Beliefs about bowel cancer among the target group for the National Bowel Cancer Screening Program in Australia

Objective: To assess awareness of and intentions and self‐reported participation in the National Bowel Cancer Screening Program (NBCSP) in Australia and the program's impact on knowledge of and beliefs about bowel cancer. Method: Cross‐sectional, computer‐assisted telephone surveys of Western Australians aged 55–74 years conducted in April 2007 (n = 505) and June 2008 (n = 500) measured beliefs about the prevalence of bowel cancer, its preventability, impact of early detection on life expectancy, knowledge of the symptoms and tests for bowel cancer, and awareness of and participation in the NBCSP. Results: In 2008, awareness of the Program was 58%. Seventy‐seven per cent of those invited to participate in the program agreed to do so. The vast majority believed bowel cancer to be preventable (83%), with early treatment making ‘a great deal of difference’ to life expectancy (85%). Awareness of blood in faeces as a sign of bowel cancer increased from 64% in 2007 to 75% in 2008 (p<0.01). Awareness of FOBT as a test for bowel cancer increased from 54% in 2007 to 70% in 2008 (p<0.01). Conclusions: The NBCSP appears to have increased knowledge of bowel cancer. Implications: Education and screening campaigns are required to further increase perceived prevalence of bowel cancer and to increase knowledge of symptoms and risk factors.     

Equity of colorectal cancer screening: cross-sectional analysis of National Bowel Cancer Screening Program data for South Australia

Objective: The National Bowel Cancer Screening Program (NBCSP) is a population‐based screening program based on a mailed screening invitation and immunochemical faecal occult blood test. Initial published evidence from the NBCSP concurs with international evidence on similar colorectal cancer screening programs about the unequal participation by different population sub‐groups. The aim of the paper is to present an analysis of the equity of the NBCSP for South Australia, using the concept of horizontal equity, in order to identify geographical areas and population groups which may benefit from targeted approaches to increase participation rates in colorectal cancer screening. Method: De‐identified data from the NBCSP (February 2007 to July 2008) were provided by Medicare Australia. Univariate and multivariate statistical analyses were undertaken in order to identify the predictors of participation rates in the NBCSP. Results: The overall participation rate was 46.1%, although this was statistically significantly different (p<0.001) by gender (42.6% for males and 49.5% for females), socioeconomic status (40% in most deprived quintile through to 48.1% in most affluent quintile) and remoteness (45.6% for metropolitan, 46% for remote and 48.6% for rural areas). These findings were confirmed in multivariate analyses. Of the NBCSP participants, 0.24% (CI 95% 0.20–0.30) identified themselves as Indigenous and 8% (CI 95% 7.7–8.3) reported speaking a language other than English at home. Conclusion: Findings from this study suggest inequities in participation in the NBCSP on the basis of gender, geographical location, Indigenous status and language spoken at home.     

Predictors of Compliance with Recommended Cervical Cancer Screening Schedule: A Population-Based Study

Background: The prevalence of routine cervical cancer screening and compliance with screening schedules are low compared to the Year 2000 objectives. Identifying predictors of routine screening and screening schedule compliance will help achieve these objectives. Methods: We analyzed data from probability samples of 1,609 Missouri women responding to both the 1994 Behavioral Risk Factor Surveillance System (BRFSS) and the Missouri Enhanced Survey (ES). We generated prevalence odds ratios to identify predictors of non-compliance to cervical cancer screening guidelines. Also, among a sample of women reporting a reason for last Pap test, we estimated the relative odds of a screening v. diagnostic exam. Results: In the combined probability sample, compliance with screening schedule was likely among women younger than 50 years of age and women who had either a recent mammography or a clinical breast exam. Being African-American, not experiencing a cost barrier when seeking medical care, having at least a high-school education and health coverage were each associated with an increased compliance with a screening schedule in the combined probability sample. Among women in the combined probability sample, whites, those who experienced no cost barrier to seeking medical care, the non-obese, and those who had a recent mammography were each more likely to have had a screening as opposed to a diagnostic exam. Discussion: Cancer control and cardiovascular (CVD) prevention programs should consider jointly targeting those at high risk for cervical cancer and CVD because of aging and associated high-risk behavior such as non-compliance with cervical cancer screening, smoking, and obesity. Also, further research is needed to examine whether the increased compliance with cervical cancer screening guidelines among African American women may be in part due to higher occurrence of diagnostic Pap smears.     

A Community-based Cervical Cancer Screening Program among Women of Delhi using Camp Approach

Background:

Cervical cancer is the commonest malignancy among women in developing countries. Cytological screening (Pap smear) have been claimed to reduce incidence and mortality of carcinoma cervix significantly for which sensitization of women is required through community-based approach.

Objectives:

To find out number of cervical cancer cases among patients reporting to a general health care camp through screening program and study the prevalence of perceived morbidity and its confirmation.

Settings:

Cross-sectional study among women attending cancer awareness camps.

Materials and Methods:

A total of 435 women attending cancer awareness camps were screened for carcinoma cervix. The findings of history and clinical examination were recorded. Pap smears of all the symptomatic patients were collected and cytological diagnosis was confirmed by a pathologist.

Results and Conclusions:

The perceived gynecological morbidity was observed to be 59.8%. The smear of the women who were suspected of carcinoma on clinical examination was confirmed to be the cases of carcinoma-in-situ (7.8%) and high-grade neoplasia (2.9%) on laboratory investigations. The findings of the study highlight the utility and need of cancer cervix screening among the women at regular intervals through camp approach in the community.     

Individual and Community Effectiveness of a Cervical Cancer Screening Program for Semi-Urban Mexican Women

The effectiveness at the individual and community level of an educational intervention to increase cervical cancer screening self-efficacy among semi-urban Mexican women was evaluated and changes in reported community barriers were measured after the intervention was implemented. The educational intervention was evaluated with a quasi-experimental pre-test/post-test design and a control group, based on the Integrative Model of Behavior Prediction and AMIGAS project materials. For the intervention group, increased self-efficacy increased requests to obtain a Pap (p < 0.05). Barriers to obtaining a Pap were embarrassment and lack of time at the individual level, and lack of time, test conditions and fear of social rejection in the community’s cultural domain. At both the individual and community levels, having more information about the test and knowing it would be performed by a woman were primary facilitators. Few women used medically precise information when referring to the Pap and cervical uterine cancer. Although the level of self-efficacy of the participants increased, barriers in the health system affect the women’s perceived ability to get a Pap. Better care for users is needed to increase consistent use of the test. The study shows the importance of using culturally adapted, multilevel, comprehensive interventions to achieve successful results in target populations.     

Screening using National Cholesterol Education Program guidelines in a population of urban Hispanic mothers

We measured serum total cholesterol, high-density lipoprotein cholesterol, and triglycerides and calculated low-density lipoprotein cholesterol in 217 urban Hispanic mothers. On the basis of total cholesterol values, as recommended by the Expert Panel of the National Cholesterol Education Program, 6 subjects (2.8%) had high blood cholesterol (greater than or equal to 240 mg/dl), 27 (12.4%) had borderline-high blood cholesterol (200-239 mg/dl), and 184 (84.8%) had desirable blood cholesterol (less than 200 mg/dl). One of the 27 with borderline-high total cholesterol had two other coronary risk factors. Thus 7 of the 217 (3.2%, 95% confidence interval 1.4 to 6.8%) met Expert Panel criteria for lipoprotein measurement. Six of the seven had high-risk low-density lipoprotein cholesterol (greater than or equal to 160 mg/dl). Four additional subjects with borderline-high total cholesterol, not identified by this sequential screening strategy, also had high-risk low-density lipoprotein cholesterol. Thus a total of 10 of 217 (4.6%, 95% confidence interval 2.4 to 8.6%) met Expert Panel criteria for high-risk low-density lipoprotein cholesterol and initiation of cholesterol-lowering treatment. None of these 10 had been previously identified as having high-risk low-density lipoprotein cholesterol. Two years later subjects with high or borderline-high total cholesterol were rescreened. Seven of 22 subjects completing the second screening were classified differently with regard to having high-risk low-density lipoprotein cholesterol, illustrating the potential for misclassification of individuals on the basis of a single measurement. The prevalence of women with high-risk low-density lipoprotein cholesterol was not significantly different at the two screenings.(ABSTRACT TRUNCATED AT 250 WORDS)     

Measuring human papillomavirus (HPV) vaccination coverage and the role of the National HPV Vaccination Program Register, Australia

Accurate estimates of HPV vaccination coverage are critical for determining the proportion of the target female population that is not protected by the vaccine, as well as for monitoring the performance of vaccine delivery programs. The implementation of an HPV vaccination register, either as part of an existing immunisation register or stand-alone, can add substantial benefits to an HPV vaccination program. In Australia, the National HPV Vaccination Program Register supports the HPV vaccination program by providing information to consumers and providers about incomplete courses as well as estimates of vaccination coverage by age and area. Future monitoring of vaccine effectiveness will be facilitated by cross-linking to Pap test registries.     

Cervical screening in migrants to Australia

OBJECTIVE: To examine differentials and time trends in self-reported Pap test rates by migrant status from the 1989/90 and 1995 Australian National Health Surveys (NHS). METHOD: Unit record data for females with the variables of interest were extracted from the 1989/90 and 1995 NHS and combined. The dichotomous outcome variables were 'ever had a Pap test' and 'had a Pap test within three years'. The principal study factor was country-of-birth, but language spoken at home (English or not) was also examined. The indirect age-standardised screening ratio was used to calculate proportions of 'ever had a Pap test' and 'had a Pap test within three years' and differences were tested statistically using logistic regression analysis for each year of survey by migrant status. RESULTS: Odds ratios for rates of reporting 'ever had a Pap test' were significantly lower in women born in southern Europe, Italy, other countries, southern Asia, Middle East, Greece and South-East Asia compared with Australian-born. Reported rates of 'ever had a Pap test' were significantly higher in the 1995 NHS (p<0.001). There were significant increases in screening for the Australian-born, New Zealand-born, and women born in southern Europe, South-East Asia, South Asia and Italy, and both English and non-English speakers over the 1989/90 and 1995 NHSs. Odds ratios for reporting 'had a Pap test within three years' showed significantly lower ORs for women born in the UK, Other countries, Middle East, Greece, and South-East Asia compared with the Australian-born. CONCLUSIONS: This study reveals differentials in reported Pap test behaviour by country-of-birth in Australia and that reported screening rates have improved from the 1989/90 NHS to 1995 NHS in most country-of-birth groups.     

Evaluation of a Free-Coupon Program for Cervical Cancer Screening Among the Young: A Nationally Funded Program Conducted by a Local Government in Japan

Background

Finding ways to improve the cervical cancer screening rates among young women has been seen as a critical national health problem in many countries, including Japan. The aim of the present study was to evaluate the effects of a free-coupon program for cervical cancer screening conducted by a local government under financial support from the Japanese national government.

Methods

The personal cervical cancer screening information was analyzed for all female residents of Toyonaka City, including any past screening history and clinical results since the year 2009, when a free-coupon program for screening was started. These results were compared to results from 2008, prior to implementation of the free-coupon screening program.

Results

The screening rates of women eligible for the free-coupon peaked dramatically compared to women of similar age who paid for their screening; however, the rates for the ineligible-age population also increased significantly in parallel to those in the free-coupon program, possibly by indirect peer and publicity effects. In women aged 20 to 25 years, the consecutive screening rate after a free-coupon screening was significantly lower than for those women who received a regular residential screening. After a free-coupon screening, the rate for participating in consecutive screenings depended significantly on the institution where the participant received her first screening test.

Conclusions

These results suggest that, for a generation of young women 20–25 years of age, a free-coupon program for cervical cancer screening was effective in increasing the first-time participation rate for screening; however, the increase in first-time participation did not lead to the expected increase in consecutive screenings.Key words: cervical cancer screening, free-coupon, screening rate, consecutive screening