Veronique Verhoeven

Factors Associated with Under- and Over-Screening for Cervical Cancer in Rural Areas of Cuenca, Ecuador

Background: Cervical cancer (CC) remains a leading cause of death among women worldwide despite the availability of effective preventive strategies. In Ecuador, CC is the second most prevalent cancer among women. However, many women in rural areas remain inadequately screened, resulting in both underscreening and overscreening patterns. Objective: To identify the determinants associated with under- and overscreening for CC among women in rural areas of Cuenca, Ecuador. Methods: A cross-sectional, door-to-door survey was conducted between September and December 2023 in the rural parishes of Nulti and Chiquintad. A total of 1692 women aged 18 years and older were included. Participants were categorized as under-, optimally, or overscreened based on self-reported Pap test frequency according to the World Health Organization (WHO) recommended 3-to-5-year screening intervals. Odds ratio (OR) with 95% confidence intervals (CI) were calculated to identify associated factors. Results: Among the participants, 42.7% were underscreened, 19.3% optimally screened, and 37.9% overscreened. Underscreening was associated with being older than 45 years, having a low educational level, being single, experiencing embarrassment during genital examination, and lack of time. Overscreening was associated with being younger than 45 years, having higher education, and a strong willingness to undergo screening. Conclusions: Targeted interventions should address informational and emotional barriers contributing to underscreening while discouraging unnecessary overscreening. Strengthened counseling, public education, and standardized guidelines could improve the efficiency and equity of CC screening programs.

Knowledge and Perceptions about Cervical Cancer and HPV Screening in Women in Rural Areas of Ecuador: A Qualitative Research Study

Background: Cervical cancer continues to be a major health problem in developing countries. Educational programs, as well as Pap and HPV screening and vaccination, are important tools to reduce the morbidity and mortality rates associated with this disease. The objective of this study is to explore the diverse knowledge and perceptions about cervical cancer and the different diagnostic tests for HPV of populations living in the rural parish “El Valle”. Method: A qualitative study was conducted through eight focus groups, which included 46 participants from mixed ethnic groups. A phenomenological analysis was performed. Results: Four topics and seven sub-topics were identified. By analyzing all the narratives, it was possible to identify that the perception of cervical cancer was focused on its severity, secondary to its infectious process and screening periodicity. However, despite the diverse knowledge, indigenous people do not relate it to the human papilloma virus; in addition, there is also certain resistance to undergo the Pap smear test, for reasons such as inaccessibility and its sampling process. Conclusions: It is necessary to develop educational programs for the prevention of cervical cancer and to implement diagnostic alternatives to reach populations with precarious accessibility, as well as women who refuse to undergo the Pap smear test.

Role of Self-Sampling for Cervical Cancer Screening: Diagnostic Test Properties of Three Tests for the Diagnosis of HPV in Rural Communities of Cuenca, Ecuador

Background: HPV primary screening has shown effectiveness for cancer prevention; however, gynaecological examination is considered uncomfortable. Self-sampling methods increase the acceptance of screening. The aim of this study is to compare the sensitivity and specificity of clinician sampling versus vaginal and urine self-sampling for HPV diagnosis. Methods: A diagnostic test study was conducted in a rural parish of Cuenca, Ecuador. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for HPV testing. The latter was considered as the golden standard. All three samples were processed with the same amplification and hybridization protocol for HPV detection (Hybribio) following the manufacturer’s instructions. Results: Characteristics of the participants were: median age 35 years; 40.8% married; 46.7% had a primary level of education; and median age of sexual onset, 17.6 years. The prevalence of any type of HPV with clinician sampling was 15.0%, 17.5% with urine sampling and 18.3% with vaginal self-sampling. Self-sampling sensitivity reached 94.4% (IC 74.2–99.9), and specificity 92.1% (IC 85.2–95.9). Urine sampling had a sensitivity of 88.8% (IC 67.2, 96.9), and specificity 94.1% (IC 67.2–96.9). The negative predictive value was 98.9% (IC 94.2–99.8) for vaginal self-sampling and 97.6% (IC 92.6–99.4) for urine sampling. Conclusions: This study shows that vaginal and urine self-sampling methods have similar sensitivity and specificity compared with clinician sampling for the diagnosis of HPV. The correlation between HPV genotypes among the three tests is satisfactory.