the FDA approved expanding the use of the test to include screening performed in conjunction with a Pap test for women over the age of 30 years, referred to as "cotesting." Cotesting allows women to extend the testing interval to 3 years if both tests have negative results. In April of 2014, the FDA approved the use of an HPV test (the cobas HPV test) for primary cervical cancer screening for women over the age of 25 years, without the need for a concomitant Pap test. The approval recommended either colposcopy or a Pap test for patients with specific high-risk HPV types detected by the HPV test. This was based on the results of the ATHENA trial, which included more than 40,000 women. Reaction to this decision has been mixed. Supporters point to the fact that the primary-screening algorithm found more disease (cervical intraepithelial neoplasia 3 or worse [CIN3+]) and also found it earlier than did cytology or cotesting. Moreover, the positive predictive value and positive-likelihood ratio of the primary-screening algorithm were higher than those of cytology. Opponents of the decision prefer cotesting, as this approach detects more disease than the HPV test alone. In addition, the performance of this new algorithm has not been assessed in routine clinical use. Professional organizations will need to develop guidelines that incorporate this testing algorithm. In this Point-Counterpoint, Dr. Stoler explains why he favors the primary-screening algorithm, while Drs. Austin and Zhao explain why they prefer the cotesting approach to screening for cervical cancer.

Cotesting Detects Cervical Cancers Missed by Human Papillomavirus–Only Testing in Clinical Practice [144

INTRODUCTION: Current American College of Obstetricians and Gynecologists and American Society for Colposcopy and Cervical Pathology guidelines support the use of Pap and human papillomavirus (HPV) cotesting for cervical cancer screening in women 30 years of age and older. The U.S. Food and Drug Administration approval of an HPV test for primary cervical cancer screening in women 25 years of age and older differs from these guidelines. This Quest Diagnostics Health Trends report describes how often primary HPV screening might miss an actionable lesion. METHODS: We reviewed deidentified cotesting and cervical biopsy results from January 2005 to September 2011 in women 21 years and older who had undergone cervical biopsy within 1 year of cotesting. Pap test results of atypical squamous cells of undetermined significance or more severe were considered abnormal. RESULTS: Of the 455,945 women, 6,515 had cervical intraepithelial neoplasia (CIN) type 3 or more severe lesions, including 587 cancers. As expected, cotesting was positive (ie, HPV-positive or abnormal Pap test results) in most women with CIN 3+ lesions (6,469 of 6,515 [99.3%]), including those with cancer (558 of 587 [95.1%]). However, HPV was negative in 295 of 6,515 (4.5%) women with CIN 3+ and 109 of 587 (18.6%) women with cancer. In HPV-negative women, Pap testing showed abnormal results in 249 of 295 (84%) with CIN 3+ lesions, including 80 of 109 (73%) with cancer. CONCLUSION: This retrospective, longitudinal analysis suggests that primary HPV testing alone would have missed detection of 4.5% of CIN 3+ lesions identified by cotesting (including 18.6% of cancers). Pap test results would have prompted further evaluation in a significant proportion of women with HPV-negative CIN 3+ pathology. These findings, supporting cotesting, may have implications for an individual woman's choice, guideline development, and legal risk.

Teaching tools to engage Anishinaabek First Nations women in cervical cancer screening: Report of an educational workshop.

To explore educational strategies for engaging First Nations women in Canada to attend cervical cancer screening. Within a participatory action research framework, semi-structured interviews with health-care providers in First Nations communities revealed that education about the value of screening is perceived as being a key factor to promote cervical cancer screening. To obtain feedback from workshop informants, a 1-day educational workshop was held to identify appropriate educational intervention strategies, which would be applied in a forthcoming randomised controlled cervical screening trial. Common discussion and discussion groups, which were facilitated by a First Nations workshop moderator and a note taker. This workshop helped to strengthen the ethical space dialogue with the First Nations communities with whom the study team had established research partnerships. The workshop atmosphere was relaxed and the invited informants decided that an educational health promotion event for community women needed to be held prior to inviting them to the cervical screening trial. Such an event would provide an opportunity to communicate the importance of attending regular cervical screening allowing women to make informed decisions about screening participation. Complementary promotional items, including an eye-catching pamphlet and storytelling, were also suggested. The key messages from the events and promotional items can help to destigmatise women who develop a type of cancer that is caused by a sexually transmitted virus that affects both men and women. Developing and implementing positive health education that respectfully depicts female bodies, sexuality and health behaviours through a First Nations lens is strongly warranted.

Cervical cancer screening in women referred to healthcare centres in Tabriz, Iran.

Background:Cervical cancer is the second most common cancer among Iranian women and among the few cancers that could be easily diagnosed in the pre-malignant stage. We aimed to assess the status of cervical cancer screening in women referred to health care centres in Tabriz, northwest Iran.Materials and Methods:This descriptive-analytical study was done on 441 women referred to health care centres of Tabriz, northwest Iran. The centres were selected using the multi-stage cluster sampling method. The participants were selected from the active records of those centres. A questionnaire regarding the socio-demographic characteristics and cervical cancer screening and reasons for referring or not referring for screening was completed by the participants A P < 0.05 was considered as significant.Results:Out of the participants 49.4% of women had done the Pap smear test while 50.6% had never done this test. The main reason why women had not performed cervical cancer screening was being unaware of the importance of it (46.1%). Logistic regression analysis with adjustment showed a significant relationship between screening and awareness scores (OR = 1.17, CI = 95%:1.12-1.23), when the effect of other confounding factors [total awareness scores, risk factors (marriage or having sexual intercourse at a young age, history of obvious cervical infection, cautery, cryotherapy or repeated curettage), age and type of family planning] in screening was controlled.Conclusion:Suitable and continuous educational programmes especially for high risk women should be implemented through the health care services. Preparing educational brochures and pamphlets and providing adequate training on the necessity of early referral and marriage counseling could also be effective in improving woman's awareness and performance.