Mothers’ screening histories influence daughters’ vaccination uptake: An analysis of linked cervical screening and human papillomavirus vaccination records in the North West of England

AimAchieving high human papillomavirus (HPV) vaccine coverage is important because cervical screening coverage is declining. As key decision makers, mothers’ experiences of, and participation in, the cervical screening programme could affect vaccination consent. We investigate whether mother’s screening history influences daughter’s participation in the HPV vaccination programme.MethodsMothers’ cervical screening records from the National Health Authority Information System were linked to the daughters’ HPV vaccination records from the Child Health System in North West England by address. Odds ratios for daughter’s vaccination were computed using Logistic Regression, adjusting for age, Primary Care Trust and vaccine cohort (AOR).ResultsDaughters in both the routine and catch up programmes were more likely to have initiated vaccination and completed the course if their mothers had attended screening. The association was strongest when mothers had attended within the last 5 years (AOR in routine group: 3.5 (95% confidence interval (CI) 3.1–4.0) for initiation and 2.2 (1.6–2.9) for retention). Mothers who had personally decided to cease screening were less likely to have vaccinated daughters than those who had ceased for medical indications. Daughters were more likely to have been vaccinated if their mothers had received an abnormal smear result.ConclusionsDaughter’s HPV vaccination uptake was associated with mother’s cervical screening attendance. Daughters of mothers who are not engaged with preventive services are less likely to be vaccinated and may be less likely to engage with screening. This makes mothers central to health interventions to promote both cervical screening and HPV vaccination.     

Promotion of cervical screening among nonattendees: a partial cost-effectiveness analysis.

Measures to increase attendance rate in cervical screening programmes have been suggested, but few have been evaluated in terms of value for money. The aim of this study was to describe the cost-effectiveness of a resource-intensive intervention to promote attendance at cervical screening among women with no registered cervical smear during the last 5 years. Among all 56 644 women (28-65 years) in Kalmar County, January 2004, a total of 6565 women had no registered cervical smear during the last 5 years. From this population, 400 women were randomly selected to a study group and another 400 women to a control group. The intervention was composed of a variety of efforts intended to promote attendance at cervical screening. We included, for example, all costs for identifying the women, sending out invitation letters, making phone calls and helping to make arrangements. Data on registered cervical smears at follow-up were collected from a data register within 1 year. In the study group, 118 women had a registered cervical smear compared with 74 in the control group (P=0.000). In the study group, the cost per cervical smear taken was 66.87 euro compared with 16.63 euro in the ordinary screening programme. The incremental cost per additional registered cervical smear was calculated at 151.36 euro in an area with high coverage, efforts to promote attendance at cervical screening were related to high costs per extra cervical smear gained and is not considered as reasonable from a cost-effectiveness perspective.     

The Acceptance of Human Papillomavirus Self-Sampling Test among Muslim Women:A Systematic Review

Introduction: Human Papillomavirus (HPV) self-sampling test has the potential to increase cervical cancer screening rate. Although every screening test has its own advantages and disadvantages, culture and religion can be significant predictors for the acceptability of screening tests among patients, including the HPV self-sampling test. This systematic review intends to identify and review published literature on the acceptance of HPV self-sampling test among Muslim women globally. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review protocol was utilised to guide this systematic review. We also used the Mixed Method Appraisal Tool (MMAT) for the evaluation of articles, and data from selected papers were retrieved and analysed using thematic analysis. Results: This systematic review includes seven publications that discussed on Muslim women’s perceptions of HPV self-sampling test. This comprises articles that revealed Muslim women’s acceptance of the HPV self-sampling test, including considerable positive factors that influenced their approval. On the other hand, the test’s disadvantages were mentioned, which served as barriers for these women’s participation. Convenience, cultural sensitivity, and availability were positive features, whereas religious taboo, low self-confidence, and perceived cost were some of the negative factors that were discussed. Conclusion: This review emphasises the positive and negative aspects that have an impact on the acceptance of HPV self-sampling test among Muslim women. Identifying the elements that influence HPV self-sampling test acceptance will help policymakers to better understand cervical cancer screening programmes and further guide future plans in reducing the incidence of cervical cancer.     

Promoting Attendance at Cervical Cancer Screening: Understanding the Relationship with Turkish Womens’ Health Beliefs

Background: The aim of the study was to identify the relationship between ‘Health Belief Model Scale forCervical Cancer and the Pap Smear Test’ subscale scores and demographic/gyneco-obstetric characteristics.Materials and Methods: This cross-sectional study was conducted with 256 women. Data were obtained usingthe ‘Demographic and Gyneco-Obstetric Identification Form’ and the ‘Health Belief Model Scale for CervicalCancer and the Pap Smear Test. Results: The percentage of women who had heard about the Pap test was 77.7whereas only 32.4% had actually undergone the test. Some 45.7% of the women stated that they did not knowthe reason for having a Pap test. Women who had obtained a Pap smear test had statistically significantly fewerperceived barriers than those who had never had (p<0.05). Scores with regard to the subscales including ‘Benefitsof Pap Smear Tests and Health Motivation’, ‘Perceived Seriousness of Cervical Cancer’, ‘Susceptibility to CervicalCancer’ and ‘Cervical Cancer Health Motivation’ did not differ with demographic/gyneco-obstetric characteristicssuch as womens’ educational level, whether or not young age at first marriage, whether or not having familyhistory of female cancer, and whether or not having had a Pap test (p>0.05). Conclusions: Increasing knowledgeabout benefits of Pap smear tests, increasing motivation to obtain Pap Smear Test and increasing perceivedseriousness of cervical cancer could promote attendance at cervical cancer screening. Different strategies areneeded for behavioural change. Implementation of educational programmes by nurses in a busy environmentcould result in a major clinical change, based on the findings of this study.     

Factors Affecting Cervical Cancer Screening Uptake by Hmong Hilltribe Women in Thailand

Background: Cervical cancer is relatively common in Thai women, but the proportion of females receivingPap smear screening is still low. Objective: The purpose of this cross-sectional study was to study factors relatedto cervical cancer screening uptake by Hmong hilltribe women in Lomkao District, Phetchabun Province.Materials and Methods: Interview data were collected from 547 of these women aged 30-60 years living in thestudy area and analyzed using multiple logistic regression. Results: The results showed that 64.9% of the studysample had received screening, and that 47.2% had attended due to a cervical screening campaign. The mostcommon reason given for not receiving screening was lack of time (21.4%). The factors found to be positivelyassociated with uptake (p value <0.05) were as follows: number of years of school attendance (OR=1.56,95%CI:1.02-2.38), animistic religious beliefs (OR=0.55, 95%CI:0.33-0.91), a previous pregnancy (OR=6.20,95%CI:1.36-28.35), receipt of information about cervical cancer screening (OR=2.25, 95%CI:1.35-3.76), andperceived risk of developing cervical cancer (OR=1.83, 95%CI:1.25-2.67). Conclusions: To promote the uptakeof cervical screening, Hmong hilltribe women need to know more about cervical cancer and cervical cancerscreening, and access to screening services should be provided in conjunction with existing everyday services,such as family planning and routine blood pressure monitoring or diabetes services.     

Age‐specific prevalence of HPV16/18 genotypes in cervical cancer: A systematic review and meta‐analysis

The prevalence of HPV16/18 in cervical cancer has been reported to decline with age in some papers. However, whether this decline in proportion of cancers positive for HPV16/18 is consistently observed across studies remains to be elucidated. Thus, the aim of this study was to identify papers reporting data on age‐specific prevalence of HPV16/18 in cervical cancer and to summarize the results. We employed MEDLINE and Embase for a systematic literature search and thereby identified a total of 644 papers published in the period 1999–2015, of which 15 papers, reporting cross‐sectional data, were included for review (11,526 cervical cancers). The prevalence of HPV16/18 in cervical cancer declined significantly with age (ρ = ?0.83, p = 0.04) from 74.8% (95% CI 67.6–80.8) in women aged 30–39 years to 56.8% (95% CI 43.9–68.8) in women aged ≥70 years. As the HPV16/18 positive cancers are prevented in fully vaccinated cohorts, the age‐specific epidemiology of cervical cancer is anticipated to change, with a shift in peak incidence rate to older ages. It will be important for integrated vaccination and screening strategies to consider predicted change in the age‐specific epidemiology of cervical cancer.     

The cost of screening for breast and cervical cancer in France

This article presents existing data on the cost of breast cancer and cervical screening programmes in France. The average direct cost of breast cancer screening was estimated at 57.77-60.51 Euro per woman attending for screening. Organisational costs account for 15-24% of total costs and the efficiency of existing screening programmes has improved over time. There is little available data on the cost of cervical cancer screening in France. The decentralised model of screening followed for both cervical and breast cancer programmes in France is more costly than the centralised model adopted by most other European countries. The best way to improve the economic value of screening programmes is to increase attendance rates. Attendance is currently inadequate for both screening programmes in France. For cervical screening, it is more cost-effective to increase screening attendance than to increase the frequency of screening. As long as screening attendance remains low, the impact of existing screening programmes will be suboptimal. Thus any new allocation of resources towards cervical and breast cancer screening in France should be assessed with caution.     

Community-Based Health Education has Positive Influence on the Attitude to Cervical Cancer Screening among Women in Rural Nepal

The main purpose of this study was to assess the knowledge of cervical cancer among women in rural Nepal and explore the feasibility and impact of a community-based awareness program on cervical cancer. Community-based educational meetings on cervical cancer and its prevention were conducted among women’s groups in rural Nepal. Through a questionnaire, the women’s baseline knowledge of risk factors, symptoms, and perceived risk of cervical cancer were identified. The willingness to participate in cervical cancer screening was compared before and after the educational meeting. The meetings were followed by a cervical cancer screening program. Among the 122 participants at the educational meeting, only 6 % had heard of cervical cancer. Their baseline knowledge of risk factors and symptoms was poor. The proportion of women willing to participate in cervical screening increased from 15.6 to 100 % after attending the educational meeting. All the study subjects participated in the screening program. Additionally, the study participants recruited a further 222 of their peers for screening. Poor knowledge of cervical cancer among women in rural Nepal highlights the urgency of public awareness programs for cervical cancer at a national level. A community-based awareness program can change women’s attitude to cervical screening, and women’s groups can play a major role in promoting participation in cervical cancer screening programs.     

Knowledge,Attitudes and Practices Regarding Cervical Cancer Screening Among Village Health Volunteers

Background: In the years 2014, coverage rates of cervical cancer screening in Nakornnayok province accountedto 76.5%. This was lower than the government’s specified goal of 80%. Community health volunteers are membersof a Thai healthcare alliance established to help promoting healthcare service communication and collaborationat the primary level. Such village health volunteers (VHVs) are established in most villages. Objective: To assessthe knowledge and attitudes of cervical cancer screening among VHVs. Materials and Methods: The subjectswere 128 VHVs from four Nakornnayok sub-districts; namely KlongYai, Chomphol, Buangsan and Suksara,Thailand. The study was conducted from December 2014 to January 2015. The questionnaire was designed toassess the knowledge and attitude of cervical cancer screening provided by the VHVs. In addition, cervical cancerscreening coverage rates of each area were collected. The demographic data, scores of knowledge, attitudes,practices and the cervical cancer screening coverage rates were analyzed by one-way ANOVA. Results: Thequestionnaire reliability was assessed as 0.81. The total knowledge and attitude scores were 10 and 15 points.The mean knowledge scores of KlongYai, Chomphol, Buangsan and Suksara were 6.8, 7.0, 6.5 and 9.0 points,respectively. The VHVs had a high level of overall knowledge about cervical cancer screening. The mean attitudescores were 12.4, 13.2, 13.4 and 13.1 points. VHVs had a positive attitude to the promotion of cervical cancerscreening at the overall level. The percentages of VHVs promoting cervical cancer information in respectivedistricts were 72.2, 94.3, 94.9 and 50.0. However, the cervical cancer screening coverage rates were 62.4%,34.7%, 80.3% and 47.3% respectively. Conclusions: The knowledge, attitudes and percentages of promotinginformation of cervical cancer screening among VHVs in the four sub-districts were high but did not correlatewith the cervical screening coverage rates for each area. VHVs needed to understand socio-cultural beliefs of thewomen in the target population and design suitable strategies to encourage higher cervical screening coverage.     

Screening for gynaecological cancers.

BACKGROUND: The role of screening in gynaecological cancers is under evaluation. With mass screening proven effective in significantly reducing cervical cancer mortality, there is an interest in developing other screening methods to detect gynaecological malignancies early. This review covers advances in cervical cancer screening, strategies being investigated in ovarian cancer screening and the lack of justification in screening for endometrial, vulval and vaginal cancers. METHODS: A Medline based literature search was performed for articles relating to screening for different gynaecological malignancies. Additional original papers cited in those identified by the initial search were also reviewed. RESULTS: Advances in cervical cancer screening include liquid-based cytology and HPV testing. Results of ongoing trials are awaited before these can be fully implemented. The results of the two large, multicentre, randomised controlled trials being conducted in the United Kingdom and United States (UKCTOCS and PLCO study, respectively) to assess impact of screening on ovarian cancer mortality will shed some light on the need to implement screening for ovarian cancer in the general population. Novel markers, serum proteomic profiles and Doppler are some of the other technologies being explored. Currently, screening for endometrial cancer is not advocated as most women present with symptoms in early disease with good survival outcomes. Vulval and vaginal cancers are too rare to justify mass screening. CONCLUSION: Methods to screen for various gynaecological malignancies need further evaluation before implementation in the general population. Results of large multicentred trials are awaited. Presently, screening for endometrial, vaginal and vulval cancers is not justified.     

National Data Analysis and Systematic Review for Human Resources for Cervical Cancer Screening in Japan

Background: Although cervical cancer screening has been performed as a national program since 1983 in Japan, the participation rate has remained below 20%. Equity of access is a basic requirement for cancer screening. However, taking smears from the cervix has been limited to gynecologists or obstetricians in Japan and it might be a barrier for accessibility. We examined the current access and its available human resources for cervical cancer screening in Japan. Methods: We analyzed the number of gynecologists and obstetricians among 47 prefectures based on a national survey. A systematic review was performed to clarify disparity and use of human resources in cervical cancer screening, diagnosis, and treatment for cervical cancers in Japan. Candidate literature was searched using Ovid-MEDLINE and Ichushi-Web until the end of January 2020. Then, a systematic review regarding accessibility to cervical cancer screening was performed. The results of the selected articles were summarized in the tables. Results: Although the total number of all physicians in Japan increased from 1996 to 2016, the proportion of gynecologists and obstetricians has remained at approximately 5% over the last 2 decades. 43.6% of municipalities have no gynecologists and obstetricians in 2016. Through a systematic review, 4 English articles and 1 Japanese article were selected. From these 5 articles, the association between human resources and participation rates in cervical cancer screening was examined in 2 articles. Conclusions: The human resources for taking smears for cervical cancer screening has remained insufficient with a huge disparity among municipalities in Japan. To improve accessibility for cervical cancer screening another option which may be considered could be involving general physicians as potential smear takers.     

Cervical Cancer Screening in Resource-Constrained Countries:Current Status and Future Directions

Cervical cancer continues to be a major public health problem affecting large numbers of women in many developing countries. Limitations of various screening modalities and the lack of ready availability of a cost-effective point-of-care screening tool have hindered the efficient implementation of population-based screening programs in these settings. It has not proved possible for many countries to adopt cytology as a screening modality due to inadequate infrastructure and trained manpower. However, recent developments, notably design and testing of a low-cost HPV test kit and initiatives by countries like India in developing and putting into operation a framework for large-scale screening of women, have raised hopes that cervical cancer control may be possible even in resource-constrained locations. With the advent of HPV vaccination, primary prevention of cervical cancer also seems a distinct possibility. However, wide availability and acceptability of vaccination is still an unresolved issue for developing countries. The possible future effects of vaccination on test characteristics of various screening strategies also need to be evaluated. This review gathers information on the current status of cervical cancer screening with a special focus on low resource settings. It revisits the strengths and limitations of the available screening modalities for cervical cancer viz. cytology, visual methods and HPV testing, in the context of their applicability in developing countries. In addition, the role of newer HPV-detection methods, for instance DNA, RNA and protein-based techniques, in triage of screen-positive women is discussed. The contemporary issue of impact of HPV vaccination on cervical cancer screening is also addressed briefly. The main highlight of the review is the reference to ‘operational framework guidelines’ for population-based cervical cancer screening, which have recently been formulated and are in the process of being implemented in India. The guidelines may serve as a model for other similar low-resource settings where implementation of cancer screening is desired.     

Cervical cancer screening in developing countries at a crossroad: Emerging technologies and policy choices

Cervical cancer (CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas, the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies, researchers have attempted to find new strategies that are adapted to low- and middle-income countries (LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus (HPV) testing is more effective than cytology for CC screening. Therefore, highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages, HPV-based screening has a low positive predictive value for CC, so that HPV-positive women need to be triaged with further testing to determine optimal management. Visual inspection tests, cytology and novel biomarkers are some options. In this review, we provide an overview of current and emerging screening approaches for CC. In particular, we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care (POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress, but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.     

Oncologists experience with second primary cancer screening: current practices and barriers and potential solutions

Objectives: Screening for second primary cancer (SPC) is one of the key components of cancer survivorship care. The aim of the present study was to explore oncologists’ experience with promoting second primary cancer screening. Methods: Two focus group interviews were conducted with 12 oncologists of diverse backgrounds. Recurrent issues were identified and placed into thematic categories. Results: Most of the oncologists did not consider SPC screening promotion as their responsibility and did not cover it in routine care. All of the study participants had experience with unexpected SPC cases, and they were under emotional tress. There was no systematic manner of providing SPC screening. Oncologists usually prescribe SPC screening in response to patients’ requests, and there was no active promotion of SPC screening. Short consultation time, limited knowledge about cancer screening, no established guideline for SPC screening, and disagreement with patients about oncologists’ roles were major barriers to its promotion. An institution-based shared care model was suggested as a potential solution for promoting SPC screening given current oncology practices in Korea. Conclusion: Oncologists could not effectively deal with the occurrence of SPC, and they were not actively promoting SPC screening. Lack of knowledge, limited health care resources, and no established guidelines were major barriers for promoting SPC screening to cancer survivors. More active involvement of oncologists and a systematic approach such as shared-care models would be necessary for promoting SPC screening considering increasing number of cancer survivors who are vulnerable.     

Cervical cancer screening: on the way to a shift from cytology to full molecular screening

Cytology-based nation-wide cervical screening has led to a substantial reduction of the incidence of cervical cancer in western countries. However, the sensitivity of cytology for the detection of high-grade precursor lesions or cervical cancer is limited; therefore, repeated testing is necessary to achieve program effectiveness. Additionally, adenocarcinomas and its precursors are often missed by cytology. Consequently, there is a need for a better screening test. The insight that infection with high-risk human papillomavirus (hrHPV) is the causal agent of cervical cancer and its precursors has led to the development of molecular tests for the detection of hrHPV. Strong evidence now supports the use of hrHPV testing in the prevention of cervical cancer. In this review, we will discuss the arguments in favor of, and concerns on aspects of implementation of hrHPV testing in primary cervical cancer screening, such as the age to start hrHPV-based screening, ways to increase screening attendance, requirements for candidate hrHPV tests to be used, and triage algorithms for screen-positive women.     

The current position and the future perspectives of cervical cancer screening

Cervical screening programs for detecting cancer and precancer have dramatically reduced the incidence and mortality rates of cervical cancer since the 1960s. The efficacy of the screening programs depends on participation and the accuracy of the screening tests. Unfortunately, the participation rates are suboptimal; more than half the women with cervical cancer have not or have only sporadically been screened. Increasing participation is the best way of maximizing the program’s benefit. Furthermore, cytology screening lacks high sensitivity for high-grade cervical intraepithelial neoplasia (≥CIN2). High-risk human papillomavirus (hrHPV) screening is more sensitive in the detection of cervical intraepithelial neoplasia than cytology screening, but less specific, so that additional triage testing is still mandatory. The aim of this article is to reflect on the efficacy of current cervical cancer screening and on promising future screening strategies with primary hrHPV testing and additional triage strategies for hrHPV-positive screening results.     

Cancer du col et VIH en afrique: une revue de la littérature

Objectives

Assess the prevalence rate of cervical cancer in HIV positive women. Describe the underlying factors of such an association. Provide recommendations for the screening and management of cervical cancer in HIV positive women.

Methods

This was a non-systematic review of all publications on cervical cancer and HIV in Sub-Saharan Africa over the last five years (2004–2008). We searched Pubmed, Hinari, Médecine d’Afrique Noire and African Journal On Line (AJOL) for the relevant papers either in English or in French.

Results

Twenty papers were found and only 15 matched the selection criteria. Prevalence rates of cervical cancer ranged from 1.87 to 14%. The mean HIV prevalence rate in cervical cancer patients was 25.73% and this was generally higher than in non-HIV positive women. High HPV infection rates (60 to 85.3%) were also reported along with a large variety of serotypes. Radiotherapy was considered a reasonable therapeutic option in advanced cervical cancers in HIV positive women with hysterectomy for cancers at an earlier stage.

Conclusion

Cervical cancer screening should be systematic in HIV positive women. The frequency of screening should be annual. There is a need for integrating cervical cancer and HIV control programs. The continuum of care requires HIV screening for PMTCT during antenatal care and cervical cancer screening during the post-partum period.