Factors Associated with Underscreening for Cervical Cancer among Women in Canada

Background: Cervical cancer is the second most common cancer among women worldwide. Failure toprevent cervical cancer is partly due to non-participation in regular screening. It is important to plan anddevelop screening programs directed towards underscreened women. In order to identify the factors associatedwith underscreening for cervical cancer among women, this study examined Pap test participation and factorsassociated with not having a time-appropriate (within 3 years) Pap test among a representative sample ofwomen in Ontario, Canada using Canadian Community Health Survey (CCHS) data. Materials and Methods:Univariate analyses, cross-tabulations, and logistic regression modeling were conducted using cross-sectionaldata from the 2007-2008 CCHS. Analyses were restricted to 13,549 sexually active women aged 18-69 years oldliving in Ontario, with no history of hysterectomy. Results: Almost 17% of women reported they had not hada time-appropriate Pap test. Not having a time-appropriate Pap test was associated with being 40-69 years old,single, having low education and income, not having a regular doctor, being of Asian (Chinese, South Asian,other Asian) cultural background, less than excellent health, and being a recent immigrant. Conclusions: Resultsindicate that disparities still exist in terms of who is participating in cervical cancer screening. It is crucial todevelop and implement cervical cancer screening programs that not only target the general population, but alsothose who are less likely to obtain a Pap tests.     

Factors Associated with Cervical Cancer Screening Amongst Women of Reproductive Age from Yucatan,Mexico

This study aimed to analyse the participation of women of reproductive age in a cancer screening program,and survey reasons for non-screening in a region from Mexico with high cervical cancer mortality. A total of281 obstetric patients from a previous HPV study in a social security hospital during 2008-2009 were included.Reasons for not participating in the screening were directly asked. HPV positive patients were invited toparticipate in an informative workshop, and they filled in a knowledge questionnaire. The women ranged in agefrom 14-47 years; 123 (43.8%) had never participated in screening, of which 97 (78.9%) had their first sexualintercourse 2 to 10 years ago, resulting in 25% HPV positive. Screening history was strongly associated with 2or more gestations (OR= 10.07, p=0.00) and older age (OR=6.69 p=0.00). When 197 women were contacted andinterviewed, reasons referred for non-screening were ignorance, lack of interest or time, recent sexual onset,shame and fear. More than 50% of the workshop participants showed knowledge of HPV, while 38.9% and 25%knew about Pap smear and cervical cancer. A high percentage of women of reproductive age have never had aPap smear. Promoting the screening program in medical facilities seems to be important in this population. Newapproaches to inform vulnerable individuals on the benefits of screening need to be implemented, especially foryoung women.     

Prevalence and Genotype Distribution of HPV among Women Attending a Cervical Cancer Screening Mobile Unit in Lampang,Thailand

A growing body of literature is evidence that identifying subtypes of high-risk human papillomavirus (HR-HPV) has impacted on various steps of cervical cancer prevention.Thus, it is mandatory to determine the background prevalence and distribution of HPV subtypes for designing and implementing area-specificmanagement. The present study was conducted to evaluate prevalence and distribution of HPV subtypes among women aged 30-70 years living in Lampang, an area with a high incidence of cervical cancer, through use of a mobile screening unit. Of 2,000 women recruited in this study, 108 (5.40%, 95%CI: 4.45-6.48) were found to have HR-HPV infection. Risk was significantly correlated with age and number of partners. Singly or in combination, the most common genotype was HPV 52 (17.6%), followed by HPV 16 (14.81%), HPV 58 (13.89%), HPV 33 (11.11%), HPV 51 (11.11%), and HPV 56 (9.26%). HPV 18 was found in only 5.6% of cases. Together, HPV 16/18 were noted in approximately 20.4% of cases. Eighteen(16.67%) women were positive with multiple subtypes of HR-HPV. Co-infection most frequently involved HPV 16 or HPV 58. These findings have obvious implications for vaccine policy.     

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.     

Awareness of Cervical Cancer Risk Factors and Screening Behaviour among Nurses in a Rural Region of Turkey

The demographic characteristics of nurses and knowledge on risk factors of cervical cancer, as well asawareness of symptoms and attitudes in terms of screening programmers such as Pap smear, were assessed in across-sectional survey of nurses working in public Health Cabins and Family Health Centers in the rural area ofIzmir, located in the western region of Turkey. Of the nurses who participated in the research, 69.1% (67) saidthat they had talked about cancer and cancer prevention with their families or friends; 60.8% (59) believed thattheir occupation was important for cancer prevention; 11.3% of the nurses had a history of cancer in theirfamilies; and 63.9% (62) thought that their knowledge about cervical cancer was adequate. There were nosignificant differences between knowledge or attitudes about cervical cancer risk factors or symptoms andscreening methods regarding age, marital status, years of experience (p>0.05). However, there was a statisticallysignificant relationship between having received a pap test and having a history of cancer in their family (p<0.05).In conclusion, this study has shown that most nurses knew about the Pap smear test as a cervical cancer screeningmethods. However, there were no significant differences between knowledge or attitudes about cervical cancerrisk factors or symptoms and screening methods regarding age, marital status, years of experience.     

Opportunistic Screening for Cervical Cancer in a Tertiary Hospital in Karnataka,India

The incidence and mortality of cervical cancer remains high in India even after sixty years of introductionof the Pap smear (cervical cytology) which is an effective means of identifying preinvasive lesions of carcinomacervix. The morbidity and mortality due to cervical cancer has come down drastically in countries with wellestablished screening programmes at national level. This study aims at screening women for cervical canceropportunistically during their visit to hospital and to study various types of neoplastic and non-neoplastic lesionsof the cervix by cervical smear study (Pap smear study). In the present study, a total of 350 cervical smearswere studied. The age of patients ranged from 19 years to 80 years with mean age being 37.5 years. Out of 350cases, the diagnosis of neoplasia was given in 43 cases and 258 cases were diagnosed as inflammatory smears.Forty-cases were normal and 9 cases were inadequate to evaluate. Forty-three patients who were found to haveneoplastic lesions on cytology were referred for further investigations like colposcopy and biopsy to confirm thediagnosis and avail proper treatment. Limitation of the present study was small sample size as all female patientsaged between 20 and 60 years visiting hospital were not included in the screening, other screening tests like VIA(visual inspection with acetic acid test) and HPV DNA (human papilloma virus) tests were not done. Until thetime centrally organised screening programmes for cervical cancer are established in India, arrangements shouldbe made for hospital based opportunistic screening for all women attending hospital. The cost effectiveness ofdifferent screening tests for cervical cancer should be evaluated.     

Effectiveness of Cervical Cancer Screening among Chinese Women in North America

Background. Chinese North American women have high invasive cervical cancer rates and low screeningrates. The cost-effectiveness of strategies to improve Pap testing rates for Chinese women living in Seattle,Washington and Vancouver, British Columbia was examined. Objectives. To calculate the costs and costeffectivenessof implementing two strategies to motivate women to obtain a Pap smear. Research Design. Athree-armed randomized, controlled trial was conducted. Women in each of two interventions (high-intensityoutreach and low-intensity mailing intervention) were compared to a group of women who received usual care.Measures. Costs were captured via a group discussion of costs, accounting records, sampling of staff time logs,and estimation of costs and task times. Effectiveness was measured as the proportion of women in eachintervention arm who reported receiving a Pap smear since the trial began. Cost-effectiveness was calculated asthe incremental cost of screening each additional woman between an intervention arm and the control arm.Results. A greater percentage of women who received the outreach intervention had a Pap test than women whoreceived mailed materials or women who were in the usual care arm. The intent-to-treat cost for each additionalwoman to be screened for a Pap test was $ 415 in the Outreach arm and $ 676 for the Direct Mailing arm. Theoutreach worker intervention, though more expensive overall, was more cost-effective than the mailingintervention. Conclusions. Outreach intervention is cost-effective for sponsors and should be considered as astrategy to motivate Chinese women living in North America to seek cervical cancer screening.     

Cervical Cancer Screening: Patients Understanding in Major Hospitals in Malaysia

We studied women with cervical cancer to determine whether they had had a Pap smear within the 3 yearspreceding cancer development and their understanding of screening for this cancer. The study had 2 parts;Pathology Data and Survey Data. For pathology data, all cases of cervical cancer diagnosed in 2000-2006 wereretrieved from eight hospitals and Pap smear history was obtained from clinical records. For the Survey data;patients who were still undergoing treatment in some of these hospitals and three others were administeredstructured questionnaires to determine their awareness about screening. The results showed 1431 cases ofcervical cancer in women aged 25-85 were diagnosed in these hopsitals. Most had not had a Pap smear within 3years before cancer development. The percentage of patients who had had Pap smear ranged from 0-12%.Questionnaires were returned by 221 patients; 56.3% had none or only primary education and 61.1% had ahousehold income of RM1000 or less. Level of education and the household income were strongly associated(p<0.05) with knowledge and having had a Pap test. The main reasons cited for not having had a Pap smearwere “Never heard about it” (36.2%), “Shy” (10.4%), “Afraid to do it” (13.1%), “Think the test is not important”(8.1%) and “No encouragement from family” (4.5%). A large majority (95.9%) of the patients did not know theoptimal interval. In conclusion, a large number of cervical cancer patients had not had a Pap smear within 3years preceding cancer development and most had inadequate knowledge about this screening test.     

Cervical Cancer Risk Levels in Turkey and Compliance to the National Cervical Cancer Screening Standard

Cervical cancer screening with Pap smear test is a cost-effective method. The Ministry of Health in Turkeyrecommends that it be performed once every five years after age 35. The purpose of this study was to determinethe cervical cancer risk levels of women between 35 and 69, and the intervals they have the Pap smear test,and to investigate the relation between the two. This study was performed on 227 women aged between 35and 69 living in Balcova District of İzmir province. Using the cervical cancer risk index program of HarvardSchool of Public Health, the cervical cancer risk level of 70% of the women was found below average, 22.1%average, and 7.9% above average. Only 52% of the women have had Pap smear test at least once in their lives.The percentage screening regularly in conformity with the national screening standard was 39.2%. Women inthe 40-49 age group, were married, conformed significantly more (p<0.05) to the national screening standard.Compliance also increased with the level of education and decreased with the cervical cancer risk level (p<0.05).A logistic regression model was constructed including age, education level, menstruation state of the women andthe economic level of the family. Not having the Pap smear test in conformity with the national cervical cancerscreening standard in 35-39 age group was 2.52 times more than 40-49 age group, while it was 3.26 times morein 60-69 age group (p<0.05). Not having Pap smear test in 35-39 age group more than other groups might resultfrom lack of information on the cervical cancer national screening standard and the necessity of having Papsmear test. As for 60-69 age group, the low education level might cause not having Pap smear test. Under thesecircumstances, the cervical cancer risk levels should be determined and the individuals should be informed.Providing Pap smear test screening service to individuals in the target group of national screening standard, asa public service may resolve the inequalities due to age and educational differences.     

Cervical Cancer Screening Services at Tertiary Healthcare Facility: An Alternative Approach

Introduction: India fights massive cervical cancer burden. This article highlights an innovative feasible approachenabling tertiary hospitals to contribute to cancer prevention without compromising their primary mandate to providetreatment. Methodology: Since 1979, National Institute of Cancer Prevention and Research (NICPR) support a tertiaryhospital in cervical cancer screening through a satellite clinic. Record review of 5328 attendees of this clinic betweenJanuary-December 2016 was done. Pap-smear testing and reporting were performed by trained NICPR personnel. Patients’demographics, reproductive history, Pap-test date, cytology results were recorded and results were communicated torespective units for further management. Results: Among 5328 women screened, 2% (96/5328) had abnormal cytology,which included malignancy(33%; 32/96), Atypical Squamous Cells-Undetermined Significance(ASC-US) (20%;19/96), Atypical Glandular Cells(AGC) (23%; 22/96) with complaints of pain in lower abdomen 65.6%(59/90), whitedischarge per vaginum 46.7%(42/90) and backache 23.3%(21/90). In which, Muslims- 67% (65/96), illiterates- 58%(56/96). Age>35(p<0.001), parity>3(p<0.05), illiteracy (p<0.05), Muslim women (p<0.05) had positive association withabnormal cytology. Conclusion: Awareness about cervical cancer screening is the immediate need in resource-limitedcountries. Government hospitals in such countries should house dedicated preventive oncology unit for cancer screening.     

Population-Based Cervical Screening Outcomes in Turkey over a Period of Approximately Nine and a Half Years with Emphasis on Results for Women Aged 30-34

Purpose: To appraise the frequency of cervical cytological abnormalities in a population at normal risk viaanalysing the archive records of cytology for the period of approximately 9,5 years, comparing them with patientdemographic charecteristics, and discuss the results for women under age of 35. Materials and Methods: A totalof 32,578 cases of Pap smears were retrieved and analysed from our archive included the Pap tests performedbetween January 2001 and April 2010 at the Early Cancer Screening, Diagnosing and Education Center by theconsent of three pathologists via utilizing the Bethesda System Criteria 2001 and the results were comparedwith some demographical characteristics. Results: Our rate of the cervical cytological abnormality was 1.83%,with ASCUS in 1.18%, LSIL in 0.39, HSIL in 0.16%, AGUS in 0.07%, squamous cell carcinoma in 0.02%, andadenoarcinoma in 0.006%. Cytological abnormalities were detected mostly in those with higher age, lower parity,and premenopausal period whereas the smoking status was without influence. Bacterial vaginosis (5.6%) wasthe most frequent infectious finding (Candida albicans 2.7%; Actinomyces sp. 1.3%; and Trichomonas vaginalis0.2%) detected on the smears. The rate of abnormal cervical cytology was 9.5% among the women aged between30-34. Conclusions: Early detection of the cervical abnormalities by means of the regular cervical cancer screeningprogrammes is useful to attenuate the incidence, mortality, and morbidity of cervical cancer. Our prevalence ofthe cytological abnormalities was much lower than the one in Western populations in general but very similarto those reported from other Islamic countries that may be explained by the conservative lifestyle and the lowerprevalence of HPV in Turkey. A remarkable rate of abnormal cervical cytology of women aged 30-34 was pointedout in the present study.     

Knowledge about Cervical Cancer Risk Factors and Pap Testing Behaviour among Turkish Women

Background: The aim of the paper was to examine knowledge about cervical cancer and in relation toPapanicolaou (Pap) testing among Turkish women. Methods: This cross-sectional study research was carriedout at Ege University Faculty of Medicine Hospital’s Obstetric and Gynecology Outpatient Clinic betweenMarch 1st, and May 30th, 2008 with 92 volunteer women who were sexually active and aged 25 to 61. Data wascollected through survey forms by interviews conducted by researchers. The form consisted of 30 questions andthree parts. Results: Of the women who participated in the research, 33.7 % were aged 42-49 and 44.6 % wereprimary school graduates. It was determined that 53.3 % of the women had long experience of living in aprovince and big city and that 82.6 % had middle income. Approximately two-thirds (68.5%) had received aPap test. The knowledge of the women within the scope of the research concerning cervical cancer risk factors(having a sexually transmitted disease, giving birth to many children, smoking, having sexual activity with aman who has had partners with a cervical cancer and having sexual intercourse at an early age) was found to berelated with their condition of having pap testing. Conclusion: The women’s condition of having pap testing isinfluenced by their age group, having a history of cancer in their family and having knowledge of cervicalcancer in advance (p <0.01). This research once again demonstrated that having knowledge is influential on thehabit of having pap testing. Taking this conclusion into consideration, it is crucial that information servicesaimed at the whole society, specifically women, should become widespread with the participation of healthworkers.     

Screening histories of women with CIN 2/3 compared with women diagnosed with invasive cervical cancer: a retrospective analysis of the Norwegian Coordinated Cervical Cancer Screening Program

Objective: This study compares the screening history for women with cervical intraepithelial neoplasia (CIN) 2/3 or adenocarcinoma in situ (ACIS) with women with different stages and subtypes of cervical carcinoma.Methods: An analysis of the Norwegian Coordinated Cervical Screening Program comparing all cases with a CIN 2/3/ACIS (N=8586) with all ICC (N=777) in the period 2000–2002. All Pap smears since 1992 were used to characterise detection mode and screening history. Multinominal regression models estimated the risk associated with detection mode and adequate Pap smear history.Results: A wide range of age at diagnosis, from 16 to 92 years of age was observed regardless of the stage of the disease. Fifty five percentage of the women diagnosed with CIN 2/3/ACIS had an adequate screening history. Of women diagnosed with SCC, 45.1% in stage I, and 10.5% in stage IV had an adequate history. The median age of women with CIN 2/3 (34 years) and squamous cervical carcinoma (SCC) stage I (37 years) given an adequate Pap smear history was not significantly different. For women with ACC, the proportion with adequate screening history was roughly 50% for all stages. After adjustment for detection mode and age, the OR for being diagnosed with ICC stage I compared to CIN 2/3 was 1.2 (95% CI: 1.0–1.5), while the OR of being diagnosed with ICC stage II–IV was 3.4 (95% CI: 2.3–4.8).Conclusions: Women with CIN 2/3 and ICC stage I were similar with respect to screening histories, i.e. detection mode and age at diagnosis, while women with ICC stage II–IV seldom had an adequate screening history and were diagnosed at a significantly higher age.     

Forgone Health and Economic Benefits Associated with Socioeconomic Differences in Organized Cervical Cancer Screening

Objective: To describe cervical cancer screening participation among women in Taiwan under its population-based screening policy and to estimate the economic burden of disease attributable to avoidable disparities in cervical cancer (CC) screening. Methods: We identified a nationally-representative sample of females aged 30 years or above who were eligible for Pap smear testing in Taiwan from 1 January to 31 December 2013. An administrative database with detailed claims of health care utilization under the universal coverage health care system was used. Socioeconomic position of the female subjects was defined using the occupation classification, and two groups were specifically identified: general (O1) and low-income (O5) groups. Differences in screening rate, CC prevalence, and CC-attributable deaths were assessed between the two groups. Economic consequences as a result of screening inequalities were estimated using actual total health care spending (health care expenditure), monetary value per life-year and years of life lost for ill health and screening disparities (health as consumption good), and productivity losses alongside costs of social benefits (health as capital good). Result: A total of 301,057 enrolled females aged 30 years and older eligible for screening were identified. Overall, 3-year and 1-year screening rates among all subjects were 0.601 and 0.372, respectively. Impact of observed differences in screening translated to US$59,568 of health care spending in one year, 90.4% of which was specific to hospital admissions. When we viewed health as a consumption good and capital good, the impact of screening disparity on health losses through CC would be equivalent to US$78,095 and US$190,868, respectively. Conclusion: Forgone health and economic benefits associated with inequalities in CC screening uptake can be considerable in productive women.