Diane M. Harper

A Scoping Review of Women with Physical Disabilities and Cervical Cancer Screening

Background: Women with physical disabilities (WWPDs) have lower screening rates for cervical cancer than the general population globally. This scoping review aims to define the type of studies and content of studies currently available to promote cervical cancer screening among WWPDs. It seeks to clarify the type of disabilities WWPDs have that lead to the poorest participation in cervical cancer screening and highlight how health care systems can address the disclosed gaps. Methods: We developed our scoping review in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Review. We reviewed Ovid Medline, Scopus, and REHABDATA sources with librarian-created search strategies between August 2, 2021, and September 2023. Results: We identified 891 articles from OVID Medline, 1,237 from Scopus, and 27 from REHABDATA for 2,155 articles. After removing duplicates and articles with exclusion criteria, 17 articles remained for full review. Their study designs were limited to cohort and cross-sectional studies. The definition of disability was either self-described or a medical diagnosis. Eighty-two percent of the studies used secondary data sources, and nearly all came from high-income countries. Cervical cancer documentation was self-reported for some and medically linked for others, but all occurred in the physician’s office. No study described the cervical cancer screening technique. The severity of disability and the increasing age of the WWPDs led to less screening. Conclusions: The gaps identified included the need for studies to address self-sampling for primary HPV testing for WWPDs for future increases in cervical cancer screening.

Comparison of Human Papillomavirus Genotyping by Research vs. Clinical Assay for Two Self-Collection Devices

Abstract Background: Human papillomavirus (HPV) assays and self-collection devices for HPV detection have evolved. We aim to compare two self-sampling devices against speculum-based testing for HPV genotype agreement and their accuracy for cervical intraepithelial neoplasia grade 2 (CIN2+) disease. Secondarily, we aim to compare two HPV assays for different HPV genotype detection agreement and their accuracy for CIN2+ disease. Methods: Women from colposcopy (N = 97) and primary care (N = 96) were block-randomized to two different self-sampling device groups. Self-sampling and speculum-collected pairs of HPV specimens were analyzed with the research assay. A second speculum-collected specimen provided clinical results using the clinical HPV assay. Agreement (prevalence-based κ) and accuracy (sensitivity/specificity ratios) provided the statistical comparison. Results: The two devices did not differ in their κ agreement scores for overall HPV detection compared with the speculum-collected sample [κ = 0.83 (0.72–0.94) and κ = 0.90 (0.81–0.98), respectively, nonsignificant exact McNemar test results]. The two devices did not differ in accuracy as measured by the relative sensitivity/specificity for overall HPV at the CIN2+ disease threshold [1.0 (0.15–6.77) and 1.19 (0.56–2.54), respectively]. The two assays did not differ in HPV agreement nor assay accuracy for CIN2+ (n = 10). Conclusions: HPV self-sampling devices robustly detected high-risk HPV types for cervical cancer screening when using the research assay to compare them. Both research and clinical HPV assays provide equivalent HPV detection for specific and aggregated HPV types. Impact: This study provides a US-based population to show that self-collection for primary HPV testing is accurate for CIN2+ detection with multiple devices using a validated HPV assay.

Strategies to Optimize Cervical Cancer Screening Rates Among Transgender and Gender-Diverse People Assigned Female at Birth

Self-sampling for primary HPV detection for cervical cancer screening is now FDA-approved. Many persons interested in cervical cancer screening are eager to opt out of the invasive speculum exam and opt into the self-sampling. There is no limitation on which persons can choose self-sampling. Transgender, nonbinary, and gender-diverse assigned female at birth (TGD AFAB) people experience barriers such as gender dysphoria and discomfort with sensitive exams. They may find more comfort with this equivalent method of screening. However, no clinical guidelines describe the best practices to increase screening among this underserved population. Much community work needs to occur to make the language of screening gender-affirming for all participants. Solutions to currently invasive follow-up exams after abnormal screens need to be communicated in language directed by the TGD AFAB community.

Cancer risk perception and physician communication behaviors on cervical cancer and colorectal cancer screening

Background: Women 50–65 years of age have the lowest cervical and colorectal cancer (CRC) screening rates among ages recommended for screening. The primary aim of this work is to determine how cancer risk perceptions and provider communication behaviors, in addition to known demographic factors, influence the uptake of both cervical and CRC screening or a single screen among women in southeast Michigan. Methods: Fourteen health services and communication behavior questions were adapted from the Health Information National Trends Survey (HINTS) and administered to a multiethnic sample of adults in southeast Michigan. The outcome variable was self-reported up-to-date cervical cancer and/or CRC screening as defined by the United States Preventive Services Task Force (USPSTF). Demographic and cancer risk/communication behavior responses of the four screening populations (both tests, one test, no tests) were analyzed with multinomial regression for all comparisons. Results: Of the 394 respondents, 54% were up to date for both cervical and CRC screening, 21% were up to date with only cervical cancer screening and 12% were up to date for only CRC screening. Of the 14 risk perception and communication behavior questions, only ‘Did your primary care physician (PCP) involve you in the decisions about your health care as much as you wanted?’ was significantly associated with women having both screens compared to only cervical cancer screening (aOR 1.67; 95% CI: 1.08, 2.57). The multivariate model showed age, and Middle East and North African (MENA) ethnicity and Black race, in addition to PCP-patient dyad decision-making to be associated with the cancer screenings women completed. Conclusions: Optimizing PCP-patient decision-making in health care may increase opportunities for both cervical cancer and CRC screening either in the office or by self-sampling. Understanding the effects of age and the different interventional strategies needed for MENA women compared to Black women will inform future intervention trials aimed to increase both cancer screenings. Funding: This work was supported by NIH through the Michigan Institute for Clinical and Health Research UL1TR002240 and by NCI through The University of Michigan Rogel Cancer Center P30CA046592-29-S4 grants.

Coverage for the Entire Cervical Cancer Screening Process Without Cost-Sharing: Lessons From Colorectal Cancer Screening

US women screen at low rates for both cervical and colorectal cancers than a single cancer: a cross-sectional population-based observational study

Background: Using screen counts, women 50–64 years old have lower cancer screening rates for cervical and colorectal cancers (CRC) than all other age ranges. This paper aims to present woman-centric cervical cancer and CRC screenings to determine the predictor of being up-to-date for both. Methods: We used the Behavioral Risk Factor Surveillance System (BRFSS), an annual survey to guide health policy in the United States, to explore the up-to-date status of dual cervical cancer and CRC screening for women 50–64 years old. We categorized women into four mutually exclusive categories: up-to-date for dual-screening, each single screen, or neither screen. We used multinomial multivariate regression modeling to evaluate the predictors of each category. Results: Among women ages 50–64 years old, dual-screening was reported for 58.2% (57.1–59.4), cervical cancer screening alone (27.1% (26.0–28.2)), CRC screening alone (5.4% (4.9–5.9)), and neither screen (9.3% (8.7–9.9)). Age, race, education, income, and chronic health conditions were significantly associated with dual-screening compared to neither screen. Hispanic women compared to non-Hispanic White women were more likely to be up-to-date with cervical cancer screening than dual-screening (adjusted odds ratio [aOR] = 1.39 (1.10, 1.77) ). Compared to younger women, those 60–64 years are significantly more likely to be up-to-date with CRC screening than dual-screening (aOR = 1.75 (1.30, 2.35) ). Conclusions: Screening received by each woman shows a much lower rate of dual-screening than prior single cancer screening rates. Addressing dual-screening strategies rather than single cancer screening programs for women 50–64 years may increase both cancer screening rates. Funding: This work was supported by NIH through the Michigan Institute for Clinical and61 Health Research UL1TR002240 and by NCI through The University of Michigan Rogel Cancer62 Center P30CA046592 grants.

Cervical Cancer Elimination Is Dependent on Women's Self-Tests for Primary Human Papillomavirus Testing Triaged by Methylation Status

Acceptability of Home‐Based Urine Self‐Collection for Cervical Cancer Screening Among Women Receiving Care at the Arab Community Center for Economic and Social Services in Michigan

ABSTRACTBackgroundMichigan's Middle Eastern‐North African (MENA) community is an essential and growing part of the state's population. However, MENA individuals are underrepresented in the research literature due to a lack of recognized demographic categorization. Prior work shows that MENA women face barriers to traditional clinician‐directed cervical cancer screening. This study aims to capture the perspectives of MENA women about home‐based urine cervical cancer screening using HPV kits and to assess whether such methods could positively impact future screening intent.MethodsThrough collaboration with a community partner in southeast Michigan, we recruited MENA women ages 30–65, with 44 completing the study. Participants used urine HPV self‐sampling kits at home and then shared their perspectives through a phone interview. We used an inductive, thematic approach to analyze the interviews, which captured experiences with home‐based self‐sampling, screening preferences, and impact on future screening intent.ResultsParticipants found that urine home‐based self‐sampling was acceptable as a convenient and comfortable way to screen for cervical cancer. Most (80%) preferred self‐sampling over traditional clinician‐directed screening and preferred collecting urine samples at home (73%) rather than in the clinic. Overall, 80% reported that access to urine self‐sampling would positively impact their future screening intent.ConclusionsMENA participants in this study positively received home‐based cervical cancer screening using urine HPV self‐sampling kits. These findings support the clinical implementation of self‐sampling and home‐based cervical cancer screening to increase participation, particularly among those in under‐screened communities.

Cervical Cancer 2010–2019: An Upper Midwest Catchment of 40,000 Square Miles

Objectives American Indian (AI) women have a higher incidence and mortality from cervical cancer than non-Hispanic White (NHW) women in the US. This article’s purpose is to detail the clinical events in the cervical cancer prevention continuum among the AI and White women with cervical cancer on the US frontier. Materials and Methods A cancer center with a nearly 40,000 square-mile catchment area maintained a detailed cancer registry connected to the clinic records of all cervical cancer patients between 2010–2019. This catchment area provided records of both an AI and a White population. Descriptive and inferential statistics and modeling predictions detailed the prevention continuum. Results Among the 126 with cervical cancer, 20% were AI, and 78% were White. Sixty percent did not participate in cervical cancer screening within the 5 years before their diagnosis, and on average, 9.2 years passed since the last cervical cancer screening. 91% presented with symptoms, and most women presented with 2 or more symptoms. Thirteen percent underwent a colposcopic diagnostic step, significantly delaying the time to diagnosis compared to other diagnostic steps. Sixty-nine percent of the histopathologic diagnoses were squamous cell carcinoma, and 27% were adenocarcinoma. Forty-nine percent presented at stage I regardless of histopathology. Chemotherapy and radiation therapy were most commonly combined. Sixty-three percent of the population survived, and 42% survived at least 3 years from diagnosis. Younger age and earlier stages at diagnosis were the significant adjusted predictors of survival. Conclusions The authors’ detailed cervical cancer prevention continuum events provide new data questioning the use of colposcopy for women symptomatic at presentation.

Native American Women's Willingness to Screen for Both Cervical and Colorectal Cancer at Home

ABSTRACT Introduction Fewer than 50% of Native American (NA) women screen for both cervical and colorectal (CRC) cancer. We aim to explore the perspectives of NAs around cervical and colorectal cancer home‐based self‐screening options. Methods The NA community provided review and approval for this cross‐sectional survey on cancers in general, and specifically on cervical and colorectal cancer screening. We invited screen‐eligible Native American women, aged 45–65 years, who attended the Lakota Nation Invitational tournament in December 2023, to complete the survey. Results One hundred women, with a mean age of 54.1 (SD 6.3), completed the survey. Respondents reported visiting their doctor once a year, rarely (10%), with 66% experiencing a poor experience accessing healthcare—only 16% self‐reported screening for both cervical and colorectal cancers within the last 5 years. If the participant could screen for both cervical and CRC cancer at home, 83.0% said they would be willing to do both, compared to 9% who would do neither at home. The doctor's recommendation for how to screen for cervical and CRC cancer was the most important factor in screening decision‐making. The other two very important reasons were how easy or convenient the screening is, how comfortable I am with the screening process/what happens to me during the test. Conclusions With the recommendation of their doctors, and convenience and comfort being important, Native American women are enthusiastic to participate in home‐based cervical and colorectal cancer screening. While the home‐based CRC screening has been available for many years, with minimal effect on screening uptake, the advent of self‐sampling for primary HPV testing for cervical cancer appears to create interest for both tests at home. These options may increase both cancer screening rates and access to care in this underserved population.