The attendance of the first screening round (2002-2003) of the Hungarian organized breast cancer screening program and its effect on the number of diagnostic and screening mammography

AIM: Organised, nationwide screening for breast cancer with mammography in the age group 45-65 years with 2 years screening interval started in Hungary in January 2002. The aim of this study is to analyze the attendance rate of breast screening programme, including the analysis of the ratio of screening and diagnostic mammography examinations. DATA AND METHODS: The data derive from the financial database of the National Health Insurance Fund Administration (NHIFA) covering the period 2000-2003. The ratio of women was calculated in the age group 45-65 years having either a screening mammography or a diagnostic mammography. The analysis was carried out for the years 2000-2001 (mainly opportunistic screening) before and 2002-2003 after the implementation of nationwide organized programme. RESULTS: In the years 2000-2001 7,26% of the women aged 45-65 had an opportunistic screening mammography while in 2002-2003 33,95% of the target population had screening mammography within the organized programme. During the same periods 19,67% (2000-2001) and 22,05% (2002-2003) of women aged 45-65 had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 25,85% (2000-2001) to 53,46% (2002-2003). CONCLUSIONS: The attendance of the Hungarian organized breast cancer screening programme - compared to the previous period before the implementation of the organized screening programme - is promising, although to achieve the expected results in mortality decrease a further improvement of the uptake is necessary.     

Attendance in the second phase (2004-2005) of the Hungarian organized breast cancer screening program

AIM: Organised, nationwide screening for breast cancer with mammography in the age group of 45-65 years with a 2-year screening interval started in Hungary in January 2002. The aim of this study is to analyze the attendance rate of breast screening programme, including the analysis of the ratio of screening and diagnostic mammography examinations. DATA AND METHODS: The data derive from the financial database of the National Health Insurance Fund Administration (NHIFA) covering the 6-year period between 2000-2006. The ratio of women in the age group of 45-65 years was calculated having either a screening mammography or a diagnostic mammography. The analysis was carried out for the years 2000-2001 before and 2002-2003, 2004-2005 after the implementation of nationwide organised programme. RESULTS: In the years 2000-2001 7.26% of the women aged 45-65 had an opportunistic screening mammography, while in 2002-2003 34% and in 2004-2005 29.5% of the target population had screening mammography within the organised programme. During the same periods 19.8% (2000-2001), 22.1% (2002-2003) and 23.2% (2004-2005) of women aged 45-65 had a diagnostic mammography. Thus the total (screening and diagnostic) coverage of mammography increased from 26.2% (2000-2001) to 53.5% (2002-2003) and 50.8% (2004-2005). CONCLUSIONS: The attendance of the Hungarian organised breast cancer screening programme slightly declined in 2004-2005, and to achieve the expected results in mortality decrease a further improvement of the uptake is necessary.     

Effect of an antepartum Pap smear on the coverage of a cervical cancer screening programme: a population-based prospective study

Background  

Almost one-third of Norwegian women aged 25–69 years invited to have a Pap smear do not attend during the recommended period, and thus constitute a population with high-risk of cervical cancer (CC). Since the incidence of precancerous lesions of the cervix peak with occurrence of pregnancies within the same decade in women aged 25 to 35 years of age, antepartum care presents an opportunity to offer a Pap smear thereby increasing the coverage of the programme. The study objective was to describe the effect of the antepartum Pap smear on the coverage of a cytological CC screening programme.     

上海地区女性宫颈脱落细胞筛查工作的实施及其影响因素

[目的]了解上海地区女性宫颈癌宫颈脱落细胞检查的覆盖情况,并分析其影响因素。[方法]采用随机入户调查的方法收集女性居民宫颈癌宫颈脱落细胞检查覆盖情况及其影响因素,采用单因素和多因素分析其影响的因素。[结果]上海地区女性人群一生中曾做过宫颈脱落细胞检查的占37．61％（中心城区女性为32．04％,非中心城区为42.01％）。其中,86．14％的人最近一次宫颈脱落细胞检查年限〈3年;在最近3年中做过检查的人群中,73．50％是由于参加单位组织女工体检获得受检机会。〈35岁年轻女性的检查覆盖率为21．97％;55,64岁组妇女最近一次检查距本调查（2007年）的平均时间为4．00年,明显长于〈35岁组及35～54岁组。居住在非中心城区、在婚、年龄在35～54岁、农民、由单位组织女S-体检者、对宫颈癌的癌前症状和女性需要定期检查的知识知晓者检查覆盖率高。3年内做过筛检的主要影响因素仅为年龄和女工体检的组织者。[结论]上海市女性宫颈涂片检查的覆盖率相对发于达国家较低;单位组织女工体检是女性接受宫颈涂片检查的主要途径;35岁以下女性宫颈涂片检查的覆盖率低;55—64岁者宫颈涂片筛查间隔时间长。     

Perceptions of cervical cancer threat, benefits, and barriers of Papanicolaou smear screening programs for women in Iran

OBJECTIVES: The main purpose was to assess associations between HBM variables and participation in cervical cancer screening programs in a sample of Iranian women. METHODS: A total of 333 married women of childbearing age were recruited with cluster sampling. The study was conducted from spring 2002 to spring 2003 and a self-report questionnaire and structured interview were designed to measure the four HBM constructs and Iranian women's knowledge about Pap smear screening. RESULTS: A total of 68.5% reported having undergone at least one Pap test. Women were more likely to participate in Pap smears when they had access to knowledge about cervical cancer and screening programs. Furthermore, the perceived benefit and barrier variables of the Health belief model were two factors related to participation in Pap smear testing. CONCLUSIONS: Health care professionals must provide women with more information about cervical cancer and the benefits of participating in cervical cancer screening programs.     

Cobertura del cribado de cáncer de cuello uterino en Cataluña (2008-2011)

Objective

To estimate cervical cytology coverage for the period 2008-2011 by age groups and health regions from data recorded in the medical records of women attending centers within the Catalan national health system.

Methods

The data used to estimate coverage were obtained from the primary care information system. This information was anonymous and included age, center, date, and the results of cytological smears for a total of 2,292,564 women aged 15 years or more.

Results

A total of 758,690 smears were performed in 595,868 women. Among women aged 25-65 years, the estimated coverage was 32.4% of the assigned population and was 40.8% in the population attended. Geographical variation was observed, with higher coverage among health regions closer to Barcelona. Abnormal Pap smears increased slightly from 2008 to 2011 (from 3% to 3.5%, respectively, p <0.001). In women with a negative first smear, the mean interval until the second smear was 2.4 years, but only 50% of women with a negative first smear in 2008 attended a second round during the study period.

Conclusions

Cervical screening coverage in the National Health Service of Catalonia includes one in three women. Second round participation was poor. Existing computer systems in primary care centers can ensure monitoring of population-based screening programs for cervical cancer. These systems could be used to plan an organized screening program to ensure wider coverage and better follow-up.     

Review of screening and preventive strategies for cervical cancer in India

Cervical cancer is the commonest cancer among Indian women. The predominant risk factor is persistent infection with human papilloma virus (HPV) which is now well established. Despite being the commonest cancer, and the fact that it is a type of cancer, which can be detected early by sensitive screening methods there is no effective screening programme or preventive strategy for reducing its burden. This article reviewed the published studies that has been carried out in India during 1965-2005 on cervical cancer with emphasis on screening by Pap smear and other alternative methods. Conventionally, Pap smear cytology is the only method for screening; but recently various studies have been carried out to explore alternative methods like visual inspection methods. Due to the operational difficulties by Pap smear, these alternative screening methods could be more feasible for organized population based screening in a low resource country. There is therefore a need for initiating screening programmes within the existing health system in India.     

Inadequacy of cervical cancer screening among urban recent immigrants: a population-based study of physician and laboratory claims in Toronto, Canada

OBJECTIVE: In Canada, Pap smears are recommended from 18 to 69. Self-reported socioeconomic gradients in screening have been documented in North America but there have been few direct measures of Pap smear use among immigrants or socially disadvantaged groups. Our purpose was to investigate whether socioedemographic factors are related to cervical cancer screening in Toronto, Canada. METHOD: Pap smears were identified using fee and laboratory codes in Ontario physician service claims for 3 years (2000-2002 inclusive) for women aged 18-66. Area-level socioeconomic factors were derived from the 2001 census. At the individual level, recent registrants for health coverage, over 80% of whom are expected to be recent immigrants, were identified as women first registering after January 1, 1993. RESULTS: Among 724,584 women, 55.4% had Pap smears within 3 years. Recent immigration, visible minority, foreign language, low income and low education were all associated with significantly lower area rates. Recent registrants had much lower rates than non-recent registrants (36.9% versus 60.9%). CONCLUSION: Pap smear rates in Toronto fall below those dictated by evidence-based practice. Recent registrants, a largely immigrant group, have particularly low rates. Efforts to improve coverage need to emphasize women who recently immigrated and those with socioeconomic disadvantage.     

Hispanic acculturation and utilization of cervical cancer screening in the US

BACKGROUND: Hispanic women have an incidence rate of invasive cervical cancer that is twice as high as that of non-Hispanic White women. Previous investigations have reported that Hispanics are less likely to utilize cancer screening services. Using data from the 2000 National Health Interview Survey, this study examined whether acculturation of Hispanic women was associated with cervical cancer screening. METHODS: The subjects included 2307 Hispanic women aged 21-70 who did not have a history of cervical cancer or a hysterectomy. Women were analyzed by acculturation level according to whether or not they ever had a Pap smear and had one in the previous year and previous 3 years. RESULTS: Acculturation levels tended to be inversely correlated with no Pap smear. Compared to lower acculturated women, women who were more acculturated were less likely to never had a Pap smear (OR = 0.86; 95% CI = 0.58-1.27 for moderate acculturated women and OR = 0.51; 95% CI = 0.29-0.89 for higher acculturated women). Similar results were found for having no Pap smear within the past 3 years (OR = 0.83; 95% CI = 0.61-1.13 for moderate acculturated women and OR = 0.73; 95% CI = 0.49-1.08 for higher acculturated women). CONCLUSION: The findings show that lower acculturation was associated with the under use of cervical cancer screening and suggest that these women might have barriers in accessing and utilizing Pap smears.     

Perceptions of Cervical Cancer Threat,Benefits, and Barriers of Papanicolaou Smear Screening Programs for Women in Iran

ABSTRACT

Objectives: The main purpose was to assess associations between HBM variables and participation in cervical cancer screening programs in a sample of Iranian women.

Methods: A total of 333 married women of childbearing age were recruited with cluster sampling. The study was conducted from spring 2002 to spring 2003 and a self-report questionnaire and structured interview were designed to measure the four HBM constructs and Iranian women's knowledge about Pap smear screening.

Results: A total of 68.5% reported having undergone at least one Pap test. Women were more likely to participate in Pap smears when they had access to knowledge about cervical cancer and screening programs. Furthermore, the perceived benefit and barrier variables of the Health belief model were two factors related to participation in Pap smear testing.

Conclusions: Health care professionals must provide women with more information about cervical cancer and the benefits of participating in cervical cancer screening programs.     

Limited Pap screening associated with reduced risk of cervical cancer in South Africa

BACKGROUND: We investigated the effect of Pap smear screening on the incidence of invasive cancer of the cervix in the Western Cape, South Africa where screening is limited. METHODS: Data were derived from a case-control study of the association of hormonal contraceptives and invasive cervical cancer. Incident cases (n = 524) of invasive cervical cancer who presented at two tertiary hospitals and controls (n = 1540) series matched for age, race, and place of residence were interviewed. Information on a wide range of variables was collected including whether the women had previously had a Pap smear taken and the number and timing of smears. Odds ratios (OR) and 95% CI were calculated using multiple logistic regression. RESULTS: The OR of cervical cancer was reduced among women who had ever had a smear (OR = 0.3, 95% CI: 0.3-0.4). The OR declined with increasing number of smears to 0.2 for >/=>3 smears (trend P = 0.0003). Among women who had a smear <5 years previously the OR was 0.3, but even if the smear was taken >/=15 years previously the women remained at reduced risk (OR = 0.5). CONCLUSION: The data suggest that even limited Pap smear screening reduces the risk of cervical cancer. Should a screening programme be successfully implemented, the incidence of cervical cancer might be reduced by as much as 70%.     

常州市2000名农村已婚妇女宫颈癌筛查结果分析

目的 了解我市农村地区已婚妇女宫颈癌发病情况,争取做到早发现、早治疗和降低死亡率,探讨更适合农村已婚妇女的宫颈癌筛查方式.方法 对我市2 000名农村已婚妇女采用改良巴氏涂片法行宫颈采样,对经妇科检查和脱落细胞学检查有异常的已婚妇女再行阴道镜检查和组织病理学检查.结果 参加宫颈癌筛查的2 000人中,问卷调查确定阳性者175例（8.75％）,巴氏细胞涂片检测确定阳性者170例（8.50％）,二者结合确定阳性者316例（15.80％）.109例接受伯塞斯达系统（TBS）阴道镜检查,检出宫颈病变29例（检出率为26.61％）.结论 对已婚妇女进行宫颈癌筛查最简单的检测方法为细胞学检查,如果同时配合阴道镜检查,采用TBS分类法报告比较检查结果,不仅可以提高检测准确率,而且便于宫颈癌的早期发现、早期治疗.     

Participation and Risk of High Grade Cytological Lesions Among Immigrants and Italian-Born Women in an Organized Cervical Cancer Screening Program in Central Italy

Few studies analyzed the risk for high-grade squamous intraepithelial lesions or worse (HSIL+) among immigrants and natives attending organized cervical cancer (CC) screening programs (SP). We evaluated participation and diagnosis of HSIL+ by country of birth with logistic models. Overall 540,779 invitation letters were delivered to target women of Florence SP in three screening rounds (years 2000–2002, 2003–2005, 2006–2008). The probability of attending screening was lower for immigrants than natives, but the difference decreased from 35 % (1st round) to 20 % (2nd–3rd round) for women born in high migration pressure (HMP) countries. The risk of HSIL+ was double than natives for HMP-born women from countries with high prevalence of human papillomavirus, even adjusting for age and previous history of Pap test. This is an important public health problem due to an increasing proportion over time of immigrant women with a lower attendance and greater risk for CC.     

1602例农村妇女宫颈细胞学涂片配合阴道镜筛查宫颈疾病效果分析

目的:探讨宫颈细胞学巴氏涂片配合阴道镜检查对农村妇女宫颈疾病筛查的诊断价值。方法:对妇科门诊检查的1602例农村妇女行宫颈细胞学涂片及阴道镜检查,检出异常涂片176例,其中100例配合阴道镜检查,76例行肉眼碘试验活检(对照组),以组织学诊断为"金标准",并对结果进行分析。结果:1602例涂片中检出异常涂片176例(10.99%),对其中100例行阴道镜下活检,病理结果显示:宫颈上皮内病变(CIN)16例(16.00%);宫颈癌2例(2.00%);巴氏Ⅲ级以上可疑病变30例,活检证实CIN21例,与细胞学诊断符合率为70.00%,细胞学阴性临床可疑宫颈病变10例,活检证实CIN3例(3.00%);76例肉眼碘试验下活检诊断CIN10例(13.16%),宫颈癌1例,巴氏Ⅲ级以上29例,活检证实CIN7例,与细胞学诊断符合率为24.14%;细胞学阴性7例,CIN检出1例(14.29%),两者比较差异有统计学意义(P<0.05)。结论:宫颈细胞学涂片配合阴道镜检查能及早发现宫颈癌前病变,是方便、安全、经济、可靠的检查方法,尤其适用于农村妇女的宫颈疾病筛查。     

Pap Smear Screening among Urban Southwestern American Indian Women

Background. American Indian women have among the highest incidence and mortality rates of cervix cancer in the United States. The incidence of cancer of the cervix among American Indians is 19.5/100,000 versus 7.8/100,000 in U.S. whites, and comparison by geographic region/tribe indicates that the rate is four to six times higher in some tribes. Papanicolaou cytological testing (Pap smear) permits the detection of cervical lesions before they become cancerous, effectively reducing the incidence of cervical cancer by 75–90%. The American Cancer Society recommends a Pap smear every year beginning at age 18 years or when sexually active, and more frequent screening in high-risk populations.Methods. A random household cross-sectional survey was conducted in Phoenix, Arizona, to assess cervical cancer screening rates among 519 adult urban American Indian women. Logistic regression was used to identify predictors of Pap smear use.Results. Three-quarters (76.1%) of urban women American Indian surveyed received a Pap smear within the past 3 years, but only 49.5% received a Pap smear within the last year. Women over age 50 years were significantly less likely to have received a recent Pap smear in comparison to younger women.Conclusions. The results of this study indicate that limited access to health care and lack of knowledge about the procedure were important barriers to Pap smear use. Improving cervix cancer screening participation rates is an important step in reducing the disease burden in this high-risk population.     

Low knowledge of cervical cancer and cervical pap smears among women in Peru, and their ideas of how this could be improved

Estimates of the percentage of women who have had Pap smears in Peru vary between 7% and 43%. This study explores what women know about cervical cancer and Pap smears, as well as their barriers to obtaining Pap smears. Focus group discussions (FGD) were conducted with a total of 177 women in four Peruvian cities. Discussions reveal that most women did not know what causes cervical cancer. Most women did not know the purpose of Pap smears, although knowledge about Pap smears was higher than knowledge about cervical cancer. Fear, embarrassment, and lack of knowledge were the main barriers identified for not getting Pap smears. Programs and policies aiming to increase Pap smear coverage must start by educating women on cervical cancer and its prevention in order to improve women's perceptions about the screening test and increase Pap smear seeking behaviors in the long term.     

Pap smear use in California: are we closing the racial/ethnic gap?

BACKGROUND: Minority women continue to be disproportionately affected by cervical cancer. Minority population groups at high risk for cervical cancer may be failing to fully comply with screening recommendations. The use of Pap smears among women in California was evaluated to identify ethnic groups at higher risk for noncompliance with cervical cancer screening. METHODS: Cross-sectional analysis of 2001 California Health Interview Survey data. Logistic regression was used to assess the independent contribution of race/ethnicity to the use of Pap smears. RESULTS: Hispanic (aPR = 1.03, 95% CI 1.02-1.05) and Black (aPR = 1.03, 95% CI 1.001-1.06) women are more likely to report a Pap smear in the past 3 years as compared to White women. Asians were the least likely to report cervical cancer screening despite a more favorable sociodemographic profile. Screening rates varied among Hispanic or Asian subgroups; Mexicans, Vietnamese, Chinese, and South Asians are particularly underserved. CONCLUSIONS: In contrast to the country as a whole, Hispanic women in California are more likely to report a recent Pap smear as compared to White women. However, racial/ethnic disparities in Pap smear use persist; Asian women are the least likely to report cervical cancer screening as compared to any other group.     

Gebärmutterhalskrebsscreening in Deutschland

Cytological examination for the early detection of cervical cancer (CCS) has been available in Germany since 1971. Women over the age of 20 are entitled to a Pap smear every year; however, thus far an organized screening program and personal invitations have been missing.The incidence rate of cervical carcinoma declined dramatically in the decades following the introduction of CCS, but the incidence rate has stagnated in recent years. The cause of cervical cancer is a persistent infection with high-risk types of human papillomavirus (HPV). HPV tests have been approved by the American Food and Drug Administration (FDA) for CCS for several years. Furthermore, since 2006, the HPV vaccination has been offered as a form of primary prevention.As part of the German National Cancer Plan, the European Guideline for Cervical Cancer Screening was implemented and adopted into the 2013 Law on Cancer Screening and Registration. The Federal Joint Committee (G-BA) was commissioned with the implementation of an organized cervical cancer screening program.In April 2018, the G?BA published updated key points for the implementation of an organized nationwide screening program in Germany. While annual cytological screening for women between the ages of 20 and 34 will continue, women over the age of 34 years will be given a co-test comprising a Pap smear and an HPV test, every three years. Women between the ages of 20 and 60 will be contacted by their health insurance provider every five years and receive an information leaflet. After a test phase of at least six years, the new program will be evaluated.