Patumrat Sripan

Factors Associated with Suboptimal Screening for Cervical Cancer among Ethnic Women in Thailand-Myanmar Border Area

Suboptimal screening for cervical cancer is found in remote areas. This study aims to evaluate the suboptimal screening prevalence and determine the factors associated with suboptimal cervical cancer screening among  ethnic women in the Thailand-Myanmar border area. This is a cross-sectional study conducted from July to December 2023. The eligible criteria were ethnic women aged 30-60 in Pai district, Mae Hong Son province in northern Thailand. Descriptive statistics were used to describe the characteristics, accessibility to health care service, knowledge, attitude and perceptions about Human Papillomavirus (HPV), cervical cancer and screening, and support for cervical cancer screening. The factors associated with suboptimal screening were determined using binary logistic regression. Among 354 ethnic women, one-fourth had suboptimal screening for cervical cancer. The positive attitude towards cervical cancer screening and the perceived risk of cervical cancer were high. Most of the participants had a medium level of knowledge about HPV and cervical cancer. Factors associated with suboptimal screening were younger age (adjusted Odds Ratios(aOR) = 1.48, 95% confidence interval (CI): 1.06-2.07), being Hmong ethnic group (aOR = 2.63, 95%CI: 1.30-5.34) compared to Karen ethnic group, and lack of information support from health care personnel (aOR = 1.88, 95%CI: 1.08-3.29) . Positive attitude toward the screening was associated with less suboptimal screening (aOR=0.56, 95%CI: 0.32-0.96). Information support from local health personnel plays an important role in health promotion and health literacy for cervical cancer screening in ethnic women as information and support to accommodate the languages and cultural can enhance engagement and trust.

The Utilization of Human Papillomavirus Testing for Cervical Cancer Screening in Thailand: A Comparison of Screening with and without Self-sampling Samples

Cervical cancer (CC) screening shifted from Pap-smear to human papillomavirus (HPV) testing HPV with and without a self-sampling HPV-test in Thailand. Few studies have reported the initial outcomes of such a transition. This study aims to explore CC screening rate, CC detection and compare the CC detection rate by HPV with and without self-sampling methods in Krabi, province. A retrospective study was conducted from 1st October 2023 to 30th September 2024. A total of 11,925 women's records were retrieved. Information on demographic, screening results and cancer diagnosis was retrieved from the Krabi provincial hospital. Different proportions of CC detections and self-test collection based on demographic features were tested using chi-square and Fisher's exact tests.  Result: CC screening rate was 42.4%: 10,619 (89%) of women had an HPV test and 1,306 (11%) had a Pap-smear test. The screening rate was 30.2% in 2023 and 52.1% in 2024. With regard to age, occupation, and health insurance schemes there was a significant difference in the proportion of those taking the self- collection test. Religion showed non-significance difference in the proportion of self-sampling test in relation to religion. CC detection was 3% among women who underwent the Pap-smear test and 0.12% for those who performed the HPV test. There is a significant difference in CC detection between the HPV with and without a self-sampling test. CC screening with HPV testing, especially with self-sampling, showed a promising approach to increasing CC screening uptake in the population. The rate of CC detection through self-sampling was lower in the early years of implementation compared to non-self-sampling methods. Ensuring the correct performance of self-sampling should be carefully considered and monitored in the future.

Knowledge and Behaviors toward Human Papillomavirus and Cervical Cancer in the Women of Reproductive Age in Thailand-Myanmar Border Areas

Infectious disease is an important health problem in border areas as there is a possibility that the migrants may carry the disease into the area. The purpose of this study is to evaluate the knowledge and behaviors toward human papillomavirus (HPV) and cervical cancer in the women of reproductive age in the Thailand-Myanmar border area. A survey study in a population of 418 women of reproductive age in Mae Hong Son Province in the Thailand-Myanmar border area. Knowledge and risk behaviors of HPV and cervical cancer were described using descriptive statistics. Fifty percent of the participants had sexual debut at age less than 20 years, 27% had more than one lifetime sexual partner and only 3% had sex outside a monogamous relationship during the past 12 months. In term of knowledge, 62.5% knew about HPV. The proportion of correct answers about HPV and cervical cancer questions ranged from 14-95% and 52-94%, respectively. Among the cervical cancer screening target, 69.4% accessed the screening. The factors associated with better knowledge about HPV and cervical cancer were education level higher than high school and sexual debut. The women of reproductive age in the Thailand-Myanmar border areas showed relatively low sexually risk behaviors for HPV infection. More than one-third of the participants did not know about HPV. The percentage of correct answer to questions about cervical cancer were low.  We encourage the Thai Ministry of Public Health to increase health promotion and health literacy on prevention of HPV and cervical cancer in the women of pre- and reproductive age in the Thailand-Myanmar border area.

Geographical risk pattern and temporal trends in incidence of HPV-related cancers in northern Thailand: A population-based study

Background The burden of HPV-related cancers in different regions worldwide varies according to several factors. This study aims to measure inequality in the risk of incidence of HPV-related cancers in term of geographical risk patterns in northern Thailand using a population-based cancer registry data. Methods Trends in age-standardized HPV-related cancer incidence were calculated for the 2008–2017 time period. The Besag-York-Molli´e model was used to explore the spatial distribution of the relative risk (RR) of HPV-related cancers at the district level. A higher RR reflects a larger disparity. The geographical risk pattern of the diseases in two periods, 2008–2012 and 2013–2017 were described and compared. Results From 2008 to 2017, the incidence of oropharyngeal and anal cancers showed a slightly increased trend in males but remained stable in females, the incidence of vulvar, vaginal and penile cancers were stable while the incidence of cervical cancer decreased. The RR range was closer to 1 in the second period compared to the first period. This suggests a decrease in the disparities of incidence of cervical cancer. However, in some areas near the Thai-Myanmar border, the RR values remained high. Conclusion The incidence rate of most HPV-related cancers remained low and stable over the study period in northern Thailand. For the most common HPV-related malignancy, cervical cancer, the incidence rate steadily decreased but with marked geographic disparities, possibly reflecting health inequity especially in the border areas.