BMC Public Health

“Easy women get it”: pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program

Abstract Background Cervical cancer is preventable with vaccination and early detection and treatment programs. However, for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system and community of a low-resource setting prior to implementation of an HPV screen-and-treat program. Methods This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. Results We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women’s HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. Conclusions Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system and community in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.

The global burden of polycystic ovary syndrome, endometriosis, uterine fibroids, cervical cancer, uterine cancer, and ovarian cancer from 1990 to 2021

Abstract Background Globally, common gynecological disorders such as Polycystic Ovary Syndrome (PCOS), endometriosis, uterine fibroids (non-malignant gynecological diseases), as well as cervical cancer, uterine cancer, and ovarian cancer (gynecological cancers), profoundly impact women’s physical and mental health. The burden of these diseases exhibits significant geographical disparities across different countries and regions, making a comprehensive and precise assessment of the global burden of gynecological diseases particularly crucial. Such an assessment will facilitate the development of region-specific prevention and treatment strategies, contributing to a more effective response to these health challenges. Methods Incidence, prevalence, mortality rates, and Disability-Adjusted Life Years (DALYs) data for the aforementioned gynecological conditions were obtained from the 2021 Global Burden of Disease (GBD) study and analyzed by age, location, and year. The burden associated with gynecological diseases was analyzed based on the Socio-demographic Index (SDI) and attributable risk factors. The Estimated Annual Percentage Change (EAPC) and its 95% Confidence Interval (CI) were used to assess temporal trends in burden. Results In 2021, uterine fibroids were the leading non-malignant gynecological condition contributing to the highest Age-Standardized Incidence Rate (ASIR) and Age-Standardized Prevalence Rate (ASPR), with rates of 250.93 and 2841.07 per 100,000, respectively. Cervical cancer was the main contributor to the Age-Standardized Mortality Rate (ASMR) and Age-Standardized Disability Rate (ASDR) among the eight selected gynecological diseases, with rates of 6.62 and 226.28 per 100,000, respectively. From 1990 to 2021, the ASIR and ASPR for non-malignant gynecological conditions, such as PCOS and uterine fibroids, increased, while the ASDR for PCOS also rose. Among gynecological cancers, the ASIR for uterine cancer increased, while the ASPR for cervical cancer rose. However, the ASIR for cervical and ovarian cancers decreased, along with reductions in the ASMR and ASDR for these cancers and uterine cancer. There were notable regional disparities based on the SDI. In 2021, lower SDI regions had higher incidence, prevalence, mortality rates, and DALYs for endometriosis and cervical cancer, whereas higher SDI regions saw higher rates for PCOS, uterine fibroids, ovarian cancer, and uterine cancer, with more significant mortality and DALYs for ovarian and uterine cancers. The age distribution of these conditions varied. Non-malignant gynecological conditions, such as PCOS and uterine fibroids, primarily affect women aged 30–34 and 40–69. Endometriosis is most common in women aged 20–34, particularly between 25 and 29. Gynecological cancers, including cervical, uterine, and ovarian cancers, predominantly affect women over 35, especially between 40 and 69, with cervical cancer peaking at ages 50–54. Regarding attributable risk factors globally, 1% of cervical cancer deaths were linked to unsafe sexual behaviors, while a high Body Mass Index(BMI) contributed to 0.09% of ovarian cancer deaths and 0.34% of uterine cancer deaths. Conclusion The global burden of these six gynecological conditions poses a significant public health challenge. There is an urgent need for international collaboration to advance the development of age and regionally differentiated management strategies for gynecological diseases, including the development of effective diagnostic screening tools and the implementation of high-quality, targeted prevention and treatment strategies.

Barriers and facilitators to cervical cancer screening in the Eastern Mediterranean Region: a systematic review

Cervical cancer is the sixth most common cancer among women in Eastern Mediterranean Region. Although screening is recommended as the early detection policy to enable timely intervention, women across the region face diverse factors that either facilitate or hinder their participation in screening programmes. We aimed to systematically identify facilitators and barriers to cervical cancer screening (CCS) uptake among women in EMR countries. This systematic review was conducted in 2024 (Prospero code = CRD42023443818). Literature search was performed using the PICO framework through Web of Sciences, Scopus, Science Direct, Embase and WHO Index Medicus for the Eastern Mediterranean Region (IMEMR) databases. PRISMA algorithm was followed for literature screening independently by two researchers. Extracted data were categorised based on Andersen and Newman Framework of Health Services Utilization. Out of 234 studies identified, 66 met the inclusion criteria. Iran and Jordan contributed the highest number of included articles. Predisposing factors at the individual and health system-related were categorised into demographics, social structure and beliefs. Enabling individual items were classified at personal/family and community levels, whereas health system-related factors were grouped into health policy, financing and organizational domains. Need factors were designated solely as individual determinants and accordingly grouped into perceived and evaluated CCS facilitators or barriers. Cervical cancer screening uptake in EMR countries is influenced by a complex interplay of individual, social, and health system-related factors. These were categorised into predisposing, enabling and need-based determinants require multi-level strategies to be addressed. Despite the existing supportive regional policies, persistent barriers such as lack of awareness, stigma, financial constraints, and limited access to services continue to pose significant challenges. These findings offer a foundation for future policy adaptation and programme development in countries of the EMR.

Perceptions of cervical screening uptake amongst South Asian women in Ontario, Canada: a concept mapping study

Abstract Background Regular cervical screening can significantly reduce the onset and prevalence of cervical cancer. In Ontario, Canada, South Asian women have the lowest rates of cervical cancer screening among major ethnic groups in the province. Methods Using an innovative and participant-driven method called Concept Mapping (CM), we set out to understand how the lives and experiences of South Asian women living in Ontario shape their decisions around getting screened for cervical cancer. We engaged over 70 South Asian women and people who serve them in healthcare and community, to drive the CM process. Results Participants brainstormed 45 unique and distinct statements. Through sorting and map interpretation, participants identified and interpreted 6 clusters amongst the statements: (1) Personal beliefs and misconceptions around cervical cancer; (2) Education and knowledge issues around cervical cancer; (3) Cultural beliefs and influences specific to sexual health; (4) Barriers to prioritizing uptake of cervical screening; (5) System/ infrastructure gaps or inadequacies; and (6) Lack of comfort and supportive relationships in healthcare. Additional analysis shows us the interrelationships between the ideas. Statements within the clusters about education and knowledge issues around cervical cancer, personal beliefs and misconceptions, as well as cultural beliefs and influences specific to sexual health are viewed as distinct beliefs with clear effects on the uptake of cervical screening. More complex interrelationships are seen with the cluster of statements about barriers to prioritizing uptake of cervical screening. Conclusions As Ontario and many other jurisdictions around the world seek to strengthen cervical screening efforts in line with national and international goals to eliminate cervical cancer by 2040, it is critical to address underscreening. This CM study recognizes the value of engaging those most impacted by an issue, to identify and prioritize how and where to intervene to address low rates of cervical screening. To address underscreening we need to design multi-level interventions that address the identified ideas and the interrelationships among them.

The effect of the music-supported education program on the awareness and health beliefs of Roma women about cervical cancer and screening

Roma women, who have low education, are one of the risk groups for cervical cancer as it has proven that they marry and give birth at an early age and have limited access to preventive health services. This study aims to reveal the effect of a music-supported education program based on the Health Belief Model on the awareness and health beliefs of Roma women about cervical cancer and screening. This study was conducted between June 2021- January 2022 with 40 Roma women in the experimental group and 40 in the control group. Data were collected using the Personal Information Form and the Health Belief Model Scale for Cervical Cancer and Pap Smear Test. The experimental group received a four-week training and a two-week music-supported training. It was revealed that 27.5% of the Roma women in the experimental group had the pap smear test after the intervention, and there was a significant difference in the mean scores of the awareness of cervical cancer and screening and the factors of the Health Belief Model Scale for Cervical Cancer and Pap Smear Test compared to the pre-intervention. It was found that the intervention had a significant effect at the level of 77.9% in reducing the perceived barriers to the pap smear test (p < 0.001). It was found that the music-supported education program based on the Health Belief Model positively affected the awareness and health beliefs of Roma women about cervical cancer and screening. The study was registered with the U.S.National of Medicine Clinical Trials Registry (NCT04756440 -15.08.2020).

Navigating the challenging storms of cancer management in a national cancer centre: perspectives of female patients

Breast, cervical, and ovarian cancers are among the top ten global cancers, affecting women, with age-standardized rates per 100,000 being 47.8 for breast, 13.3 for cervical, and 6.6 for ovarian cancer. The journey from cancer symptoms, through diagnosis and treatment, to survivorship, presents numerous challenges. These challenges encompass physical, psychological, and social aspects, significantly impacting patients' quality of life. It is crucial for research to explore not only the challenges faced by patients but also the strategies they employ to cope with these obstacles. This study employed a cross-sectional qualitative approach. Twenty respondents, aged between 15 and 45 years and had been diagnosed with a reproductive cancer (breast, ovarian, or cervical), and were either undergoing treatment or had completed treatment within one year of the study period were purposively selected. Respondents were interviewed using a semi-structured interview guide. A thematic analysis was conducted on twenty in-depth interviews (IDIs) to understand the challenges and support systems for cancer patients. The study identified two principal themes: the challenges faced by patients and the available support systems. The findings are based on patient narratives regarding the obstacles encountered during diagnosis, treatment, and follow-up, along with the mitigation strategies employed. Patients reported a range of challenges, categorized into financial and non-financial. Prominent among the non-financial challenges were psychological distress, body image issues, reduced sexual drive, and overall health deterioration. Support was primarily found through personal relationships and religious or spiritual beliefs. The research highlights the extensive psychological and social effects of cancer and it's treatment. The study revealed the intertwined nature of financial difficulties and non-financial challenges, emphasizing the importance of social support, including religious, family, healthcare, and peer support. The findings suggest that a comprehensive, multidisciplinary management plan which encompasses both medical and supportive care is required to enhance patient well-being.

Acceptability of self-collected vaginal samples for human papillomavirus testing for primary cervical cancer screening: comparison of face-to-face and online recruitment modes

Abstract Background This study aimed to assess the acceptability and attitudes of women towards human papillomavirus (HPV) self-sampling and compare the effectiveness of two delivery modes utilising face-to-face and online website for cervical cancer screening in Hong Kong. Methods Women aged 30–65 years were invited to participate by distributing the study information pamphlets at the specialist clinics of a regional acute hospital. Those who were interested in participating were given the option to join directly face-to-face or through an online website. All participants provided informed consent and received self-sampling kits and acceptability questionnaires either immediately (face-to-face) or through the post after registering at the website (online). All participants were requested to collect their own vaginal samples using a swab which was then brushed on a DNA sample storage card and returned to the hospital either in person or by post. The self-collected samples were tested for high-risk HPV using the Sentis™ HPV assay, a validated isothermal nucleic acid amplification real-time fluorescent detection assay. The primary outcome was the uptake rate of HPV self-sampling. Results Of the 1998 women recruited (1200 face-to-face, 798 online), 1377 returned their samples, giving an overall uptake rate of 68.9%. The uptake rate was significantly greater in the face-to-face mode than in the online mode (74.6% vs. 60.4%, p &lt; 0.001). The median age of the participants was 49 years, 43.7% were never or under-screened, and 7.1% had high-risk HPV detected. Overall, 82.1% of the participants reported self-sampling convenient, and 79.3% were not embarrassed when collecting self-samples. However, only 49.8% were confident that they had collected the self-samples correctly. Most (91.1%) of the participants expressed willingness to perform self-sampling again, mostly because it was simple (79.2%) and quick (56.3%). Conclusions HPV self-sampling can serve as an alternative primary screening method for cervical cancer in Hong Kong, especially for individuals who have not been adequately screened in the past. Both face-to-face and online website recruitment were associated with high acceptability, emphasising the potential benefits of utilising different platforms and strategies for reaching diverse populations.

Cervical cancer screening and its associated factors among women of reproductive age in Kenya: further analysis of Kenyan demographic and health survey 2022

Abstract Introduction Although cervical cancer screening is one of the most effective strategies to reduce the incidence and mortality of cervical cancer, the percentage of cervical cancer screening in low- and middle-income counties is low. In Kenya, the current nationwide prevalence and associated factors for the detection of cervical cancer is unknown. Therefore, this study aimed to assess the prevalence and associated factors for the detection of cervical cancer screening among women of reproductive age in Kenya using the Kenyan Demographic and Health Survey 2022. Methods This study used the most recent Kenyan Demographic and Health Survey data (2022) with a total weighted sample of 16,901 women. A mixed effects logistic regression analysis was performed and in the multivariable analysis, variables with a p-value below 0.05 were considered statistically significant. The strength of the association was evaluated using adjusted odds ratios along with their corresponding 95% confidence intervals. Results The prevalence of cervical cancer screening in Kenya was 16.81%(95% CI: 16.24, 17.38%). Having a history of abortion (AOR = 1.33, 95% CI: 1.171.50, 1.43), using modern contraceptive methods (AOR = 1.57, 95% CI: 1.25, 1.95), media exposure (AOR = 1.31, 95%CI: 1.03, 1.65), primary education (AOR = 1.56, 95%CI: 1.09, 2.22), secondary education (AOR = 21.99, 95% CI: 1.1.38, 2.87), higher education (AOR = 2..50, 95% CI: 1.71, 3.65), visiting health facility within the past 12 months (AOR = 1.61, 95%CI: 1.46, 1.79), positive HIV status (AOR: 3.50, 95% CI: 2.69, 4.57), being from a community with a higher proportion of educated individuals (AOR = 1.37, 95%CI: 1.13, 1.65) and being from a community with high proportion of poor individuals (AOR = 0.72, 9 5%CI: 0.60–0.87)) were significantly associated with cervical cancer screening. Conclusion In Kenya, the prevalence of cervical cancer screening was found to be low. A history of abortion, use of modern contraceptives, exposure to the media, visits to health facilities in the past 12 months, HIV status, level of education, community educational level, and community wealth were identified as significant associated factors for cervical cancer screening. Therefore, it is recommended to implement targeted public health interventions that focus on these identified factors to improve the adoption of cervical cancer screening in Kenya.

A hybrid type III effectiveness–implementation study designed to test implementation best practices of deploying a Screen-Triage-Treat approach to cervical cancer screening and management utilizing self-collected HPV DNA testing in Chokwe District, Mozambique

Abstract Background The current World Health Organization (WHO) recommendation for cervical cancer screening utilizing HPV DNA testing is now being endorsed by the Mozambican Ministry of Health (MOH). Initial studies showing the feasibility of screening in the Mozambican context have been encouraging, with women participants reporting a preference for self-collection approaches. A high HPV prevalence among women living with HIV/AIDS will result in a significantly higher number of women requiring follow up, many of whom can receive thermal ablation at the primary level to avoid creating bottlenecks for those who require specialized follow up. Studies designed to evaluate best practices for implementation among a high-risk, lower-resourced population within Mozambique´s already busy HIV care and treatment services are needed to provide the evidence required national scale-up this approach. Methods The overall aim of this study is to evaluate implementation best practices for deploying a Screen-Triage-Treat approach to cervical cancer screening and management utilizing self-collected HPV DNA testing among HIV-infected women in care within select health facilities of Chókwè District, Mozambique. The main objectives are 1) to develop an in-depth understanding of the HPV Screen-Triage-Treat care cascade within HIV care and treatment based on a collaborative, exploration-focused process with local stakeholders; 2) to evaluate the effectiveness of the Screen-Triage-Treat approach utilizing self-collected HPV DNA testing; and 3) to use the Consolidated Framework for Implementation Research (CFIR) to identify factors that explain site- and provider-level variation in the implementation of the Screen-Triage-Treat approach to cervical cancer screening and management. Discussion This study will contribute to the literature related to cervical cancer screening and management, and to implementation science by providing information on how screening and management can be implemented within the high-volume HIV care and treatment clinics of Mozambique. Studies that generate evidence on barriers and facilitators to the uptake of this approach, and that identify context-specific implementation strategies are important for large-scale adoption. The knowledge gained from this study will be used to assist decision makers in determining a course of action for increasing cervical cancer screening and management coverage, optimizing the intervention’s impact, and translating our findings into evidence-based programming. Trial registration NCT06810739 (Protocol ID: 2024–1641). Registered 04 February 2025, at https://clinicaltrials.gov/

Knowledge of Palestinian women about cervical cancer warning signs: a national cross- sectional study

Abstract Background Timely presentation and diagnosis of cervical cancer (CC) are crucial to decrease its mortality especially in low- and middle-income countries like Palestine. This study aimed to evaluate the knowledge of Palestinian women about CC warning signs and determine the factors associated with good knowledge. Methods This was a national cross-sectional study conducted between July 2019 and March 2020 in Palestine. Stratified convenience sampling was used to recruit adult women from hospitals, primary healthcare centers, and public spaces of 11 governorates. A translated-into-Arabic version of the validated CC awareness measure (CeCAM) was used to assess women’s knowledge of 12 CC warning signs. Results Of 8086 approached, 7223 participants completed the CeCAM (response rate = 89.3%). A total of 7058 questionnaires were included in the analysis: 2655 from the Gaza Strip and 4403 from the West Bank and Jerusalem (WBJ). The median age [interquartile range] for all participants was 34.0 [24.0, 42.0] years. Participants recruited from the WBJ were older, getting higher monthly income, and having more chronic diseases than those recruited from the Gaza Strip. The most frequently identified warning sign was ‘vaginal bleeding after menopause’ (n = 5028, 71.2%) followed by ‘extreme generalized fatigue’ (n = 4601, 65.2%) and ‘unexplained weight loss’ (n = 4578, 64.9%). Only 1934 participants (27.4%) demonstrated good knowledge of CC warning signs. Participants from the Gaza Strip were slightly more likely than participants from the WBJ to have a good level of knowledge. Factors associated with having good knowledge included having a bachelor or postgraduate degree, being married, divorced, or widowed as well as knowing someone with cancer. Conclusion The overall awareness of CC warning signs was low. Educational interventions are needed to increase Palestinian women’s awareness of CC warning signs.

Comparison of cervical Cancer-Related knowledge, attitudes, and behaviors among women in urban and rural regions

The aim of this study was to compare the knowledge, attitudes and behaviors of women living in urban and rural areas about cervical cancer. The study was conducted cross-sectionally between May 2024 and December 2024 among women living in rural and urban areas in a province in Western Turkey. The sample of the study consisted of 198 women calculated with the G-Power programme. The data of the study were collected with a questionnaire form consisting of questions about socio-demographic characteristics, knowledge, attitudes and behaviours related to cervical cancer and the Attitude Scale for Early Diagnosis of Cervical Cancer. The necessary permissions were obtained for the conduct of the study. Descriptive statistical analyses, Paired samples t test, Pearson Chi Square, Likelihood Ratio, Binary Logistic Regression tests were used in the statistical evaluation of the study. It was found that the frequency of being a primary or secondary school graduate was higher among those living in rural areas, whereas the frequency of having a university degree or higher, being employed, and having a father with a high school education was higher among those living in urban areas (p < 0.05). Individuals living in urban areas perceived the benefits of early diagnosis screening more than those living in rural areas (p < 0.05). Individuals living in urban areas are more likely to have regular gynaecological examinations and Pap smear tests than those living in rural areas (p < 0.05). In addition, individuals living in urban areas were found to be more knowledgeable about the transmission routes of HPV (p < 0.05). However, individuals living in rural areas were more aware of the effects of early sexual life and multiple sexual partners (p < 0.05). These results reveal that there are differences between urban and rural areas in terms of access to health services, utilisation of health services and difference of the content of health services and women's sexual health knowledge. To address these differences, it is recommended that mobile health services be expanded in rural areas, and that HPV screening programs and educational initiatives be broadened. In urban areas, efforts should focus on developing comprehensive awareness programs that go beyond disease prevention to include promotion of healthy sexual behavior and understanding of associated risk factors.

Barriers and facilitators of pap-smear test uptake in Asia: a systematic review

In addition to the establishment of screening procedures, it is important to identify the barriers and facilitators for promoting preventive behavior. Many studies have been conducted in the field of investigating the factors affecting Pap smear test uptake and the barriers related to it. However, a systematic approach is still needed. Therefore, this present study was conducted with the aim of systematically reviewing the barriers and facilitators of Pap smear test uptake in Asia. To collect the data, searches were performed in PubMed, WOS, ProQuest, Scopus and Cochrane databases from January 1, 2018 to January 15, 2025. Two people separately and independently evaluated the quality of the studies by Newcastle-Ottawa Scale. To conceptualize influential factors, barriers and facilitators of Pap-smear test uptake among Asian women, a theoretical thematic analysis was applied. A search yielded 4057 records, of which 44 documents discussing the determinants, barriers, and facilitators of Pap smear uptake were included in the review. There were economic, social, awareness, test and provider characteristics, and lifestyle and health behaviors dimensions in both categories of barriers and facilitators. In addition, two religious and psychological dimensions were included in the barriers category. In total, 55 components representing barriers and 51 components representing facilitators were identified. To improve Pap smear uptake, implement financial assistance and comprehensive insurance coverage. Enhance community engagement through outreach and support groups, provide counseling, and create positive messaging. Increase accessibility with mobile clinics, flexible hours, and train providers. Promote health education and offer incentives to motivate women to participate in screenings.

Determinants of cancer screening participation in Türkiye: a nationwide study of demographic, socioeconomic, and lifestyle factors

Cancer screening participation rates remain low globally, and understanding the factors influencing these rates is crucial for designing effective public health interventions. This study examines the demographic, socioeconomic, and lifestyle determinants of breast, cervical, and colorectal cancer screening participation in Türkiye. This cross-sectional study utilized data from the 2022 Turkish Health Survey, a nationally representative survey conducted by the Turkish Statistical Institute. The survey employed a stratified two-stage cluster sampling method to ensure national representativeness, covering both urban and rural areas of Türkiye. The study population included 5554 women aged 40-69 years for breast cancer screening, 7277 women aged 30-65 years for cervical cancer screening, and 6541 men and women aged 50-70 years for colorectal cancer screening. Multivariate logistic regression models were used to identify factors associated with non-participation in screenings. Key variables included sociodemographic characteristics, health status, healthcare access, and lifestyle factors. The proportions of individuals who had never undergone screening were 54.1% for colorectal, 45.9% for breast, and 51.4% for cervical cancer. Higher education and income levels were associated with increased screening participation across all cancers. Individuals with chronic diseases and those who had visited family physicians in the past year were more likely to be screened. Participation in one cancer screening significantly increased the likelihood of engaging in others. Women who had undergone cervical cancer screening had a 91% lower odds of avoiding breast cancer screening (OR: 0.09; 95% CI: 0.08-0.11). Those who participated in breast or cervical screening had 45-51% lower odds of avoiding colorectal cancer screening. Cancer screening participation is influenced by sociodemographic factors, healthcare access, and engagement in other screenings. Findings highlight the need for targeted interventions, particularly for underserved populations, and coordinated screening strategies to improve participation and reduce disparities.

Cervical cancer screening coverage and its related knowledge in southern Malawi

Abstract Background Cervical cancer (CC) is the fourth most common cancer among women worldwide and Malawi has the world’s highest rate of cervical cancer related mortality. Since 2016 the National CC Control Strategy has set a screening coverage target at 80% of 25-49-year-old women. The Ministry of Health and Médecins Sans Frontières (MSF) set up a CC program in Blantyre City, as a model for urban areas, and Chiradzulu District, as a model for rural areas. This population-based survey aimed to estimate CC screening coverage and to understand why women were or were not screened. Methods A population-based survey was conducted in 2019. All resident consenting eligible women aged 25-49 years were interviewed (n = 1850) at households selected by two-stage cluster sampling. Screening and treatment coverage and facilitators and barriers to screening were calculated stratified by age, weighted for survey design. Chi square and design-based F tests were used to assess relationship between participant characteristics and screening status. Results The percentage of women ever screened for CC was highest in Blantyre at 40.2% (95% CI 35.1-45.5), 38.9% (95% CI 32.8-45.4) in Chiradzulu with supported CC screening services, and lowest in Chiradzulu without supported CC screening services at 25.4% (95% CI 19.9-31.8). Among 623 women screened, 49.9% (95% CI 44.0-55.7) reported that recommendation in the health facility was the main reason they were screened and 98.5% (95% CI 96.3-99.4) recommended CC screening to others. Among 1227 women not screened, main barriers were lack of time (26.0%, 95% CI 21.9-30.6), and lack of motivation (18.3%, 95% CI 14.1-23.3). Overall, 95.6% (95% CI 93.6-97.0) of women reported that they had some knowledge about CC. Knowledge of CC symptoms was low at 34.4% (95% CI 31.0-37.9) and 55.1% (95% CI 51.0-59.1) of participants believed themselves to be at risk of CC. Conclusion Most of the survey population had heard about CC. Despite this knowledge, fewer than half of eligible women had been screened for CC. Reasons given for not attending screening can be addressed by programs. To significantly reduce mortality due to CC in Malawi requires a comprehensive health strategy that focuses on prevention, screening and treatment.

Barriers, facilitators, needs, and preferences in seeking information regarding cervical cancer prevention programs among Turkish, Moroccan, and Syrian immigrant women: a scoping review

Abstract Background Cervical cancer (CC) is the fourth most frequently diagnosed cancer in women worldwide. Immigrant women are often disproportionately affected by CC but show low participation in CC screening and human papillomavirus (HPV) vaccination. Methods We conducted a scoping review on immigrant women’s information needs regarding CC screening participation and HPV vaccination uptake. A total of 584 articles were found on Embase.com, PsychINFO, and CINAHL, of which 87 articles were included. Results This review revealed that immigrant women indicate a need for more personalized information regarding CC screening and HPV vaccination. We identified barriers to obtaining, processing, and understanding the information, which included overall practical, emotional, cultural and religious aspects (e.g., shame, taboo, lack of trust, fatalism, and cultural norms and values regarding sexual activity). Facilitators, such as translation services, receiving information from people with similar cultural and/or religious backgrounds, encouraging other women or family, and using home visits as an outreach strategy, were also identified. Conclusions Our review provides a comprehensive overview of the information needs and preferences of immigrant women, which could be used to tailor interventions, considering the contextual nuances in which these women are situated. The needs and preferences of immigrant women should be taken into account during the development of new information materials or other interventions. This would help immigrant women make informed decisions regarding participation in CC screening and HPV vaccination.

Socioeconomic inequalities in cervical cancer screening practices in Vietnam: a decomposition analysis

In Vietnam, cervical cancer remains a critical public health issue, with disparities in screening uptake reflecting broader socioeconomic inequalities. This study aims to dissect socioeconomic disparities in cervical cancer screening uptake among Vietnamese women, using data from the 2020-2021 Multiple Indicator Cluster Survey 6 (MICS). Employing a cross-sectional design, we analysed MICS Survey data for women's cervical cancer screening reports over the past three years. The study utilised decomposition analysis to unravel the contributions of various determinants to socioeconomic disparities in screening uptake, employing Poisson regression with robust variance models to explore the association between socioeconomic status, quantified through Wealth Index quintiles, and screening practices. Among participants, 28.2% reported receiving cervical cancer screening. The positive Erreygers concentration index value (ECI) was overall 0.296, which was statistically significant at a 1% level, indicating that cervical cancer screening was predominantly concentrated among individuals with higher wealth index scores. Decomposition analysis indicated that ethnic minority status significantly contributed to this disparity, alongside factors such as education and residency. The use of the concentration index in this study elucidates significant socioeconomic and ethnic inequalities in cervical cancer screening in Vietnam. It underlines the necessity of tailored interventions aimed at the most disadvantaged groups, including ethnic minorities and low-income populations, to mitigate these disparities. Strategic policy reforms and targeted health initiatives are essential for promoting equitable access to cervical cancer screening and improving public health outcomes across Vietnam.

Adherence to national guidelines for colorectal, breast, and cervical cancer screenings in Japanese workplaces: a survey-based classification of enterprises’ practices into “overscreening,” “underscreening,” and “guideline-adherence screening”

Workplace cancer screening programs are determined as part of an employee's benefits package and health checkups are perceived positively. However, the current status of workplace cancer screening programs in Japan is unavailable. This study aimed to assess the adherence to national guidelines for colorectal, breast, and cervical cancer screenings in the workplace among Japanese enterprises and identify factors associated with excessive or inadequate screenings. A cross-sectional study design was employed. Data were obtained from a survey conducted by the "Corporate Action to Promote Cancer Control" between November and December 2022 among registered partner enterprises in Japan. The survey included questions on background characteristics, cancer screening practices, and intervention approaches. The analysis included 432 enterprises that provided complete responses regarding colorectal, breast, and cervical cancer screenings. The guideline-adherence rates for colorectal, breast, and cervical cancer screenings in the workplace were 12.7%, 3.0%, and 8.8%, respectively. Enterprises had lower adherence to screening guidelines than local governments. Colorectal (70.8%) and breast (67.1%) cancer screenings were predominantly categorized as "overscreening" and cervical (60.6%) cancer screening, as "underscreening." Factors such as enterprise scale, health insurance associations, and the number of interventional approaches were significantly associated with increased "overscreening" (101-1000: β = 0.13, p = 0.01; ≥ 1000: β = 0.17, p < 0.01; health insurance association: β = 0.23, p < 0.01; and approaches: β = 0.42, p < 0.01) and reduced "underscreening" (101-1000: β = -0.13, p = 0.01; ≥ 1000: β = -0.17, p < 0.01; health insurance association: β = -0.18, p < 0.01; and approaches: β = -0.48, p < 0.01). Adherence to national guidelines for colorectal, breast, and cervical cancer screenings in the workplace was suboptimal among Japanese enterprises. Therefore, appropriate cancer screening measures and interventions to ensure guideline adherence and optimization of screening benefits while minimizing potential harms should be expeditiously implemented.

The role of knowledge, risk perceptions, and cues to action among Iranian women concerning cervical cancer and screening: a qualitative exploration

Abstract Background Iran has a low incidence but higher rate of death from cervical cancer (CC). The country is in the process of implementing an organized screening program including HPV testing and cytology. Studies show high dropout in continued testing among eligible women. This qualitative study aimed to explore women’s awareness regarding CC and CC testing and the role of knowledge, perceived risk, and cues to action in this process. Method Through a qualitative study based on the Framework Method, we recruited 81 women aged 25–65 who participated in 15 focus group discussions (FGDs) and two in-depth interviews in Tehran. The interviewees were selected purposefully during January to May 2015 from households belonging to different socioeconomic classes until data saturation. The data were acquired through 11 open-ended questions and 32 related probe questions. All interviews were transcribed and independently analyzed by two researchers (Kappa and agreement testing respectively: 0.77, 97.11%). Results The coded texts were categorized under three themes and 13 subthemes. The three thematic areas referred to knowledge, cues to action, and perceived risks regarding CC and screening. The results showed that women had limited and unspecified knowledge about CC and screening, compounded by misconceptions regarding infection and cancer prevention measures. Social and cultural barriers hindered proper communication between health system/providers and clients and within communities on subjects related to CC and screening. The perceived risk of getting CC was low because of overestimating the role of hereditary factors for CC, difficulty in differentiating between cancer and sexually transmitted infections (STI), and the absence of visible symptoms. Conclusion The results indicate a strong need to invest more efforts to improve health education and communication in the current national health program to promote awareness of the need to screen for CC through, for example, establishing correct knowledge and risk perceptions among women. In addition, this intervention should address women’s social environment in order to prevent misconceptions being communicated to women.

Knowledge and attitude towards cervical cancer among reproductive age group women in Gondar town, North West Ethiopia

Abstract Background Cervical cancer is the second most commonly diagnosed cancer and the third leading cause of cancer death in women worldwide. Nearly 83% of the world’s new cases and 85% of all cervical cancer-related deaths occur in developing countries. It is primarily caused by human papilloma virus (HPV); a sexually transmitted pathogen that could be prevented with safe sexual practice and using vaccines among others. The aim of the study was to assess the knowledge and attitude of reproductive age group women towards cervical cancer and its prevention in Gondar town. Methods A descriptive community based cross-sectional study was carried out. An interviewer-administered questionnaire was employed for data collection. A multistage sampling technique was employed to select the study participants. Descriptive statistics like frequency, mean and percentage were computed using SPSS version 20 software program. Results Seven hundred and seventy women (n = 770) participated with a response rate of 100%. More than half, (65.1%) of the participants claim hearing of cervical cancer. However, majority (&gt; 80%) of them lack knowledge that HPV is a causative agent of cervical cancer which is extremely worrying as the most important way to prevent cervical cancer is blocking HPV infection. Of those who had heard of it, only 107 (21.4%) said they have heard about Pap smear test. From them, less than half, 47 (43.9%) said that an apparently healthy woman should undergo the test at least three times in her life. This means in addition to the lack of information about the test, majority of those who had heard about it didn’t know how many times they should have the test in their life. Overall, only 153 (19.87%) of the participants were found having a good knowledge of cervical cancer and its prevention. Conclusion The overall knowledge of women towards cervical cancer was inadequate. On the other hand, those who had heard about it had a somewhat encouraging attitude. Mass media was the major source of information. But, any public health problem cannot be solved in isolation. Hence, initiating large-scale awareness campaigns is recommended.

Cervical cancer screening program based on primary DNA-HPV testing in a Brazilian city: a cost-effectiveness study protocol

Abstract Background The causal relationship between high-risk (hr) HPV infection and precancerous lesions or cervical cancer has led to the development of strategies to increase screening performance and prevent this cancer. The increased sensitivity of DNA-HPV testing compared to cervical cytology favors DNA-HPV testing as a primary screening test. Cervical cancer screening in Brazil is opportunistic, and this cancer remains a considerable health problem with a high proportion of diagnoses in advanced stages. This paper aims to describe the design and implementation of the Cervical Cancer Screening Program with primary DNA-HPV testing (CCSP-HPV) planned for Indaiatuba City (SP), Brazil; the strategies to achieve higher population coverage; and a study protocol for cost-effectiveness analyses. Methods The CCSP-HPV was designed based on successful guidelines that replaced cervical cytology-based screening by the DNA-HPV test performed at 5-year intervals. The screening will be performed for the female population aged 25-64 years cared for by the public health system and aim to reach 80% coverage after completing the first round. The chosen DNA-HPV test detects 14 hr-HPV types and genotypes HPV-16 and 18. All women with a negative test will be reassessed after five years. Women showing a positive test for HPV-16 and/or 18 will be referred for colposcopy. Those showing the other 12 hr-HPV types will be tested by cytology, and if any abnormality is detected, they will also be referred for colposcopy. The histopathologic evaluation will be reviewed by a pathologist panel and aided by p16 immunohistochemistry. A cost-effectiveness analysis will be performed by a Markov model comparing the cost of the new program and the screening performed by conventional cytology five years prior (2011–2016). Discussion The new screening program is considered a breakthrough for public health regarding cervical cancer, which is the third leading cause of cancer death among Brazilian women. Achieving at least 80% coverage will have the possibility to change this scenario. The proposed program will provide a modern cervical cancer screening method for women, and information about cost-effectiveness will help other similar places support the decision of implementing cervical cancer screening using the DNA-HPV test.

Time trends in HPV vaccination according to country background: a nationwide register-based study among girls in Norway

Abstract Background Since the human papillomavirus (HPV) vaccine was introduced in Norway in 2009, the vaccine uptake has increased. Whether this increase is similar regardless of the girls’ country background is unknown. We examined changes in HPV vaccine uptake from 2009 to 2014 and studied the impact of parental education and income on HPV vaccine uptake according to country background. Methods Girls in the first six birth cohorts (1997–2002) eligible for HPV vaccination were identified through the National Registry. Information on HPV vaccination, country background and socioeconomic factors was extracted from the Norwegian Immunisation Registry and Statistics Norway. Risk differences (RDs) and confidence intervals (CIs) were estimated with linear binomial regression. A total of 177,387 girls were included in the study. Results The HPV vaccine uptake increased from 72.5% in 2009 to 87.3% in 2014. The uptake increased for girls in all country background categories. Highest vaccine uptake was observed in girls with East−/South-East Asian background, 88.9% versus 82.5% in the total population. Vaccine uptake decreased slightly with increasing parental education, RD = − 1.6% (95% CI: − 2.3% to − 0.8%) for highest compared with lowest education level. In contrast, the uptake increased with increasing household income, RD = 4.9% (95% CI, 4.3 to 5.5%) for highest compared with lowest quintile. Parental education had largest impact in girls with Asian background, RD = − 8.1% (95% CI − 10.5% to − 5.6%) for higher vs lower education. The largest impact of household income was observed in girls with background from Middle East/Africa, RD for a 200,000 NOK increase in income was 2.1% (95% CI 1.2 to 3.0%). Conclusions The HPV vaccine uptake differed with country background but increased over time in all country background categories. Moreover, the impact of education and income on vaccine uptake differed with country background.

General practitioners may improve cervical screening equality in France

Abstract Background Vulnerable social groups have greater difficulty in accessing care and a lower quality of care. Health systems focused on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care are persisting . We focused on primary care screening for cervical cancer through Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing disease incidence and mortality. In this study, we aimed to investigate the characteristics of women who undergo CUS according to the category of health professionals (general practitioners or gynaecologists) performing CUS and to analyse potential differences in access to care in terms of socioeconomic and geographical characteristics. Methods This was a retrospective observational study based on data from the main health insurance schemes in France, allowing analysis of health care consumption according to socioeconomic levels and proximity to health care services. We included women aged 25 to 64 years in 2012 for whom CUS would be a relevant procedure (695,694). The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed using multinomial logistic regression. Results A total of 202,271 (29%) patients underwent CUS; of whom 68% underwent CUS administered by gynaecologists and 28% were administered by general practitioners (GPs). However, inequalities in CUS screening rates were observed, with a decrease in the number of CUSs performed with increased age, a rural location, deprivation, and sparse health care provisions. Deprived people seemed less penalised by GPs. Conclusions Involvement of General Practitioners may improve cervical screening equality in France. The organisation of health systems around primary care may allow a better access to care and to account for the specific needs of deprived populations.

German mammography screening program: adherence, characteristics of (non-)participants and utilization of non-screening mammography—a longitudinal analysis

Abstract Background In Germany, all women aged 50–69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups. Methods Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1–2, 3–4, 5–6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy. Results Overall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1–2 times, 31.7% participated 3–4 times and 25.6% participated regularly (5–6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50–59 were 25%, 18%, and 15%, respectively. Conclusions Using a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50–59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.

Acceptance of HPV vaccination in boys among mothers from selected churches in Accra, Ghana

Abstract Background Almost all cases of cervical and anal cancer have been linked to the human papillomavirus (HPV). However, in addition to women who develop HPV-related cervical cancer, both men and women can also develop cancers of the anus, oral cavity, and oropharynx that are attributed to HPV. However, literature on HPV vaccination among boys globally, in Africa, and most especially in Ghana is scarce. Thus, the main objective of this study was to explore the acceptance of HPV vaccination in boys among mothers from selected churches in Accra, Ghana. Methods In this study, a qualitative exploratory design was utilized to enlist 30 mothers who have male children aged between 9 and 12 years from the Greater Accra Region of Ghana. The recruitment of participants was carried out using a purposive sampling technique, and they were subsequently interviewed in-depth in a face-to-face setting, with the entire conversation being recorded for reference. After transcription, the recorded data were analyzed through content analysis. Findings Upon analyzing the data, two (2) primary themes and 11 sub-themes emerged. The research showed that although the majority of the mothers were unaware of HPV in boys, they perceived it as a positive initiative and expressed a willingness to allow their sons to receive the vaccine. However, some participants mentioned certain factors that they believed could hinder the acceptance of HPV vaccination in boys among mothers. These included concerns about injection-related pain, high cost, and fears that the vaccine could make men immoral or infertile. Conclusion The study revealed poor awareness of HPV vaccination in boys among mothers, and hence, suggested the need to increase the awareness on HPV vaccination in boys among mothers as well as the public to increase its acceptance.

Exploring the factors contributing to low vaccination uptake for nationally recommended routine childhood and adolescent vaccines in Kenya

Abstract Background Vaccination remains the most effective means of reducing the burden of infectious disease among children. It is estimated to prevent between two to three million child deaths annually. However, despite being a successful intervention, basic vaccination coverage remains below the target. About 20 million infants are either under or not fully vaccinated, most of whom are in Sub-Saharan Africa region. In Kenya, the coverage is even lower at 83% than the global average of 86%. The objective of this study is to explore the factors that contribute to low demand or vaccine hesitancy for childhood and adolescent vaccines in Kenya. Methods The study used qualitative research design. Key Informant Interviews (KII) was used to obtain information from national and county-level key stakeholders. In-depth Interviews (IDI) was done to collect opinions of caregivers of children 0–23 months and adolescent girls eligible for immunization, and Human papillomavirus (HPV) vaccine respectively. The data was collected at the national level and counties such as Kilifi, Turkana, Nairobi and Kitui. The data was analyzed using thematic content approach. A total of 41 national and county-level immunization officials and caregivers formed the sample. Results Insufficient knowledge about vaccines, vaccine supply issues, frequent healthcare worker’s industrial action, poverty, religious beliefs, inadequate vaccination campaigns, distance to vaccination centers, were identified as factors driving low demand or vaccine hesitancy against routine childhood immunization. While factors driving low uptake of the newly introduced HPV vaccine were reported to include misinformation about the vaccine, rumors that the vaccine is a form of female contraception, the suspicion that the vaccine is free and available only to girls, poor knowledge of cervical cancer and benefits of HPV vaccine. Conclusions Rural community sensitization on both routine childhood immunization and HPV vaccine should be key activities post COVID-19 pandemic. Likewise, the use of mainstream and social media outreaches, and vaccine champions could help reduce vaccine hesitancy. The findings are invaluable for informing design of context-specific interventions by national and county-level immunization stakeholders. Further studies on the relationship between attitude towards new vaccines and connection to vaccine hesitancy is necessary.

Space-time analysis of ovarian cancer mortality rates by age groups in spanish provinces (1989–2015)

Abstract Background Ovarian cancer is a silent and largely asymptomatic cancer, leading to late diagnosis and worse prognosis. The late-stage detection and low survival rates, makes the study of the space-time evolution of ovarian cancer particularly relevant. In addition, research of this cancer in small areas (like provinces or counties) is still scarce. Methods The study presented here covers all ovarian cancer deaths for women over 50 years of age in the provinces of Spain during the period 1989-2015. Spatio-temporal models have been fitted to smooth ovarian cancer mortality rates in age groups [50,60), [60,70), [70,80), and [80,+), borrowing information from spatial and temporal neighbours. Model fitting and inference has been carried out using the Integrated Nested Laplace Approximation (INLA) technique. Results Large differences in ovarian cancer mortality among the age groups have been found, with higher mortality rates in the older age groups. Striking differences are observed between northern and southern Spain. The global temporal trends (by age group) reveal that the evolution of ovarian cancer over the whole of Spain has remained nearly constant since the early 2000s. Conclusion Differences in ovarian cancer mortality exist among the Spanish provinces, years, and age groups. As the exact causes of ovarian cancer remain unknown, spatio-temporal analyses by age groups are essential to discover inequalities in ovarian cancer mortality. Women over 60 years of age should be the focus of follow-up studies as the mortality rates remain constant since 2002. High-mortality provinces should also be monitored to look for specific risk factors.

Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island

Abstract Background Réunion Island is a French overseas territory located in the southern Indian Ocean, with a challenging socioeconomic and multicultural context. Compared to mainland France, Réunion has an overincidence and overmortality of cervical cancer. In order to investigate these two issues, it is important to evaluate the barriers and potential levers to Pap smear screening among female inhabitants of the island. We aimed to identify the specific socio-demographic factors, cultural factors, and living conditions associated with Pap smear screening in Réunion, with a view to increasing uptake. Methods We conducted a Knowledge Attitude Behavior and Practices (KABP) survey on cervical cancer screening practices among women aged between 25 and 65 years old living in Réunion Island, selected using random digit dialing sampling. Data were collected using Computer Assistant Telephone Interviews. Weighted chi-squared tests and Student’s t-tests were used to compare women who had up-to-date Pap smear screening with women who did not. Weighted logistic models were used to identify the factors associated with not having up-to-date screening. Results A total of 1000 women were included in the study. Of these, 88.1% had a Pap smear test during the previous three years. Factors independently associated with not being up to date were as follows: aged over 55 (AOR 2.3 [1.2–4.3]), no children (AOR 2.5 [1.4–4.3]), having free universal health coverage (AOR 1.7 [1.1–2.7]), an income per unit consumption lower than 1500€ per month (AOR 2.0 [1.1–3.7]), low health literacy (AOR 2.7 [1.7–4.1]), not consulting a general practitioner in the prior 12 months (AOR 3.6 [2.0-6.5]), and a BMI &gt; 30 (AOR 2.6 [1.5–4.4]). Conclusions This is the first large-scale survey focusing on recommended Pap smear screening uptake in Réunion Island. Although self-reported screening incidence was higher than in mainland France, national screening policies must take into account the island’s diverse social and cultural characteristics (e.g., an ageing population, low health literacy), while implementing actions to fight against poverty and increase general access to healthcare.

The global burden and associated factors of ovarian cancer in 1990–2019: findings from the Global Burden of Disease Study 2019

Abstract Background Ovarian cancer (OC) is a major cause of cancer-related deaths among women. The aim of this study was to estimate and report data on the current burden of ovarian cancer worldwide over the past 30 years. Method Based on the data provided by GBD 2019, we collected and interpreted the disease data of ovarian cancer by incidence, mortality, disability-adjusted life-years (DALYs), and used corresponding age-standardized rates as indicators. Also, we categorized the data by attributed risk factors and captured deaths due to high fasting plasma glucose, occupational exposure to asbestos and high body-mass index, respectively. All outcomes in the study were reported using mean values and corresponding 95% uncertainty intervals (95% UI). Results Globally, there were 294422 (260649 to 329727) incident cases in 2019, and the number of deaths and DALYs were 198412 (175357 to 217665) and 5.36 million (4.69 to 5.95). The overall burden was on the rise, with a percentage change of 107.8% (76.1 to 135.7%) for new cases, 103.8% (75.7 to 126.4%) for deaths and 96.1% (65.0 to 120.5%) for DALYs. Whereas the age-standardized rates kept stable during 1990–2019. The burden of ovarian cancer increased with age. and showed a totally different trends among SDI regions. Although high SDI region had the declining rates, the burden of ovarian cancer remained stable in high-middle and low SDI regions, and the middle and low-middle SDI areas showed increasing trends. High fasting plasma glucose was estimated to be the most important attributable risk factor for ovarian cancer deaths globally, with a percentage change of deaths of 7.9% (1.6 to 18.3%), followed by occupational exposure to asbestos and high body mass index. Conclusions Although the age-standardized rates of ovarian cancer didn’t significantly change at the global level, the burden still increased, especially in areas on the lower end of the SDI range. Also, the disease burden due to different attributable risk factors showed heterogeneous, and it became more severe with age.

The costs of treating vaginal and vulval cancer in England (2009–2015)

Abstract Background Human papillomavirus (HPV) infection is a pre-requisite for cervical cancer, which represents the third most common cancer among women worldwide. A causal relationship also exists between HPV and cancer in other areas of the female reproductive system including the vagina and vulva. Whilst the incidence of vaginal cancer in the UK has remained relatively stable over the past 25 years, vulval cancer rates are increasing. A body of literature exists on the epidemiology and aetiology of vaginal and vulval cancer, but little is known about the economic burden. The objective of this study was to quantify the costs of treating these cancers on the National Health Service (NHS) in England. Methods Inpatient and outpatient episodes were derived from Hospital Episode Statistics (HES). Health Resource Group (HRG) tariffs and National Reference Costs were used to estimate the cost of treating pre-cancerous and invasive vaginal and vulval lesions in England. Results The study showed that for the 5 years from 2009/2010 to 2014/2015 the total cost associated with pre-cancerous and invasive vaginal and vulval lesions was over £14 million per year on average (95% of which was attributed to inpatient costs). Vulval cancer accounted for the largest proportion; an estimated 60% of the total cost (£8.82 million). On average 4316 patients per year in England were admitted to hospital and 912 patients attended outpatient settings for pre-cancerous and invasive disease of the vagina and vulva. Conclusion The results indicate that vaginal and vulval cancer cost the English health care system over £14 million per year. Given the causal role of HPV in a proportion of these cancers, preventative measures such as the national HPV immunisation programme have the potential to reduce the economic burden. To ensure optimal use of NHS resources, it is important that future economic evaluations of such preventative measures consider the full burden of HPV related disease.

Cervical cancer screening prevalence and its correlates in Cameroon: secondary data analysis of the 2018 demographic and health surveys

AbstractBackgroundCervical cancer, although preventable, is the fourth most common cancer among women globally, and the second most common and deadliest gynaecological cancer in low-and-middle-income countries. Screening is key to the prevention and early detection of the disease for treatment. A few studies estimated the prevalence of cervical cancer screening and its correlates in Cameroon but relied on data that were limited to certain regions of the country. Therefore, this study sought to examine the prevalence and correlates of cervical cancer screening among Cameroonian women using current data that is nationally representative of reproductive-age women.MethodsWe used secondary data from the 2018 Cameroon Demographic and Health Survey. Summary statistics were used for the sample description. We employed the Firth logistic regression using the “firthlogit” command in STATA-14 to perform the bivariate analyses between the outcome variable and each of the explanatory variables. Given that all the explanatory variables were statistically significant correlates, they were all adjusted for in a multivariable analysis. All analyses were performed in STATA version 14.ResultsThe proportion of Cameroonian women who have ever screened for cervical cancer continue to remain low at approximately 4%. In the adjusted model, women with the following sociodemographic characteristics have a higher likelihood of undergoing cervical cancer screening: ever undergone HIV screening (AOR = 4.446, 95% CI: 2.475, 7.986), being 24–34 years (AOR = 2.233, 95% CI: 1.606, 3.103) or 35–44 years (AOR = 4.008, 95% CI: 2.840, 5.657) or at least 45 years old (AOR = 5.895, 95% CI: 3.957, 8.784), having attained a post-secondary education (AOR = 1.849, 95% CI: 1.032, 3.315), currently (AOR = 1.551, 95% CI: 1.177, 2.043) or previously married (AOR = 1.572, 95% CI: 1.073, 2.302), dwelling in the richest household (AOR = 4.139, 95% CI: 1.769, 9.682), and residing in an urban area (AOR = 1.403, 95% CI: 1.004,1.960). Except for the North-West region, residing in some five regions, compared to Yaounde, was negatively associated with cervical cancer screening.ConclusionCervical cancer screening programs and policies should target Cameroonian women who are younger, less educated, and those in poor households and rural areas.

Perceptions of key informants on the provision of cervical cancer prevention and control programme in Uganda: implication for cervical cancer policy

Abstract Background Uganda has one of the highest burdens of cervical cancer globally. In 2010 the Ugandan Ministry of Health launched the Strategic Plan for Cervical Cancer Prevention and Control with the hope of developing cervical cancer policy in Uganda. This study explored the beliefs of senior key informants in Uganda about cervical cancer prevention, the control programme, and the relevance of cervical cancer policy. Methods We conducted 15 key informant interviews with participants from six organisations across Northern and Central Uganda. Participants were drawn from district local government health departments, St. Mary’s Hospital Lacor, Uganda Nurses and Midwifery Council, non-governmental organisations (NGOs) and Ministry of Health in Kampala, Uganda. The interview recordings were transcribed and analysed using thematic analysis. Results Seven themes emerged relating to the cervical cancer prevention and control programmes in Uganda: (1) policy frameworks for cervical cancer, (2) operationalising cervical cancer prevention and control, (3) financial allocation and alignment, (4) human resources and capability, (5) essential supplies and vaccines, (6) administrative data and resource distribution, and (7) cervical cancer services. Conclusions The key informants perceive that the lack of a cervical cancer policy in Uganda is hindering cervical cancer prevention and control programmes. Therefore, the Ministry of Health and stakeholders need to work together in coming up with an effective policy framework that will accelerate efforts towards cervical cancer prevention and control in Uganda.

HPV-based cervical cancer screening in Nicaragua: from testing to treatment

Abstract Background In Nicaragua, cervical cancer is the leading cause of cancer death among women. Human papillomavirus (HPV) testing, primarily using self-sampling, was introduced between 2014 and 2018 in three provinces. We analyzed data from the HPV screening program with the goal of describing key characteristics including reach, HPV prevalence, triage and treatment, and factors associated with follow-up completion. Methods We analyzed individual-level data from routinely collected forms for women attending HPV-based cervical cancer screening. HPV-positive women were triaged with Pap or visual inspection with acetic acid (VIA) prior to treatment. Logistic regression was used to identify factors associated with receiving triage and treatment; analyses were adjusted for province, age, and self- vs. provider-collected sampling. Results Forty-four thousand six hundred thirty-five women were screened with HPV testing; 96.6% of women used self-sampling. Six thousand seven hundred seventy-six women were HPV positive (15.2%), 54.0% of screen-positive women received triage, and 53.1% of triage-positive women were treated, primarily with cryotherapy. If women lost at triage are included, the overall treatment percentage was 27.8%. Province and provider sampling were significantly associated with completing triage. Province and triage type were significantly associated with receiving treatment. The odds of receiving treatment after Pap triage as compared to VIA was significantly lower (aOR: 0.05, 95% CI: 0.04–0.08, p  &lt; 0.001), and the relative proportion of women receiving treatment after Pap triage versus VIA was 0.29. Conclusions Introduction of HPV testing resulted in a substantial number of women screened, and acceptance of self-sampling was high. Management of screen-positive women remained a challenge, particularly with Pap triage. Our results can inform other developing countries as they work to reach World Health Organization (WHO) elimination targets.

Health system factors influencing uptake of Human Papilloma Virus (HPV) vaccine among adolescent girls 9-15 years in Mbale District, Uganda

Abstract Background Globally, cervical cancer is the fourth most common cancer in women with more than 85% of the burden in developing countries. In Uganda, cervical cancer has shown an increase of 1.8% per annum over the last 20 years. The availability of the Human Papillomavirus (HPV) vaccine presents an opportunity to prevent cervical cancer. Understanding how the health system influences uptake of the vaccine is critical to improve it. This study aimed to assess how the health systems is influencing uptake of HPV vaccine so as to inform policy for vaccine implementation and uptake in Mbale district, Eastern Uganda. Methods We conducted a cross sectional study of 407 respondents, selected from 56 villages. Six key informant interviews were conducted with District Health Officials involved in implementation of the HPV vaccine. Quantitative data was analyzed using Stata V.13. Prevalence ratios with their confidence intervals were reported. Qualitative data was audio recorded, transcribed verbatim and analyzed using MAXQDA V.12, using the six steps of thematic analysis developed by Braun and Clarke. Results Fifty six (14%) of 407 adolescents self-reported vaccine uptake. 182 (52.3%) of 348 reported lack of awareness about the HPV vaccine as the major reason for not having received it. Receiving vaccines from outreach clinics ( p  = 0.02), having many options from which to receive the vaccine (p = 0.02), getting an explanation on possible side-effects ( p  = 0.024), and receiving the vaccine alongside other services (p = 0.024) were positively associated with uptake. Key informants reported inconsistency in vaccine supply, inadequate training on HPV vaccine, and the lack of a clear target for HPV vaccine coverage as the factors that contribute to low uptake. Conclusion We recommend training of health workers to provide adequate information on HPV vaccine, raising awareness of the vaccine in markets, schools, and radio talk shows, and communicating the target to health workers. Uptake of the HPV vaccine was lower than the Ministry of Health target of 80%. We recommend training of health workers to clearly provide adequate information on HPV vaccine, increasing awareness about the vaccine to the adolescents and increasing access for girls in and out of school.

Integrated cervical cancer screening in Mayuge District Uganda (ASPIRE Mayuge): a pragmatic sequential cluster randomized trial protocol

AbstractBackgroundCervical cancer is almost entirely preventable through vaccination and screening, yet remains one of the ‘gravest threats to women’s lives’ according to the World Health Organization. Specific high-risk subtypes of human papillomavirus (HR-HPV) are well-established as the primary cause of cervical cancer. Uganda has one of the highest cervical cancer incidence rates in the world (54.8 per 100,000) as a result of limited screening access and infrastructure. The integration of a self-collected cervical cancer screening program using HPV testing within existing community-based primary health care services could increase access to screening and reduce cervical cancer rates among Ugandan women.MethodsUsing a pragmatic, sequential, cluster randomized trial design; we will compare the effectiveness of two cervical cancer screening models for self-collected HPV testing: 1) community health worker recruitment (door-to-door); and 2) community health meetings. In Mayuge district, Uganda, 31 villages are randomized to one of two treatment arms. Due to the nature of this trial, blinding is not possible. Women are eligible to participate if they have no previous history of hysterectomy or treatment for cervical cancer or pre-cancer and are aged 25–49 years old. All participants receive an integrated package of cervical cancer screening and education. Samples are tested for HPV using GeneXpert point of care testing. All women who test positive for HR-HPV types are referred to a designated health centre for follow-up inspection by Visual Inspection with Acetic acid (VIA) and treatment with thermal ablation. The primary outcome for the trial is the number of women who attend follow-up for VIA screening at a designated Health Centre after a positive HR-HPV test out of all women screened per arm. Secondary outcomes include: cervical cancer screening knowledge; patient-reported experience measures for self-collected cervical cancer screening; and HPV incidence.DiscussionResults from this study will inform the national scale-up of cervical cancer screening in Uganda, aligning with the World Health Organization’s target of achieving cervical cancer elimination through the pillar of increased HPV screening coverage.Trial registrationISRCTN,ISRCTN12767014. Registered 14 May 2019,10.1186/ISRCTN12767014;clinicaltrials.gov, NCT04000503; Registered 27 June 2019,https://clinicaltrials.gov/ct2/show/NCT04000503Protocol versionJanuary 8, 2020, version 1.

Trends of cervical cancer at global, regional, and national level: data from the Global Burden of Disease study 2019

Abstract Background Cervical cancer is an important global health problem. In this study we aimed to analyze trends in cervical cancer at the global, regional, and national levels from 1990 to 2019, to inform health service decision-making. Methods Data on cervical cancer was extracted from the Global Burden of Disease study, 2019. Trends in cervical cancer burden were assessed based on estimated annual percentage change (EAPC) and age-standardized rate (ASR). Results Globally, decreasing trends were observed in incidence, death, and disability adjusted life years (DALYs) of cervical cancer from 1990 to 2019, with respective EAPCs of − 0.38 (95% confidence interval [CI]: − 0.41 to − 0.34), − 0.93 (95%CI: − 0.98 to − 0.88), and − 0.95 (95 CI%: − 1.00 to − 0.90). Meanwhile, decreasing trends were detected in most sociodemographic index (SDI) areas and geographic regions, particularly death and DALYs in Central Latin America, with respective EAPCs of − 2.61 (95% CI: − 2.76 to − 2.46) and − 2.48 (95% CI: − 2.63 to − 2.32); hhowever, a pronounced increasing trend in incidence occurred in East Asia (EAPC = 1.33; 95% CI: 1.12 to 1.55). At the national level, decreasing trends in cervical cancer were observed in most countries/territories, particularly DALYs in the Maldives (EAPC = − 5.06; 95% CI: − 5.40 to − 4.72), Whereas increasing trends were detected in Lesotho, Zimbabwe, and Bulgaria. Conclusions Slowly decreasing trends in cervical cancer were detected worldwide from 1990 to 2019. Cervical cancer remains a substantial health problem for women globally, requiring more effective prevention and control strategies.

Knowledge, attitude and practices on cervical cancer screening among undergraduate female students in University of Gondar, Northwest Ethiopia: an institution based cross sectional study

Abstract Background Cervical cancer is a major public health problem. In the world, cervical cancer is the fourth most common cancer among women and it is one of the leading causes of cancer mortality in females. It is the second most common women cancer in Ethiopia with almost 6300 new cases and 4884 deaths annually. Despite the high burden of new cases and deaths, there is a scarcity of data on knowledge, attitude and practices (KAP) towards cervical cancer screening among female university students in Ethiopia particularly in the study area. Therefore, the present study was aimed to assess the KAP of undergraduate female students towards cervical cancer screening. Methods An institution based cross-sectional study was conducted in April 2018 at the University of Gondar, College of Medicine and Health Sciences undergraduate female students. Pretested, self-administered questionnaire was used for data collection. Four hundred and three female students were recruited by a simple random sampling method and the data were entered and analyzed using SPSS version 20 statistical packages. Descriptive data analysis was used to report the results. Results More than half of the respondents (59.3.3%) had good knowledge, whereas nearly 67.7% of the respondents had favorable attitude towards cervical cancer. However, less than 1% of the respondents had been screened for cervical cancer. Conclusion Although undergraduate female students had apparently good knowledge and favorable attitude, their practices on cervical cancer screening were quite low. Therefore, the health sectors and the gender streaming office of the university mobilize students to strengthen the uptake the cervical cancer screening practice.

HPV vaccine: uptake and understanding among global Indigenous communities – a qualitative systematic review

Abstract Background Indigenous populations have a high prevalence of Human Papillomavirus (HPV) infection and a high incidence of HPV associated cancers, such as cervical and oropharyngeal cancer. There is an effective HPV vaccination program in almost all developed countries to prevent the incidence of cervical cancer, but reports suggest that the uptake of these vaccinations by Indigenous populations is low. The objective of this qualitative systematic review was to explore the knowledge and beliefs of global Indigenous populations regarding HPV vaccines. This review was performed to identify the barriers faced by Indigenous peoples and to provide evidence for more effective and acceptable execution of vaccination policies for Indigenous peoples. Methods Two investigators independently searched MEDLINE, PubMed, SCOPUS, and Web of Science databases using a pre-specified search strategy to identify qualitative studies on narratives of Indigenous peoples regarding HPV vaccine awareness, knowledge and experiences across all geographic and income-level settings. Results After performing the literature search and quality appraisals 5 papers were included in the final review. Three core synthesised findings were identified: reasons for acceptance or hesitancy, and areas for improvement. Lack of correct knowledge and mistrust in the healthcare system were important categories observed in all papers included in the review. Other categories within the conceptual model included prioritising disease prevention, health professional guidance, family support and supportive community environment. Conclusion Qualitative systematic reviews are an excellent means of exploring the gaps in current healthcare practices. Indigenous healthcare research should be grounded in community experiences and feedback. This review provides insights into HPV vaccination understanding and acceptance amongst Indigenous populations, from which recommendations for increasing resonance of vaccination strategies with Indigenous communities can be formed.

Assessment of secular trends of three major gynecologic cancers burden and attributable risk factors from 1990 to 2019: an age period cohort analysis

Abstract Background This study aims to assess the long-term trends in the burden of three major gynecologic cancers(GCs) stratified by social-demographic status across the world from 1990 to 2019. To assess the trends of risk factor attributed mortality, and to examine the specific effects of age, period, cohort behind them in different regions. Methods We extracted data on the mortality, disability-adjusted life years(DALYs), and age-standardized rates(ASRs) of cervical cancer(CC), uterine cancer(UC), and ovarian cancer(OC) related to risks from 1990 to 2019, as GCs burden measures. Age-period-cohort analysis was used to analyze trends in attributable mortality rates. Results The number of deaths and DALYs for CC, UC and OC increased since 1990 worldwide, while the ASDRs decreased. Regionally, the ASDR of CC was the highest in low SDI region at 15.05(11.92, 18.46) per 100,000 in 2019, while the ASDRs of UC and OC were highest in high SDI region at 2.52(2.32,2.64), and 5.67(5.16,6.09). The risk of CC death caused by unsafe sex increased with age and then gradually stabilized, with regional differences. The period effect of CC death attributed to smoking showed a downward trend. The cohort effect of UC death attributed to high BMI decreased in each region, especially in the early period in middle, low-middle and low SDI areas. Conclusions Global secular trends of attributed mortality for the three GCs and their age, period, and cohort effects may reflect the diagnosis and treatment progress, rapid socioeconomic transitions, concomitant changes in lifestyle and behavioral patterns in different developing regions. Prevention and controllable measures should be carried out according to the epidemic status in different countries, raising awareness of risk factors to reduce future burden.

Common misconceptions and myths about ovarian cancer causation: a national cross-sectional study from palestine

Abstract Background Women’s inability to recognize ovarian cancer (OC) causation myths to be incorrect may lead to behavioral changes that could distract them from actual risk factors and impact their treatment decision making. This study examined Palestinian women’s recognition of OC mythical causes, and explored factors associated with good recognition. Methods A national cross-sectional study was conducted. Adult Palestinian women were recruited from hospitals, primary healthcare facilities, and public areas in 11 governorates. The Cancer Awareness Measure-Mythical Causes Scale was modified and utilized for data collection. Awareness level was determined based on the number of myths around OC causation recognized to be incorrect: poor (0–4), fair (5–9), and good (10–13). Results A total of 5618 participants agreed and completed the questionnaire out of 6095 approached (response rate = 92.1%), and 5411 questionnaires were included in the final analysis. The most recognized food-related myth was ‘drinking from plastic bottles’ (n = 1370, 25.3%) followed by ‘eating burnt food’ (n = 1298, 24.0%). The least recognized food-related myth was ‘eating food containing additives’ (n = 611, 11.3%). The most recognized food-unrelated myth was ‘having a physical trauma’ (n = 2899, 53.6%), whereas the least recognized was ‘using mobile phones’ (n = 1347, 24.9%). Only 273 participants (5.1%) had good awareness of OC causation myths as incorrect. Earning higher monthly incomes as well as visiting governmental healthcare facilities were associated with a decrease in the likelihood of exhibiting good awareness. Conclusion The overall recognition of OC causation myths was low. Addressing mythical beliefs should be included in OC prevention strategies and public health interventions to improve women’s understanding of OC risk factors versus mythical causes.

Using online search activity for earlier detection of gynaecological malignancy

Abstract Background Ovarian cancer is the most lethal and endometrial cancer the most common gynaecological cancer in the UK, yet neither have a screening program in place to facilitate early disease detection. The aim is to evaluate whether online search data can be used to differentiate between individuals with malignant and benign gynaecological diagnoses. Methods This is a prospective cohort study evaluating online search data in symptomatic individuals (Google user) referred from primary care (GP) with a suspected cancer to a London Hospital (UK) between December 2020 and June 2022. Informed written consent was obtained and online search data was extracted via Google takeout and anonymised. A health filter was applied to extract health-related terms for 24 months prior to GP referral. A predictive model (outcome: malignancy) was developed using (1) search queries (terms model) and (2) categorised search queries (categories model). Area under the ROC curve (AUC) was used to evaluate model performance. 844 women were approached, 652 were eligible to participate and 392 were recruited. Of those recruited, 108 did not complete enrollment, 12 withdrew and 37 were excluded as they did not track Google searches or had an empty search history, leaving a cohort of 235. Results The cohort had a median age of 53 years old (range 20–81) and a malignancy rate of 26.0%. There was a difference in online search data between those with a benign and malignant diagnosis, noted as early as 360 days in advance of GP referral, when search queries were used directly, but only 60 days in advance, when queries were divided into health categories. A model using online search data from patients ( n  = 153) who performed health-related search and corrected for sample size, achieved its highest sample-corrected AUC of 0.82, 60 days prior to GP referral. Conclusions Online search data appears to be different between individuals with malignant and benign gynaecological conditions, with a signal observed in advance of GP referral date. Online search data needs to be evaluated in a larger dataset to determine its value as an early disease detection tool and whether its use leads to improved clinical outcomes.

Global and China burden of hormone-related cancers and risk factors, 1990–2021: results from the Global Burden of Disease Study 2021

HPV vaccine knowledge gaps and vaccination intent: a cross-sectional study of vocational students in Southern Xinjiang of China in 2023

Abstract Background Female students in tertiary vocational institutions, particularly in regions with limited medical resources, play a crucial role in grassroots healthcare and cervical cancer prevention. Understanding their awareness of human papillomavirus (HPV), willingness to receive the HPV vaccine, and perceived barriers is essential for promoting vaccination equity. Methods A cross-sectional study was conducted from March to April 2023 among female vocational students in southern Xinjiang, China, using a standardized electronic questionnaire. The collected data included sociodemographic characteristics, HPV-related knowledge, vaccination willingness, and barriers. Descriptive statistics and logistic regression analyses were performed. Results Among 1,157 participants, only 37.0% had heard of HPV, and 28.9% were aware of the HPV vaccine. Univariate analysis revealed that non-medical majors and students from rural areas had significantly lower odds of having adequate knowledge (OR = 0.450, 95% CI: 0.360–0.563, p  &lt; 0.001; and OR = 0.458, 95% CI: 0.350–0.600, p  &lt; 0.001; respectively). In contrast, higher parental education (junior college/bachelor’s degree or above) was associated with 58% greater odds of higher awareness (OR = 1.576, 95% CI: 1.119–2.219, p  = 0.009). Additionally, students who had not heard of HPV or the HPV vaccine were significantly less likely to possess sufficient awareness (OR = 0.230, 95% CI: 0.181–0.293, p  &lt; 0.001; and OR = 0.194, 95% CI: 0.150–0.250, p  &lt; 0.001; respectively). Further, multivariate analysis confirmed that major, residence, prior HPV awareness, and vaccine awareness were independent predictors of knowledge level (all p  &lt; 0.001). Specifically, medical students demonstrated greater knowledge regarding HPV typing (41.8% vs. 25.6%) and optimal vaccination timing (16.7% vs. 7.9%) than non-medical students. Regarding vaccination attitudes, only 32.1% of the overall students expressed willingness to receive the HPV vaccine, with higher willingness rates observed among medical students (44.6% vs. 19.7%), urban residents (47.8% vs. 27.9%), and individuals who were aware of HPV (50.5%) or the HPV vaccine (59.3%). Actual uptake of HPV vaccine, however, remained low (1.1%–4.5%). Regression analysis showed that medical students had 2.4 times higher vaccination intent, and urban residents exhibited 1.7 times higher intent, compared to their counterparts. Furthermore, awareness was positively correlated with willingness to vaccinate, whereas an earlier age at sexual debut was linked to reduced vaccination intent (OR = 0.57, 95% CI: 0.37–0.89; p  = 0.02). The main barrier to vaccination was the low perceived risk associated with young age (45.4%); medical students reported greater concerns about access and cost, whereas psychological barriers, such as worries about side effects and doubts about safety and efficacy, were common across all groups. Conclusions HPV awareness and vaccination uptake among female vocational students in southern Xinjiang remain low. Targeted health education initiatives should focus on non-medical students, rural populations, and individuals from lower socioeconomic backgrounds. Enhancing vaccine accessibility and affordability through institutional and governmental efforts is critical to improving vaccination coverage in this population.

Is the domestic bivalent HPV vaccine cost-effective compared with quadrivalent or nine-valent HPV vaccines in the context of cervical cancer screening? A modeling study

The World Health Organization (WHO) released the Global Strategy for Accelerated Elimination of Cervical Cancer (GSAICC), which points out that low- and middle-income countries are in a difficult situation in terms of the cervical cancer prevention challenge, and that the focus should be on the economics of prevention strategies. In the context of cervical cancer screening, it is unclear whether China's self-developed, domestically produced bivalent HPV vaccine is economical compared to quadrivalent and nine-valent HPV vaccines. To evaluate the cost-effectiveness of bivalent HPV vaccine compared with quadrivalent and nine-valent HPV vaccines in China in the context of cervical cancer screening in China, and to provide a basis for the development of cervical cancer prevention policies in China and other developing countries. A Markov model was developed to evaluate 121 prevention strategies consisting of different HPV vaccines (bivalent, quadrivalent, and nine-valent) combined with different screening methods and screening frequencies from the perspective of the health care system, and to screen for the optimal prevention strategy that best suits the current situation of women aged 15-26 years in China. Probabilistic sensitivity analysis was used to assess the robustness of the model results. Compared with no intervention, vaccination with a domestic bivalent HPV vaccine combined with three years of visual inspection with acetic acid (VIA) screening (ICER= $144.94/QALYs), vaccination with a quadrivalent HPV vaccine combined with three years of visual inspection (ICER= $643.53/QALYs), and vaccination with a nine-valent HPV vaccine combined with three early VIA screenings (ICER = 582.847 $/QALYs) were the optimal prevention strategies for each of the three valent vaccine types. Comparison of the three optimal prevention strategies showed that for Chinese women aged 15-26 years, vaccination with domestic bivalent HPV vaccine combined with three-year VIA screening was the most cost-effective strategy. Probabilistic sensitivity analyses showed that when willingness to pay was low (WTP $2,500), the cost-effectiveness of the nine-valent HPV vaccination combined with three-year VIA screening strategy became the most cost-effective prevention strategy. The cost-effective strategy for each vaccine type was vaccination combined with three-year VIA screening compared with the current situation. Comparing the three optimal strategies, it was found that bivalent HPV vaccine combined with three-year VIA screening is the most cost-effective prevention strategy at this stage when the willingness to pay is low, and with the gradual increase in willingness to pay, the nine-valent HPV vaccine combined with three-year VIA screening will become the optimal prevention strategy. It is recommended that the Chinese government consider gradually increasing the vaccination coverage of domestically produced bivalent HPV vaccines through immunization programs, while promoting preventive measures that combine VIA screening with vaccination. This approach will help developing countries, including China, achieve the goal of eliminating cervical cancer.

Iranian women’s perceptions of human papillomavirus and barriers to vaccination: a qualitative study based on the health belief model

Human papillomavirus (HPV) is a common sexually transmitted infection (STI) and the main cause of precancerous changes in the cervix. Despite the undeniable role of HPV vaccines in preventing cervical cancer, the vaccination rate has remained low. The perception of a disease can predict preventive behaviors such as vaccination. This qualitative study aimed to explore women's perceptions of HPV and its vaccine. In-depth, semi-structured interviews were conducted in four focus groups (FG) with 23 eligible women (aged 15-45), who had no prior history of cervical cancer, HPV infection, and vaccination. Interviews were recorded, transcribed verbatim, and analyzed using a directed content analysis approach based on the Health Belief Model (HBM). Perceived sensitivity, the risk of HPV infection, benefits and barriers of HPV vaccination, cue to action, self-care, and new category named social support were the main categories that emerged. Two main concerns for women included worries about the virus leading to cancer as well as marital and sexual relationship tension in case the husband contracts an infection. Main barriers to vaccination included informational, psychological, socio-cultural, and economic barriers. Self-protection acts, stress management, and medical care were the women's main perceptions of self-care and they expressed a need for informational, emotional, and financial support. The results of our study indicate that educating women and their families, improving people's sexual health awareness, integrating the vaccine into the national vaccination program, and establishing sexual health counselling units at healthcare centers are essential actions for encouraging women to get vaccinated and preventing HPV infection and its related adverse outcomes such as cancers.

Transport stipend to facilitate cancer early detection: experiences of beneficiaries and perspectives of program personnel in Rwanda

Transportation barriers can hinder patients' access to timely cancer diagnosis and treatment, particularly in low- and middle-income countries. In Rwanda, where cervical and breast cancer burdens are high, support through transport stipends can alleviate transportation barriers and improve patient outcomes. This study aims to understand the experiences and perspectives of women beneficiaries and program personnel involved in Rwanda's Bugesera District transport stipend program. Purposive sampling selected seventeen participants for in-depth interviews, including twelve women beneficiaries and five program personnel. Document review and household visits provided context. From September 2021 to May 2023, 204 women attended follow-ups for cervical and breast cancer screening and 75% of them received transport stipends. Five themes emerged from beneficiaries' interviews: financial difficulties in accessing transportation for cancer care, impact of transport stipend on access to cancer services, barriers faced during transportation to cancer services, challenges in the process of receiving transport stipend, and recommendations to overcome stipend provision challenges. Five themes emerged from program personnel's interviews: impact of transportation stipend on access to cancer services, challenges in the process of providing transport stipend, recommendations to overcome stipend provision challenges, recommendations for implementation of transport stipend in other settings, and sustainability. The stipend was found to be impactful, but challenges in the provision process, including communication and delays, were identified. Insufficiency of the stipend was highlighted, with recommendations to expand coverage to other expenses. The study highlights the role of transport stipends in improving cancer early detection and linkage to needed follow-up and recommends strong partnerships and funding for program replication and sustainability. These findings can inform the planning of similar programs in low-income countries of Sub-Saharan Africa.

Perceptions and sentiments associated with HPV vaccine uptake among Indian Reddit users: a qualitative social media analysis

Cervical cancer is mainly caused by the human papillomavirus (HPV), a sexually transmitted infection. An effective prevention method includes early screening and vaccination. HPV vaccine uptake is low in India, despite the approval of various vaccines. It has been observed that multiple factors affect the uptake of the vaccine. Social media platforms give space to the users to vocalize their views better. Therefore, this study aims to assess the perceptions and sentiments associated with HPV vaccine uptake among Indian Reddit users. This qualitative study analyzed the posts related to the HPV vaccine during the timeframe of 1 July 2023 to 31 December 2024, taken from the Indian population's Reddit social media platform. Sentiment analysis was done on sentiment distribution using the Valence Aware Dictionary and sEntiment Reasoner (VADER) package. Content analysis was done manually using a deductive approach, and a stepwise thematic analysis was done. The 5 A model (access, availability, awareness, acceptance, and activation) was used as the conceptual framework for vaccine uptake. For other relevant analysis, R software version 4.5.0 was used. A total of 3,743 Reddit posts were extracted, and 339 of these were found to be relevant according to the 5 A framework and subsequently coded. Among the coded texts, the majority of responses were found to have a neutral sentiment (46%), followed by positive sentiments (33.6%) and negative sentiments (20.4%), respectively. Four themes were identified: access, availability, awareness, and acceptance. A tree-cum heat map for both positive and negative sentiments shows the frequency of the codes in accordance with their repetition in the posts. High cost, safety concerns, misinformation, limited access, and cultural factors were the key negative sentiments identified, while positive sentiments included right knowledge, healthcare worker (HCW) recommendations, personal health beliefs, and past experiences. Social media and peer influence emerged as both an enabler and a challenge. The study reveals a complex mixture of knowledge gaps, attitudes, systemic barriers, and social influences that inform decision-making. These findings may help policymakers to enhance the vaccine coverage in an effective manner through targeted, culturally sensitive awareness campaigns during the national rollout.

Evaluating the quality and reliability of cervical cancer related videos on YouTube, Bilibili, and Tiktok: a cross-sectional analysis

Cervical cancer continues to pose a significant global health burden for women, especially in low-resource settings. Although HPV vaccination and screening programs are available, public awareness remains limited. Social media platforms have become major sources of health information; however, the quality of content varies considerably. This study assesses the quality, reliability, and dissemination patterns of cervical cancer-related videos on YouTube, Bilibili, and TikTok, with a focus on how uploader characteristics influence information accuracy. On February 21, 2025, we retrieved the top 100 videos using the keyword "cervical cancer" on YouTube, and its Chinese equivalent "" on Bilibili and TikTok. Two independent reviewers evaluated video quality using the Global Quality Score (GQS), Video Information and Quality Index (VIQI), modified DISCERN (mDISCERN), and Patient Education Materials Assessment Tool (PEMAT). Inter-rater agreement was assessed, and statistical analysis was performed using non-parametric tests and Spearman correlation. A total of 84 YouTube videos, 82 Bilibili videos, and 91 TikTok videos were included. TikTok videos showed significantly higher user engagement than those on other platforms (p<0.001), but scored significantly lower in GQS, VIQI, mDISCERN, and PEMAT evaluations (p<0.001). Videos uploaded by professionals consistently received higher quality scores than those from non-professionals. (p<0.001) Although TikTok had higher uploader activity, its content was largely based on personal experiences, lacking scientific rigor and practical guidance. The video quality on TikTok and Bilibili is negatively correlated with their interactivity. The three platforms show distinct differences in how cervical cancer-related health information is disseminated. TikTok demonstrates superior dissemination and engagement performance, whereas YouTube provides higher content quality and credibility. These findings underscore the importance of leveraging each platform's strengths to promote evidence-based health communication.

Barriers and facilitators to cervical cancer screening among under- and neverscreened women in Flanders, Belgium – a qualitative study on community and healthcare providers’ perspectives

Cervical cancer is detectable and preventable in premalignant stages. In 2013, a population-based cervical cancer screening (CCS) programme was set up in Flanders (Belgium) promoting screening by means of sending reminder letters. Yet, in 2021, only a CCS coverage of 63.6% has been reached, which is just a bare increase since the implementation of the programme (62.7% in 2013) (Jaarrapport 2022, Centrum voor Kankeropsporing (CvKO), 2022; Jaarrapport 2015, Centrum voor Kankeropsporing (CvKO), 2015). To explore the characteristics of under- and neverscreened women in Flanders and to gain a better understanding of the barriers that prevent these women from attending CCS as well as factors that may facilitate CCS uptake. Twelve in-depth interviews and six focus group discussions were conducted with gynaecologists, general practitioners, community health workers and stakeholders providing support to women belonging to potentially underscreened population groups. Reported barriers and facilitators were subsequently classified using the Socio-Ecological Model (SEM). Finally, a causal loop diagram was constructed to visualise the dynamic interrelations among the barriers and facilitators. Stakeholders and healthcare professionals confirm the vulnerability for cervical cancer screening in women with a substance use disorder and women with a migration background. The participation in screening among female sex workers is contingent upon their specific work environment. The group of never- or underscreened women is very heterogeneous and includes many women who are either unaware of CCS or have other priorities. A lack of focus on prevention is the most commonly reported barrier at the healthcare system level. Increasing awareness about cervical cancer (screening) and creating more opportunities for healthcare workers to offer prevention services are the primary facilitators. To improve screening participation in Flanders, different screening strategies tailored to a diversity of women are needed.

Preventive insights and practices of female health professionals regarding cervical cell dysplasia: a cross-sectional study in Egypt

Abstract Background Cervical dysplasia is preventable through screening methods and Human Papillomavirus (HPV) vaccination. Cervical cancer (CC) mortality is disproportionately higher in low-and-middle-income nations, which lack a population-based screening program. Health professionals should promptly counsel and educate females about cervical dysplasia prevention. Aim this work aimed to determine the level of knowledge, attitudes, and practices of female health professionals about cervical cell dysplasia. As well as addressing the potential barriers against routine cytological screening tests. Methods A cross-sectional multicentric study at two tertiary hospitals; Tanta and Menoufia University Hospitals, recruited 1300 women (physicians, nurses, pharmacists, and dentists) via a multistage stratified random sampling technique. A self-administered questionnaire consisting of 4 sections was used to collect the relevant data. Results Across all professions, 25% and 49.2% respectively had good knowledge levels and positive attitudes regarding cervical dysplasia. The majority had not been vaccinated against HPV nor undergone a Pap smear. Older age, urban residence, and positive family history were significant predictors of negative attitudes towards screening, p  &lt; 0.0001, beta 95%(CI) = -0.8 ( -0.1,-0.05), -0.9 (-1.2,-0.6), -0.2 (-0.8,0.4)) respectively. The most encountered barriers opposing screening included lack of awareness about health facilities providing CC screening and the belief that there is no need so far, no complaints (72.6%,73%). Conclusion Female health professionals possessed acceptable knowledge and relatively positive attitudes regarding CC prevention, while their practices were discouraging. Believing that CC is a curse was the main culprit of refraining screening. It is pivotal to enhance accessibility to cervical screening services in various healthcare settings and boost the knowledge of health practitioners as they are key promoters of public health.

Effects of an educational health promotion intervention to improve human papillomavirus vaccination acceptance and uptake among adolescent girls: a cluster randomized controlled trial

Abstract Background Human Papillomavirus (HPV) is the most common sexually-transmitted infection worldwide and the primary cause of cervical cancer. Although timely vaccination can prevent HPV infection and reduce the risk of cervical cancer, vaccine uptake among target groups such as adolescent girls is suboptimal. This study aimed to investigate the effects of a school-based educational health promotion intervention to improve HPV vaccine acceptance and uptake among young adolescent girls. Methods A cluster randomized controlled trial was conducted with 1,340 female adolescents (Mean age: 15.3 years [S.D.: 1.1]) recruited from 18 secondary schools. Recruited schools and the respective participants were randomized to either the intervention or control group in a 1:1 ratio. The school-based intervention was delivered by a registered nurse and included a health talk, small group discussions, and an online game covering topics such as stages of cervical cancer, HPV infection, and HPV vaccination. Outcome measures were participants’ uptake of HPV vaccination, intention to receive HPV vaccination, and knowledge and attitudes towards HPV vaccination, which were collected at either or both 1-month and 1-year post-intervention. Data were analyzed through a random intercept mixed-effects model. Results No significant differences were found in the HPV vaccine uptake rate and uptake intention of the two groups, though more participants in the intervention group (11.9%) were vaccinated at 1-year post-intervention compared to those in the control group (7.9%). Significant improvements were found in the intervention group’s attitudes towards HPV vaccination, particularly in the subscales of Barriers (B=-2.20, 95% CI, [-3.46, -0.94], p = 0.001), Risk denial (B=-0.82, 95% CI, [-1.60, -0.05], p = 0.038), and Uncertainty (B = 0.72, 95% CI, [0.16, 1.27], p = 0.011). Significant improvements were also found in the intervention group’s knowledge of HPV (B = 0.94, 95% CI, [0.16, 1.72], p = 0.018). Conclusions The programme was beneficial in improving adolescent girls’ knowledge and attitudes, though there is room for optimization in order to significantly improve vaccination intent and uptake. Future studies may investigate lengthier interventions involving other stakeholders such as parents and healthcare providers. An adapted programme may also be investigated among other demographics such as older females and adolescent boys. Trial registration ClinicalTrials.gov, NCT04438291; Registration date: 2020-06-18.

Associations of socioeconomic factors with parents’ awareness and acceptability of HPV vaccination in sub-Saharan Africa - a systematic review and meta-analysis

Abstract Background Despite the effectiveness of Human Papillomavirus (HPV) vaccines in preventing cervical cancer, the low coverage of the vaccine remains a significant challenge, particularly in Sub-Saharan Africa, where the disease burden is high, and access to preventive services is limited. Socioeconomic determinants play a central role in shaping health behaviors and health outcomes. The uptake of the HPV vaccine is partly determined by parental decision-making, and this review aimed to examine whether socioeconomic factors are associated with awareness and acceptability of HPV vaccination among parents in sub-Saharan Africa. Methods A systematic literature review was carried out according to the Preferred Reporting Items for Systemic Reviews and Meta-analysis guidelines. The databases searched included Medline, Embase, Web of Science, and the Cochrane Library. Three independent reviewers conducted the screening, study selection, data extraction and risk of bias assessment. Meta-analyses were performed and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation. Results The review included 26 articles, comprising 24 cross-sectional and two cohort studies. Seven studies examined parental awareness, 14 studies examined parental acceptability, and four studies examined both outcomes. Parents’ awareness of the HPV vaccine was associated with higher levels of education (OR = 3.81, 95% CI: 2.11–6.88, I2 = 84%, four studies), higher income (OR = 1.96, 95% CI: 0.72–5.29, I2 = 89%, four studies), moderate income (OR = 1.22, 95% CI: 0.67–2.23, I2 = 74%, four studies). Parents’ acceptance of HPV vaccination was associated with higher levels of education (OR = 2.06, 95% CI: 1.35–3.15, I2 = 77%, seven studies), higher income (OR = 2.16, 95% CI: 1.21–3.84, I2 = 77%, five studies), moderate income (OR = 1.33, 95% CI: 0.86–2.07, I2 = 74%, five studies) and urban residence (OR = 1.28, 95% CI: 0.84–1.96, I2 = 64%, five studies). The certainty of evidence ranged from low to very low. Conclusions There may be a positive association between socioeconomic status, especially higher education and higher income, and parental awareness and acceptance of HPV vaccination. However the evidence is currently limited and inconsistent.

Efforts to increase uptake of cervical cancer screening in the absence of a national programme in Ghana: a qualitative study of stakeholders’ experience

Cervical cancer is the fourth most frequently diagnosed cancer in women globally. Ghana, West of Sub-Saharan Africa (SSA), is reported to have a high crude cervical cancer incidence of 18.3 per 100,000 women. Cervical cancer screening (CCS) uptake in Ghana has been reported to be between 0.8% and 12%. Ghana, like many developing countries worldwide, are yet to experience the benefits of organised screening. This study sought to understand the direct and indirect actions of key stakeholders in Ghana that contributed to the promotion of CCS in a country without a population-based screening programme. Primary qualitative data was obtained from 16 stakeholders using in-depth interviews via ZOOM virtual platform. Stakeholders were those involved in the delivery of CCS activities and were identified through purposive and snowball sampling. Transcripts were manually created from verbatim accounts of interviews. Data was managed in NVivo software and analysed using an inductive approach to qualitative data evaluation. Emerging themes were drawn out by thematic analysis. Key findings identified were intra-health facility-based factors that promoted CCS including cost control measures, screening methods, opportunistic CCS, promotion linked activities and innovative health practices. Additionally, sponsored mass CCS, staff training, policy advocacy and proactive health promotion and education were extra-health facility-based factors that stakeholders felt led to CCS uptake at the facility and community levels. Stakeholders played an active role in promoting CCS using health education through health promotional measures such as mass media advertisements, electronic fliers, creating social media content especially during the Cervical Cancer Awareness Month (CCAM) in January. CCS costs were often reduced during in January because of negotiations with non-governmental organisations and corporate bodies, ultimately resulting in sponsored mass cervical cancer screening which improved cervical cancer screening uptake. In the absence of a national cervical cancer screening programme, the study found out that it is the contributions of committed stakeholders that may be ensuring the continued existence of CCS services in Ghana. The goodwill that is shown by society during the CCAM in January should be harnessed to broaden the scope and reach of cervical screening activities beyond January.

Determinants of cervical cancer screening uptake in Lesotho: evidence from 2024 Demographic and Health Survey data

Cervical cancer affects approximately 13.1 women per 100,000 globally, with its incidence rates varying significantly across regions. Low- and middle-income countries bear the highest burden, partly due to inadequate access to preventive measures, such as regular screening and timely treatment. This study aims to identify the determinants of cervical cancer screening uptake among women of reproductive age in Lesotho, using data from the most recent Demographic and Health Survey. A total of 3,250 women were included in this study, utilizing data from the 2024 Lesotho Demographic and Health Survey. The analysis was conducted using STATA version 17.0. A multilevel mixed-effects logistic regression model was employed to identify potential factors associated with the outcome variable. Variables with p-values less than 0.05 were considered statistically significant. The practice of cervical cancer screening was found to be 38.90% [95% CI: 37.20-40.60]. The odds of cervical cancer screening uptake were significantly higher among women aged 20-49 years compared to those aged 15-19 years. Women with primary and secondary education levels were approximately 5.8 times more likely to undergo screening [AOR = 5.779, 95% CI: 1.1-30.0 and AOR = 5.79, 95% CI: 1.0-30.6], respectively, than women with no formal education. At the community level, women with high media exposure were 1.6 times more likely to be screened [AOR = 1.56, 95% CI: 1.05-2.33] compared to those with low media exposure. Cervical cancer screening rates were found to be low in this study. To encourage screening behavior, raising awareness through accessible media platforms and providing education to women could be effective. Additionally, older age was identified as a factor positively associated with screening uptake. The government should prioritize cervical cancer prevention and screening, as it remains the most cost-effective method for preventing cervical cancer.

Cervical cancer screening uptake in Côte d’Ivoire: Analysis of prevalence and associated factors

Cervical cancer is a major public health concern that affects millions of women worldwide. Screening for cervical cancer is one of the preventive interventions. However, cervical cancer screening uptake is low in sub-Saharan African countries. This study examined the prevalence of cervical cancer screening and its associated factors among women of reproductive age in Côte d'Ivoire. A weighted sample of 6,855 women aged 30-49 years was drawn from the 2021 Demographic and Health Survey (DHS) of Côte d'Ivoire. The DHS used a cross-sectional design, and respondents were sampled using a multistage cluster sampling technique. Percentages with confidence intervals (CIs) were used to summarise cervical cancer screening uptake. We used multilevel binary logistic regression analysis to examine the factors associated with cervical cancer screening uptake. Stata 18 was used for all the analyses and statistical significance was set at p < 0.05. The proportion of women screened for cervical cancer was 7.7% [6.4, 9.3]. The odds of cervical cancer screening uptake increased with increasing levels of education, with the highest odds among women with higher education [adjusted odds ratio (aOR) = 2.34; 95% CI = 1.14, 4.79]. Women covered by health insurance [aOR = 2.63; 95% CI = 1.48, 4.69] and those who had visited a health facility in the last 12 months before the survey [aOR = 1.83; 95% CI = 1.27, 2.65] were more likely to be screened for cervical cancer compared to their counterparts who were uninsured and those without a history of health facility visits, respectively. Also, the odds of cervical cancer screening uptake increased with an increasing wealth index, with the highest odds among those in the richest wealth quintile [aOR = 4.67; 95% CI = 1.66, 13.12]. Cervical cancer screening uptake was low in Côte d'Ivoire. To achieve Sustainable Development Goal 3, health authorities, policymakers, and other stakeholders could implement strategies to scale up uptake. The identified associated factors could aid in the development of cervical cancer screening interventions.

Stakeholders’ perspectives on lessons learnt from HPV mass vaccination in Nigeria

Abstract Background To effectively reduce the risk of cervical cancer, Nigeria launched the HPV vaccine introduction using a phased approach; first phase in October 2023 across 16 states and the second phase across 21 states in May 2024. This initiative aimed to protect girls aged 9–14 from HPV infections, a primary cause of cervical cancer, through strategic planning and targeted implementation. This paper aims to share the Stakeholders' perspectives from nine states in Nigeria on lessons learnt during HPV vaccination that could be adopted in future campaigns and vaccinations. Methods The study adopted a qualitative research design to evaluate the strategies deployed, challenges encountered, and lessons learned from the HPV Phase II vaccination campaign. Key informant interviews and in-depth interviews were conducted with officers of the healthcare agencies at the national, state, local government and ward levels and representatives of CSOs, who had key information about the strategies and those who implemented policies during the HPV mass vaccination in nine states in Nigeria. The qualitative data was validated, transcribed, coded and analyzed thematically. Results Key components of the campaign included the establishment of fixed and temporary vaccination posts, strategic school and community engagement, and targeted communication efforts via social media, influencers, and local leaders. Cultural sensitivity, trained health workers, and data-driven micro plans were emphasized to enhance the program's effectiveness. The campaign successfully raised awareness and increased vaccination coverage across the nine targeted states. Effective strategies included leveraging cultural sensitivity, utilizing trained health workers, and employing data-driven micro plans to address logistical challenges. Despite these successes, significant challenges were encountered. Vaccine hesitancy fueled by misinformation about sterility, limited resources, security concerns, and difficulties accessing remote areas posed barriers to achieving wider coverage. Key lessons from the campaign highlighted the importance of early planning, effective rumor management through existing networks, and the crucial role of influential community members in amplifying the message and encouraging participation. Conclusion The findings highlight critical lessons for future vaccination programs. Early planning, proactive social mobilization, effective rumor management, and leveraging community networks were instrumental in enhancing vaccine acceptance and coverage. These strategies serve as a model for overcoming barriers to public health interventions and should be prioritized in future efforts to improve HPV and other vaccination programs in Nigeria.

Individual-level characteristics and geospatial factors associated with cervical cancer screening participation in Alberta, Canada: a population-based cross-sectional study

Abstract Background Cervical cancer is the fourth most common cancer in women worldwide. Effective primary prevention with human papillomavirus vaccination and secondary prevention with screening can prevent most cervical cancer cases. Cervical cancer screening uptake varies among women in underserved populations. Research that adds to the understanding of the individual and geographic area-level characteristics of women and their screening status is valuable for public health intervention planning. This study aimed to identify these characteristics related to cervical cancer screening status. Methods The study population included women between the ages of 28 to 69 years in Alberta. Data was extracted from administrative health data sources and linked to the Alberta Cervical Cancer Screening Program database to determine screening status. Descriptive bivariate analysis was conducted to describe variations in cervical cancer screening statuses and individual-level sociodemographic, health system factors, and geographic characteristics. Multinomial logistic regression analysis was conducted to investigate the relationship between these characteristics and screening participation. Geospatial analyses including heat maps were used to visualize variation in screening participation across the province. Getis-Ord Gi* hot-spot analysis was used to determine the location and magnitude of spatial autocorrelation. Results The study included 933,965 eligible women. Compared with those who are currently up-to-date for screening, those who have no record of screening tend to be older (OR: 3.63; 95% CI: 3.57 to 3.70), reside in the South Zone (OR: 1.51; 95% CI: 1.47 to 1.55), were health system non-users (OR: 2.95: 95% CI: 2.86 to 3.04), did not see a general practitioner (OR: 13.86; 95% CI: 13.32 to 14.43), or had no usual provider of care (OR: 3.227; 95% CI: 3.141 to 3.315). There are statistically significant hot spots of women who are overdue or have no record of cervical cancer screening in the North, Central, and Calgary Zones. Conclusions This study found that cervical cancer screening participation varied across geographical, health system and sociodemographic characteristics and identified clusters of regions with higher proportions of women who are under-screened in Alberta, Canada. Overall, these findings will help inform the design of interventions that aims to improve cervical cancer screening participation among underserved groups.

How delays in seeking medical care for cervical cancer patients are affected by their health-seeking behaviour: a qualitative study

Cervical cancer is a global health challenge for women, characterized by high morbidity and mortality rates, along with long-term health consequences and economic burden. Early screening and timely treatment can effectively manage cervical cancer, making it crucial for patients to seek medical attention promptly. Positive health-seeking behaviors (HSB) involve the awareness of health issues, self-assessment of health status, and the proactive gathering of information and taking appropriate actions to maintain health. Positive HSB are key to reducing the risk of delayed healthcare access for cervical cancer patients. However, delays in seeking medical care remain prevalent globally. This study aimed to explore the underlying factors contributing to delayed medical care in cervical cancer patients. The findings provide a basis for improving the timely access to care for these patients. The study was conducted between July 2024 and October 2024 at a tertiary oncology hospital in China. Cervical cancer patients who experienced delays in seeking medical care were purposively sampled and interviewed. Health-seeking behaviours were collected through semi-structured interviews. Data were analyzed using a theory-driven thematic approach, guided by the Health Belief Model (HBM). Seventeen cervical cancer patients participated in the study. Four themes emerged: (1) perception and assessment of symptoms (lack of knowledge, benign attribution of symptoms, ignorance of symptoms); (2) perceived threat of the disease (feeling healthy, low susceptibility, no symptomatic threat); (3) perceived benefits and barriers to health-seeking behaviours (reduced disease threat, alleviated psychological and financial burden, low awareness of healthcare access, health insurance coverage, limited healthcare resources); and (4) cues to action (family support, symptom exacerbation). In general, patients with cervical cancer who lack knowledge about the disease and have a diminished perception of the threat of the disease may or may not choose to seek timely medical care after assessing the benefits of health-seeking behaviours and the barriers they face. This study identifies key barriers to health-seeking behaviours among cervical cancer patients, including limited awareness of early symptoms and underestimated perceptions of risk and severity. It suggests that future interventions should adopt a multifaceted approach targeting healthcare providers, patients, and their social support systems. This strategy should emphasize disease-related knowledge and timely health-seeking behaviours. Clinically, greater emphasis on culturally sensitive communication and patient education is needed to reduce stigma and fear associated with gynecological care. At the policy level, expanding access to affordable screening services and strengthening rural healthcare infrastructure could help reduce disparities and promote earlier diagnosis and treatment.

The effect of health education on hypertension, diabetes mellitus, and cervical cancer screening service utilization among eligible adults in a district around Bahir Dar city, Ethiopia: a cluster randomized controlled community trial

While screening service utilization is a proven strategy for early detection of noncommunicable diseases, population-based health checkup service utilization is very low in Ethiopia. This study aimed to assess the effect of health education in improving hypertension, diabetes mellitus, and cervical cancer screening service utilization in a district around Bahir Dar City, Ethiopia in 2024. A cluster randomized controlled community trial was conducted in a district around Bahir Dar City among 214 adults in the intervention and control groups each. The intervention was health education. Trained parent-teacher association members provided a 30 min to 1 h education for the community using the existing social structures. Adults in the control group continue receiving the routine education through the health care system A structured interviewer-administered questionnaire was used to collect data. MacNemar's test was used to assess the intervention effect. Binary logistic regression was also used to assess the intervention effect after controlling confounders. Overall difference in knowledge level of adults between the intervention and control groups was 34.4% (P < 0.005). This difference persists after controlling potential confounders. Respondents in the intervention group had 2.2 times better knowledge about noncommunicable diseases compared with respondents in the control group [AOR = 2.22, 95% CI: (1.4, 3.4)]. The overall difference in utilization of screening services for targeted NCDs between the intervention and control groups was 28.1% (P < 0.001). This difference persists after potential confounders were controlled. Respondents in the intervention group were 4.8 times more likely to utilize screening services compared with respondents in the control group [AOR = 4.83, 95% CI: (2.7, 8.5)]. Health education intervention through parent-teacher association members was an effective approach to improve screening service utilization. This study suggests to use parent-teacher association members to promote screening service utilization through the existing social structures. The trial was registered in Clinical Trials.gov (NCT06639412).

Sociocultural factors influencing women’s adherence to colorectal, breast, and cervical cancer screening: a systematic review

Cancer remains a leading cause of death among women globally, with breast, colorectal, and cervical cancers being the most prevalent. Despite established screening programs, low adherence rates persist, contributing to the continued high incidence of these cancers. Among the many influencing factors, sociocultural beliefs play a significant role in shaping women's health behaviours, often resulting in poor participation in screening initiatives. This systematic review aims to provide a thorough analysis of the impact of sociocultural factors on women's adherence to breast, colorectal, and cervical cancer screening. This review focused on the influence of sociocultural belief factors on cancer screening adherence among women, hence PRISMA checklist was used, and the study was registered with PROSPERO. A systematic search of PubMed, Scopus, and Web of Science databases without any time limit and after applying strict inclusion and exclusion criteria, 53 studies were selected for detailed review. Then, the quality of these studies was evaluated using the Mixed-Method Appraisal Tool, and all the studies were classified as low risk of bias and included for data extraction. Most studies included were quantitative, conducted in high-income countries between 2015 and 2024, primarily focusing on cervical cancer. Actual participation in cancer screening was more often measured than intentions toward adhering to screening program with individual-based theories were often used in the selected studies. In total, nine sociocultural themes were identified and clustered using the Health Belief Model and the Socioecological Model into five main themes and six key sub-themes. The factors emerging from the sub-themes of the theory were reported as the primary factors, which were further divided into key individual-level factors such as fear, worry, spirituality, medical mistrust, and fatalism, alongside influential factors from family and surrounding level factors. The review underscores that both individual-level factors, as conceptualised by the Health Belief Model, and broader contextual factors, as outlined by the Socioecological Model, play critical roles in influencing women's adherence to cancer screening. Cultural variations introduce unique sociocultural beliefs that may affect the generalisability of these findings. To improve adherence, interventions must address factors at multiple levels, ensuring a holistic approach to enhancing cancer screening programs. The review protocol was registered using the PROSPERO International Prospective Register of Systematic Reviews and Meta-Analysis (ID = CRD 42024525634).

Factors associated with cervical cancer screening: results from cross-sectional surveys in Kenya and Malawi

Abstract Background Cervical cancer screening is an essential public health intervention, and critical to meeting the Global Strategy for Cervical Cancer Elimination goals – yet most women in low- and middle-income countries are never screened. There is a need to understand context-specific factors that facilitate or prevent women from engaging in screening. Methods This analysis leverages data collected in 2022–2023 from a national mobile phone-based survey in Kenya and from a household survey conducted in three districts of Malawi. Informed by the Health Belief Model, we assess whether women’s reported cervical cancer screening history (ever or never screened) was associated with their perceived susceptibility (awareness of cervical cancer risk factors), perceived severity (knowing someone who was affected by cervical cancer), perceived barriers (access to services), perceived benefits (trust in information about cervical cancer prevention), self-efficacy (engagement in other preventive health behaviors), and cues to action (speaking with others about cervical cancer prevention). Results Ever-screening for cervical cancer was reported by 49.7% of the 736 Kenyan respondents and 42.5% of the 261 Malawian respondents. There were few associations between women’s demographic or socioeconomic characteristics and screening history. The strongest associations were seen for cues to action (women who had spoken about cervical cancer with health workers had 1.88 the adjusted risk ratio for screening in Kenya [95% CI 1.59, 2.24] and 1.89 the adjusted risk in Malawi [95% CI 1.41, 2.54] compared to women who never had these conversations); and for knowing someone who had, or who had died due to, cervical cancer (aRR 1.34 and 1.30 respectively in Kenya, and aRR 2.03 and 1.46 respectively in Malawi). In both countries, self-efficacy was also associated with screening, as was perceived severity in both countries (i.e., knowing someone who had, or who had died due to cervical cancer, which was reported by many Kenyan and Malawian respondents). In Kenya, knowledge of cervical cancer risk factors was also associated with women’s screening history, as was access to other preventive health services in Malawi. Conclusions These results suggest promising areas for interventions aiming to increase cervical cancer screening in these contexts: encouraging health workers to discuss screening with eligible women, leveraging women’s peers who have been affected by cervical cancer, and promoting screening during other preventive health services.

Association between knowledge of cervical cancer prevention and screening behaviors among women aged 20 to 49 years: a cross-sectional study in six provinces, China

Abstract Background Cervical cancer is regarded as the fourth most common cancer in terms of both incidence and mortality among women worldwide. Cervical cancer screening is a crucial method to achieve early diagnosis and treatment of cervical intraepithelial neoplasia and cervical cancer. The screening behaviors among women have been linked to knowledge level of cervical cancer prevention, yet little is known about the association in various areas and regions of China. Methods A cross-sectional study was conducted from June to September 2018 in six provinces of China. In this survey, knowledge level of cervical cancer prevention was assessed by a set of 7 question items, including the awareness, risk factors, preventive actions of cervical cancer, as well as awareness and effects of HPV vaccines, and also the benefits of regular cervical cancer screening. Screening behavior was determined by asking women whether they have had ever participated in cervical cancer screening. Socio-demographic characteristics were collected by questionnaire. Multivariate logistic regression models were used to analyze the association between cervical cancer screening behaviors and knowledge level. Results A total of 9144 women aged 20–49 years were involved in the analysis, with an average age of 37.9 ± 8.5 years. There were 37.6% of participants reported having ever screened for cervical cancer. The rate of cervical cancer screening behaviors was significantly associated with region, area, age group, occupation, education level, marital status, gravidity and knowledge level. Women with a high level of knowledge (score ≥ 5) were more likely to have screening behaviors than those with a low knowledge level (OR = 2.91, 95% CI: 2.63–3.21). Compared to women in the knowledge score ≤ 1 group, the screening rate of women with the knowledge score ≥ 6 significantly increased regardless of the regions (western region: OR = 19.62, 95% CI: 12.39–31.04; central region: OR = 10.09, 95% CI: 6.76–15.06; eastern region: OR = 5.23, 95%CI: 3.62–7.56) and areas (urban area: OR = 12.70, 95% CI: 8.79–18.36; rural area: OR = 7.12, 95%CI: 5.19–9.77). Conclusions Overall, our study demonstrated that the screening rate and knowledge level of cervical cancer among Chinese women still need to be improved. There was a significant association between knowledge scores and screening rates, regardless of region or area. Therefore, it is necessary to enhance the knowledge level of cervical cancer through intervention measures in order to promote regular cervical cancer screening.

Client perspectives and satisfaction with integrating facility and community-based HPV self-sampling for cervical cancer screening with family planning: a mixed method study

Invasive Cervical cancer is a largely preventable disease through screening, but access to cervical cancer screening (CCS) remains a challenge in Malawi. Integration of CCS with family planning (FP) services through Human papillomavirus (HPV) self-sampling may increase screening coverage. We aimed to evaluate women's perceptions, motivations, and satisfaction with integration of HPV self-sampling with family planning in Malawi. In this mixed-methods study, we purposively sampled and interviewed 29 women who underwent HPV self-sampling for CCS through one of two different CCS-FP integration models in Malawi. We also completed 766 Client Exit Surveys with CCS patients from both models. Model 1 involved only clinic-based HPV self-sampling, while Model 2 included both clinic-based and community-based HPV self-sampling supported by community health workers. In-depth interviews (IDIs) were conducted using a semi-structured guide, audio-recorded, transcribed, and translated into English for analysis. Qualitative data were analyzed using NVivo 12.0 software and thematic analysis, and quantitative data were analyzed using statistical software. Women screened in both models reported reduced transport costs for screening. Those clinic-based valued the convenience of accessing both CCS and FP services in a single visit while those screened in the community appreciated accessing services within their communities. Many found HPV self-sampling easy to use and ensured privacy, especially in the community model where samples were mainly collected within their homes, rather than public toilets or clinic consultation rooms. Women were motivated to undergo CCS due to the perceived risks of cervical cancer, particularly among those living with HIV, the availability of services within the community, and the experience of gynecological symptoms. IDI women expressed satisfaction with being able to make decisions without consulting their spouses, and none reported experiencing social harm following the disclosure of HPV results. The client exit survey data showed that 92.5% of women in both models were very satisfied with the procedure. Our findings highlight that women were satisfied with HPV self-sampling, valuing its convenience, privacy, and cost-effectiveness, which enhanced their willingness to undergo CCS. These findings suggest that integrating CCS self-sampling into FP services could potentially improve CCS uptake in Malawi.

Implementation of an electronic health information system using DHIS2 tracker to manage and evaluate the National cervical screening programme in Bangladesh

The cervical screening programme in Bangladesh upgraded its electronic health information system (e-HIS) in 2019 using DHIS2 tracker application. The upgraded e-HIS collects individual level data and has useful functionalities like sending SMS reminders. Also, the system facilitates data linkage between community clinics, VIA (visual inspection with acetic acid) screening centers, and colposcopy clinics using a unique national identifier. Our present mixed-method study aimed to perform an in-depth assessment of functioning of the new s-HIS and recommend measures to overcome the implementation challenges identified. In 2024, the Ministry of Health, Bangladesh and the International Agency for Research on Cancer, France, jointly formed a study team, which conducted desk review of documents, visited different health facilities to physically verify functioning of the e-HIS, engaged with health professionals and other stakeholders involved with the programme, and conducted in-depth interviews with e-HIS users and officials managing the system. Key performance indicators (KPIs) like VIA-positivity, colposcopy compliance, detection rate segregated by districts were derived from the e-HIS data for the years 2022 and 2023 for a selected division (Rajshahi). Till April 2024, 14,213 community clinics (out of total 15,564 in the country) were using the e-HIS to register women and motivate them to attend any of the screening centers to undergo VIA. Due to establishment of a functioning linkage between the screening and the colposcopy centers it was possible to track the screen-positive women and remind them to undergo colposcopy. KPIs could be successfully estimated based on data collected in Rajshahi division. Unstable internet connection, inability to register women without national identifier, errors in manual entry of the identifier, not being able to capture histopathology diagnosis were some of the challenges identified. A recommendation was made to prepare a quality improvement protocol specifying a set of KPIs for the programme and their benchmarks for the programme.

Existing psychological supportive care interventions for cervical cancer patients: a systematic review and meta-analysis

AbstractCervical cancer patients commonly experience psychological supportive care needs, necessitating diverse interventions to enhance psychological well-being and alleviate physical symptoms. This systematic review, covering English-published articles from January 1999 to April 2023, assessed the impact of psychological supportive care interventions on anxiety and depression. Twenty-Six studies, including 11,638 patients, were analyzed, comprising randomized controlled trials; quasi-experimental, and pre-post-test designs from PubMed; Science Direct; Wiley online library; Google Scholar; Cochrane Library; and JSTOR. The extraction of data was done by two independent authors and a third independent author checked the data extraction. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 2020 statement was adopted. The population, intervention, comparator, and outcomes (PICO) search strategy was applied. Effective Public Health Practice Project (EPHPP) tool was used to assess the quality of selected articles. Various interventions, such as psychological nursing, exercise, counselling, psycho-curative approaches, peer and family education, psychotherapy, and medication, were identified. Two studies incorporated homework sessions, predominantly administered by nursing staff. Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were commonly used instruments. Statistical analysis revealed a significant difference in anxiety and depression scores between treatment and control groups (p &lt; 0.005) post-intervention across all studies. A subsequent meta-analysis of eight homogeneous studies, utilizing a random-effects model, showed a moderate-to-high overall effect size (1.35, 95% CI: 0.75 to 1.94), indicating a statistically significant positive impact. Various studies exhibited variability in effect sizes ranging from low to high. While the meta-analysis included 936 participants, the forest plot visually represents individual study effect sizes and the combined effect size. Preliminary evidence supports the positive impact of psychological supportive care interventions on cervical cancer outcomes, urging further research, especially exploring long-term effects and employing rigorous study designs.

Understanding the mechanisms underlying the socioeconomic disparities in cancer screening among Australian women

Little is known about individual, as opposed to area-level, variance in socioeconomic status (SES) and how this impacts screening participation. This study explores potential mechanisms underlying the relationship between SES and cancer screening amongst women eligible for breast, cervical, and bowel cancer screening. Australian women aged 50-74 years (N = 874) took part in an online survey examining participants' health and cancer screening behaviours. Relationships between individual and area-level SES, cancer screening participation, stress, general self-efficacy, and screening literacy were examined using structural equation modelling. Frequency of cancer screening barriers were calculated for each cancer type and compared for SES categories. The structural equation model including stress and screening literacy as mediators yielded excellent fit, χ This study is the first to investigate the effects of individual level SES on cancer screening in Australia and one of the few studies to examine underlying mechanisms simultaneously across various screening programs. Reducing stress and improving screening literacy may help to improve cancer screening participation among low SES individuals. Our results also suggest that tailoring interventions to the SES background of women may not enhance their effectiveness. Interventions aiming to reduce the SES screening disparities may achieve more success through addressing underlying mechanisms as opposed to the behavioural barriers themselves.

Barriers of organized cervical cancer screening in Albania and Montenegro

Abstract Background Organized cervical screening is vital for preventing cervical cancer. However, many existing screening programs fail to achieve their full potential, as demonstrated by core performance indicators. There are barriers that hinder the implementation and reduce effectiveness of the programs. This article explores barriers of cervical cancer screening in two Southeastern European countries, Albania and Montenegro, aiming to inform targeted strategies to improve healthcare equity and outcomes for women. Methods The barrier assessment followed the EU-TOPIA framework, designed to identify barriers to effective breast-, cervical-, or colon cancer screening. This approach relies on an iterative process performed by country representatives responsible for screening and researchers with expertise in screening program planning and evaluation. It includes three steps: comprehensive description of screening activities; identification of key barriers via a previously published tool; and comprehensive assessment of the identified key barriers. Results The barrier assessment revealed shared challenges in cervical cancer screening in Albania and Montenegro. Both countries face difficulties in their invitation systems, limited outreach activities, and low participation rates. Fully integrated data systems at national level are absent, hindering program monitoring and data sharing. Financial constraints and resource limitations negatively affect program sustainability and quality, reducing public awareness and accessibility. Additionally, neither country has comprehensive up-to-date long-term strategies to support prevention and early detection efforts. Conclusions Our study underscores the importance of addressing organizational barriers in cervical cancer screening to improve program effectiveness and accessibility. Aligning screening practices with EU and WHO standards is crucial for Albania and Montenegro as prospective EU members. Lessons from international best practices, such as integrating IT systems, employing multi-channel outreach strategies, and adopting legally supported long-term policies, offer actionable pathways for improvement. Policymakers should prioritize sustainable funding, centralized systems, and innovative approaches to overcome structural challenges.

Factors that contribute to women’s reluctance to undergo cervical cancer screening in clinics of Limpopo Province, South Africa

Cervical cancer is a prevalent global health issue, ranking as the fourth most frequently diagnosed cancer, with a high rate of mortality among women as compared to breast cancer. The present study aimed to examine factors contributing to women's reluctance to undergo cervical cancer screening in South African clinics, in Limpopo Province. This study used exploratory and descriptive qualitative design, conducted at five clinics in the Greater Giyani municipality in Limpopo Province among women aged 30 years and older. The clinics were chosen based on their low performance in cervical cancer screening between 2018 and 2020. Data was collected using semi-structured, in-depth face-to-face interviews. Data was analysed using Tesch's open coding method. The present study revealed factors affecting reluctance to undergo cervical cancer screening. Three themes and their respective subthemes emerged from the analysis. The study noted a lack of knowledge relating to the causes, risk factors, and signs and symptoms of cervical cancer. Experiences that affected participants' reluctance to undergo cervical cancer screening included stereotyping of women regarding male health workers who provide screening services and pain associated with screening procedures. There were also challenges related to the accessibility of results to patients, fear of cancer diagnosis, and long waiting times at clinics. While women generally have an awareness of who is at risk for cervical cancer and its signs and symptoms, various experiences and obstacles deter them from undergoing screening. Health information and education that emphasises the significance of preventing cervical cancer with efforts aimed at reaching women who seldom visit healthcare facilities is needed.

Trusted health system implementation strategies to increase vaccination (TRUE SYNERGI): a stepped-wedge cluster randomized trial to reduce HPV-related cancers

Abstract Background Despite the availability of highly effective HPV vaccines that can reduce HPV-associated cancer mortality, HPV vaccination rates in Texas rank 48th nationwide. Although evidence shows Latino parents are more accepting of HPV vaccination than non-Hispanic parents, this disparity in vaccination rates underscores the importance of understanding Latino parental HPV vaccine hesitancy. Latinos/as typically receive healthcare at Federally Qualified Health Centers (FQHCs), which often need support implementing and improving access to evidence based preventive services. However, the current literature around implementation comes from large integrated healthcare systems and there is limited research around what works in the FQHC settings with Latino/a patients. Preliminary data from our previous work suggest practice facilitation is a feasible approach for building the capacity in FQHCs to select and implement provider- and practice-level strategies for increasing vaccination rates. Methods This proposal considers the HPV vaccine as the evidence-based intervention and describes the rational and study design for “TRUsted hEalth SYstem implementatioN stratEGIes to increase vaccination (TRUE SYNERGI)”, a hybrid type 2 study that uses previously-piloted implementation strategies (i.e., practice facilitation, provider education, among others) to influence provider recommendations (implementation outcome) and practice-level vaccination rates (effectiveness outcome). To test whether these facilitator-driven implementation strategies influence our implementation and effectiveness outcomes, we will use a stepped-wedge cluster randomized trial and randomize three FQHCs (n = 9 practices, 3 per FQHC) to three clusters. We will conduct baseline assessments at each practice, which will provide data to assist the practice facilitator in engaging with the providers and leadership to develop a tailored implementation plan for each practice. In addition, we will employ theory-guided, qualitative methods, to assess the complexity associated with context and the recipients involved in the implementation of strategies in practices, along with sustainability. Discussion The study will advance our understanding of what it means to conduct implementation research in resource limited practices that work with populations experiencing substantial disparities. Findings from the current study will inform national implementation efforts and contribute towards future research targeting dissemination and scale-up, key foci for health equity focused implementation research. Trial registration Registered in ClinicalTrials.gov (NCT06598475) on September 9, 2024.

Common predictors of cervical cancer related mortality in Ethiopia. A systematic review and meta-analysis

Abstract Background Cervical cancer accounts for 7.5% of all female cancer related deaths worldwide; peaking between the ages of 35 and 65, and not only kills young women but also destroys families with young children. Objective This review was intended to measure national level magnitude and the most common predictors of cervical cancer related mortality in Ethiopia. Methods Common Public databases like Science Direct, Embase, the Cochrane Library, and PubMed were thoroughly searched. The STATA 14 and Rev-Manager 5.3 statistical software packages were used for analysis, as well as a standardized data abstraction tool created in Microsoft Excel. The Cochrane Q-test statistics and the I 2 test were used to assess non-uniformity. The pooled magnitude and predictors of cervical cancer related mortality were estimated using fixed-effect and random-effect models, respectively. Result The pooled mortality among cervical cancer patients was estimated that 16.39% at 95% confidence level fall in 13.89–18.88% in Ethiopia. The most common predictors of cervical cancer related mortality were late diagnosed, radiation therapy alone, and Being anemic were identified by this review. Among cervical cancer treatment modalities effectiveness of surgery with adjuvant therapy was also approved in this meta-analysis. Conclusion and recommendation In this study high cervical cancer-related mortality was reported as compared to national strategies to alleviate cervical cancer related mortality. Advanced implementation of cervical cancer screening at the national level for early diagnosis, anaemia detection, and combination anticancer therapy during initiation, as well as combination therapy, is critical to improve cervical cancer patient survival and decreasing mortality rates.

Exploring cervical cancer screening awareness, beliefs, barriers, and practices among Indonesian Muslim women in Japan: a qualitative study

The population of migrant women in Japan is increasing, with a corresponding need for access to health services. Cervical cancer screening (CCS) coverage remains very low within this group. This is an increasingly difficult challenge for Muslim migrant women due to their religious values and beliefs. However, research addressing the awareness, beliefs, barriers, and practices of Muslim migrant women in Japan regarding CCS is lacking. This study aims to fill this gap by exploring CCS awareness, beliefs, barriers, and practices among Indonesian Muslim women in Japan. A qualitative study was conducted in Osaka, Japan, involving in-depth interviews with 12 Indonesian Muslim women. Data were collected between January and April 2023. All participants were between 20 and 50 years old, Muslim, married, had resided in Japan for a minimum of 3 years, and had no cervical cancer diagnosis. The participants demonstrated awareness regarding cervical cancer and CCS. However, in actual practice, they encountered several obstacles that might have prevented them from undergoing CCS, including language barriers, lack of information, pain, and psychological factors. All participants preferred female doctors for CCS procedures. This research provides information regarding factors that influence Indonesian Muslim migrant women seeking CCS. The need for structured and organized efforts is critical to improve the healthcare system and increase Japan's readiness to accept not only Muslim patients but also migrant patients in general. Not applicable.

Association between combined exposure to organochlorine pesticides and history of uterine fibroids in NHANES: findings from four statistical models

Organochlorine pesticides (OCPs) are extensively dispersed throughout the environment, which potentially have harmful impacts on the female reproductive system. Therefore, the purpose of this study was to clarify the association between exposure to OCPs and the history of uterine fibroids in American women. The present study comprised female individuals who were over 20 years old and were selected from the National Health and Nutrition Examination Survey (NHANES). The logistic regression models were used to investigate the associations between eight primary serum OCP compounds and uterine fibroids. The collective impact of OCP compounds on the overall association with uterine fibroids was assessed using three statistical approaches: weighted quantile sum regression (WQS), quantile g-computation model (Qgcomp), and Bayesian kernel machine regression (BKMR) model. In the end, a total of 931 individuals were included in the analysis. Out of the total, 126 participants were identified as patients with uterine fibroids. Upon accounting for covariables, the logistic regression analysis revealed a positive association between the highest tertiles of OCP compounds and ln-transformed OCP compounds and the history of uterine fibroids. The analysis of WQS and Qgcomp showed that a 25% increase in the mixture of OCPs was associated with a higher likelihood of having a history of uterine fibroids, with odds ratios (ORs) of 1.49 (95% CI: 1.02, 2.19) and 1.64 (95% CI: 1.15, 2.35), respectively. The primary factor behind this association was oxychlordane. In addition, the overall findings of BKMR demonstrated a consistent and increasing pattern, indicating a robust positive association between the amount of serum OCP compounds and the history of uterine fibroid. Our study conclusively established associations between OCPs and history of uterine fibroid. The simultaneous exposure to these chemicals is associated with an increased prevalence of uterine fibroid. Among these chemicals, oxychlordane has the most impact on the overall combined effect.

Burden of HPV-induced diseases and cost effectiveness of catch-up vaccination in Czech Republic: a model-based study

Human papillomavirus (HPV) infections are highly prevalent sexually transmitted infections, notably associated with various cancers. This study analyses the health and economic impacts of HPV-associated diseases in the Czech Republic and evaluates the cost-effectiveness of a catch-up vaccination program. Utilizing a Markov multistate model, the study assesses the lifetime impacts and costs related to HPV infections. Cohorts of ages 15-21 were simulated to assess the impact of catch-up vaccination outside the 11-year-old age group. The total quality-adjusted life years (QALYs) for the female and male cohorts (together 119,362 individuals) were higher in the vaccination scenario compared to the non-vaccination scenario. The increase in QALYs was 122,246 and 200,852 respectively, when considering the actual vaccination rates. Across both cohorts, 329 cancer-related deaths were prevented. In the probabilistic sensitivity analysis for the female population, vaccination was the dominant strategy in 99.3% of iterations. In the male population, vaccination was the dominant strategy in 80.3% of iterations. The implementation of catch-up vaccination for the 15-21 age group significantly increased QALY gains and reduced life-years-lost (LYLs). In the female cohort, all analysed rates of catch-up vaccination were the dominant strategy, while in the male cohort, the incremental cost-effectiveness ratios (ICERs) remained consistently below 42,000 CZK/QALY. The catch-up vaccination program for 15-21-year-olds is cost-effective and can prevent a significant number of HPV-related cancers in both men and women.

The effect of hrHPV prevalence on cervical cancer screening strategies: a cost-effectiveness study of Bangladesh

Cervical cancer is the second most prominent cancer among women in Bangladesh, which is mainly caused by persistent infection with high-risk human papillomavirus (hrHPV). This study aims to evaluate impact of hrHPV prevalence on cost-effectiveness of screening with self-sampling hrHPV testing versus visual inspection with acetic acid (VIA) for cervical cancer screening in low- and middle-income countries with Bangladesh as an example. A micro-simulation Markov model was developed from a health system perspective in Bangladesh to evaluate the cost-effectiveness of screening with self-sampling hrHPV testing followed by VIA and VIA as primary screening method followed by colposcopy. We compared these strategies in optimal (70%) and realistic (8.7%) uptake scenarios, considering different hrHPV prevalence rates. Key indicators for cost-effectiveness were number of prevented cervical cancers cases and incremental cost-effectiveness ratio (ICER). The number of cervical cancers cases prevented by screening and cost-effectiveness of screening strategies increased as hrHPV prevalence increased. In both optimal and realistic uptake scenarios, hrHPV test + VIA strategy prevented more cancers than VIA + colposcopy strategy in most instances. Regardless of the uptake, both screening strategies were cost-effective compared to no screening within a hrHPV prevalence range of 2-30%, and the hrHPV test-based strategy was cost-effective compared with VIA-based strategy. When the price of hrHPV test was estimated 50% lower (10 USD), the hrHPV test-based strategy gained more life years at nearly the same cost as the VIA-based strategy. Our study demonstrates that the hrHPV test + VIA strategy is cost-effective both compared to no screening and VIA + colposcopy screening strategy under the optimal (70%) and realistic (8.7%) uptake scenarios, with greater cost-effectiveness at higher hrHPV prevalence levels. While VIA-based strategy is cheaper, self-sampling hrHPV test-based strategy offers greater health benefits. Implementing hrHPV testing in national screening programs at lower hrHPV test prices is crucial for promoting health equity and accelerating cervical cancer elimination worldwide. In resource-constrained settings, screening with hrHPV testing should initially target high-prevalence populations.

Strategies for strengthening cervical cancer screening programmes in Gwanda district, Zimbabwe: a qualitative study

Numerous studies have been conducted on barriers to cervical cancer screening in low resourced settings. Few have however explored the factors that motivate women to make the decision for screening. This study therefore aimed at identifying strategies that could strengthen the utilisation of screening services, with the goal of informing the development of context for enhancing cervical cancer programmes in Gwanda district, Zimbabwe. The socio-ecological model that implies individual, inter-personal, community, and health system factors as influencers of screening behaviours guided the study. A cross sectional qualitative design using five focus group discussions with 36 screening-eligible women aged 25-50 years, and 25 in-depth interviews of health providers with varied responsibilities in the screening programme were conducted. Data were analysed thematically with the aid of the Web Atlas.ti software. Key findings suggest that women's willingness to be screened, on-going awareness campaigns and an increasing number of screening sites and nurses trained in screening procedures promote the uptake of screening. Concomitantly, awareness and knowledge about cervical cancer screening, male support, and community involvement in planning and implementation of programmes were seen as facilitators to screening, with accessibility of cervical cancer screening services being recognised as the most important. To exploit on women's willingness to be screened, delivery of screening services need to be re-engineered through development of strategies for increased and sustained educational programmes and increase of screening facilities. This could effectively address the prevalent barriers and enhance the facilitators for screening uptake.

Migrant women’s perception toward cervical and breast cancer screening in Türkiye: a qualitative analysis

This study aims to investigate the knowledge, attitudes, and behaviors of Syrian migrant women regarding breast and cervical cancer screenings in the Sultanbeyli district of Istanbul. The women were recruited from Extended Migrant Health Centre, which is a primary health care institution in Istanbul. In August 2024, face-to-face interviews were conducted using an open-ended, semi-structured question form administered by a nurse experienced in qualitative research. Sociodemographic information, their thoughts on cancer, information on the types of cancers screened and sources of information, their participation in cancer screenings, and their perspectives on cancer screenings were asked. In depth interviews were conducted with 40 migrant women. Four main themes and thirteen sub-themes were identified. These themes include "Opinions about the cancers and information about the cancer screenings" "Attitudes about the cancer screening program" "Perspectives on preventive measures against cancers" and "Problems in access to health services". Women mostly described cancer as a serious, incurable, and fatal disease. Despite this perception, almost half of the participants had not attended cancer screening programs. The majority said they did not undergo screening because they had no symptoms. The other main barriers for participation included lack of knowledge, fear of receiving a negative result, or fear of the procedures involved. Based on this study, migrant women have low level of attendance to breast and cervical cancer screening programs. Besides, they lack adequate information about breast cancer and cervical cancer, the screening protocols and preventive measuremets.

Factors associated with positive human papillomavirus (HPV) test results in cervical precancer screening: a cross-sectional study at Souro Sanou National Teaching Hospital (SSNTH) in Bobo Dioulasso, Burkina Faso

Human papilloma virus testing is a new method of screening for precancerous cervical lesions. Here we identified factors associated to the positive Human papilloma virus-testing in the context of cervical precancer screening at the Souro Sanou National Teaching Hospital in Burkina Faso. Conducted from June 2021-May 2022, this was a cross-sectional study, including patients aged between 25 and 55 years-old and screened for precancerous lesions and received HPV-testing at the Department of Gynecology, Obstetrics and Reproductive Medicine (DGORM) of the SSNTH. The proportion of positive HPV-test was calculated, and we identified factors associated to positive HPV-test using logistic regression. Of the 759 patients came for precancerous lesions screening, 559 patients were included. Their mean-age was 38.8 ± 7.9 years-old, 94.3% were from urban area and 50.3% identified as housewives. Regarding the past medical history, it noted: number of gestures (3.2 ± 2.0), parity (2.8 ± 1.9), number of living children (2.8 ± 1.9), having abortion experience (24.0%), age of first-sexual-intercourse(18.6 ± 2.3 years), alcohol (9.1%) and tobacco (1.0%) consumption, sexually-transmitted-infection (27.0%), Human immunodeficiency virus (HIV)infection (5.0%); none had been vaccinated against HPV. Biologically, 16.6% [95% CI: 13.6-20] of the women had a positive HPV-test. The factors significantly associated with positive HPV-test were: occupation in the private sector [OR: 0.06(0.0-0.5); p < 0.001], having a sexually-transmitted-infection [OR: 3.9(2.0-7.7); p < 0.001], age of first-sexual-intercourse [OR: 0.7(0.6-0.9); p < 0.001], sexual-multiple-partnership [OR: 17.5(8.1-39.6); p < 0.001], and HIV status [OR: 13.2(4.4-40.5); p < 0.001]. These results call for health actions through the reinforcement for behavioral change mainly about sexually-transmitted-infections, and for the raising awareness of the population for the screening related to the precancerous lesions and HIV.

Invitation strategy of vaginal HPV self-sampling to improve participation in cervical cancer screening: a systematic review and meta-analysis of randomized trials

Human papillomavirus (HPV) self-sampling is recognized as a feasible option for enhancing screening for cervical cancer, particularly among hard-to-reach women. The magnitude of the effectiveness of screening participation under different invitation strategies was reported. This review seeks to compare the effectiveness of invitation strategies in increasing screening participation of HPV self-sampling across diverse study settings. A systematic literature search was conducted in Embase, MEDLINE, and PubMed in April 2023. Articles were included if (1) their target participants were aged between 25 and 70 years; (2) participants in the intervention arm were randomized to receive HPV self-sampling devices through various invitation strategies; (3) participants in the control arm who either received invitations for cervical cancer screening other than HPV self-sampling or opportunistic screening as usual care; (4) studies that provided sufficient data on screening participation in HPV self-sampling as outcome measured. The study design of the included articles was limited to randomized controlled trials. A total of 15 articles were included in this review. Invitation strategies of disseminating HPV self-sampling devices included opt-out and opt-in. Meta-analysis revealed screening participation in the self-sampling group was significantly greater than control arm (OR 3.43, 95% CI 1.59-7.38), irrespective of the invitation strategy employed. Among invitation strategies, opt-out appeared to be more effective on increasing screening participation, compared to control and opt-in strategy (opt-out vs. control OR 3.91, 95% CI 1.82-8.42; opt-in vs. control OR 1.34, 95% CI 0.28-6.39). Opt-out strategy is more successful at improving screening participation compared to opt-in and routine invitation to cervical screening. It is therefore a promising way to improve participation in cervical cancer screening. The findings of this review provide important inputs to optimize strategies for inviting women to participate in vaginal HPV self-sampling across the study setting, thus improving participation in cervical cancer screening.

Challenges associated with follow-up care after implementation of an HPV screen-and-treat program with ablative therapy for cervical cancer prevention

Cervical cancer is a preventable cancer; however, decreasing its prevalence requires early detection and treatment strategies that reduce rates of loss to follow-up. This study explores factors associated with loss to follow-up among HPV-positive women after implementation of a new HPV-based screen-and-treat approach for cervical cancer prevention in Iquitos, Peru. We conducted semi-structured interviews with "obstetras" (i.e., midwives) (n = 15) working in cervical cancer prevention and women (n = 24) who were recorded as lost to follow-up after positive HPV results. We used the Health Care Access Barriers Model to guide analyses. We utilized manifest content analysis to describe barriers to follow-up according to the obstetras and thematic analysis to report themes from the women's perspectives. We also report the steps and time taken to contact women. We found an incomplete and fragmented patient monitoring system. This incomplete system, in conjunction with challenges in contacting some of the women, led to structural barriers for the obstetras when attempting to deliver positive results. Women in this study expressed a desire to receive treatment, however, faced cognitive barriers including a lack of understanding about HPV results and treatment procedures, fear or anxiety about HPV or treatment, and confusion about the follow-up process. Women also reported having important work matters as a barrier and reported frequently using natural medicine. Reported financial barriers were minimal. This study highlights the barriers to follow-up after implementation of a primary-level HPV-based screen-and-treat approach. While some barriers that have previously been associated with loss to follow-up were not as prominently observed in this study (e.g., financial), we emphasize the need for screen-and-treat programs to focus on strategies that can address incomplete registry systems, structural challenges in results delivery, cognitive barriers in understanding results and treatment, and work-related barriers.

Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study

Abstract Background India has the highest number of estimated deaths from cervical cancer globally, with most cases attributed to Human papillomavirus (HPV). The World Health Organization recommends primary HPV vaccination for girls ages 9–14, with catch-up vaccination for young women ≥ 15 if feasible. India authorized a new, inexpensive HPV vaccine in 2022; given anticipated vaccine expansion, we conducted a mixed-methods study exploring acceptability of HPV catch-up vaccination for young emerging adult women in rural Mysore, India. Methods Between September 2022-April 2023, participants were recruited with assistance from community health workers. In the qualitative phase, gender-stratified, audio-recorded focus group discussions (FGDs) were conducted in Kannada with emerging adults ages 18–26. FGDs were transcribed, translated, and analyzed using rapid approach to identify key HPV vaccination attributes. In the quantitative phase, a conjoint analysis was conducted to assess the impact of seven vaccination attributes on likelihood to vaccinate (LTV). Women ages 18–26 ranked LTV in eight hypothetical vaccination scenarios, and the relative impact of each attribute on LTV was calculated. All participants received education about cervical cancer, HPV, and HPV vaccination. Results Fifty-two young adults (female = 31, male = 21) participated in seven FGDs, and 101 women participated in the conjoint analysis. Average age of the 153 participants was 22.5 years, 66.7% had married, and all had completed high school. Only 17.9% had heard of cervical cancer, and 2.7% knew of the HPV vaccine. FGDs identified seven HPV vaccination attributes: cost, vaccination location, family support, peer influence, dose number, side effects, and risk of acquiring HPV. In the conjoint analysis, all attributes except dose number significantly impacted LTV. Family support (impact score = 19.37, p &lt; 0.0001) and peer influence (impact score = 18.01, p &lt; 0.0001) had the greatest influence, followed by cost (impact score = 16.64, p &lt; 0.0001) and HPV risk (impact score = 12.31, p &lt; 0.0001). Vaccination location (government centers preferred) and side effects were also significant. Conclusion Participants had poor knowledge of cervical cancer and HPV. Social attributes (family support, peer influence) had greatest impacts on LTV, and future studies should explore family-based interventions and peer education. Providing free vaccines at government centers through India’s national immunization program would maximize catch-up HPV vaccination for rural young women.

Pap test recency and HPV vaccination among Brazilian immigrant women in the United States: a cross-sectional study

Abstract Background The United States (U.S.) has a growing population of Brazilian immigrant women. However, limited research has explored Pap tests and human papillomavirus (HPV) vaccination among this population. Methods Participants completed an online survey between July—August 2020. Bivariate analyses examined associations between healthcare-related variables (e.g., insurance, having a primary care provider) and demographics (e.g., age, education, income, marital status, years living in the U.S., primary language spoken at home) with 1) Pap test recency (within the past 3 years) and 2) HPV vaccination (0 doses vs. 1 + doses). Variables significant at p &lt; 0.10 in bivariate analyses were included in multivariable logistic regression models examining Pap test recency and HPV vaccination. Results The study found that 83.7% of the sample had a Pap test in the past three years. Women who did not know their household income were less likely to be than women who reported a household income of &lt; $25,000 (adjusted OR [aOR] = 0.34, 95% CI: 0.12, 0.95). Women who had seen a healthcare provider in the past year were more likely to have had a Pap test within the last three years than those who had not seen a provider in the past year ([aOR] = 2.43, 95% CI: 1.32, 4.47). Regarding HPV vaccination, 30.3% of respondents reported receiving one or more doses of the HPV vaccine. The multivariable logic regression models determined that women aged 27 -45 (aOR = 0.35, 95% CI: 0.18, 0.67) were less likely than women aged 18–26 to have been vaccinated against HPV). and that women with a PCP were more likely to be vaccinated than those without a PCP (aOR = 2.47. 95% CI:1.30, 4.59). Conclusion This study found that Brazilian immigrant women in the youngest age groups (21 – 29) for Pap test, 18- 26 for HPV vaccination) had somewhat better rates of Pap screening and HPV vaccination than the general U.S. population. This study adds new information about cervical cancer prevention and control behaviors among Brazilian immigrant women.

The edutainment program on knowledge, perception, and uptake of cervical cancer screening among Muslim women in Southern Thailand: a quasi experimental study

Abstract Introduction Cervical cancer is a significant global health concern and is the third most common cancer in women. Owing to their religious beliefs, Muslim women in Thailand are less likely to be screened for cervical cancer. Objective This study aimed to explore how a Health Belief Model (HBM) (HBM = Health Belief Model)-Based Edutainment Program affects the knowledge, perception, and uptake of cervical cancer screening among Muslim women in Thailand. Methods A quasi-experimental study was conducted in two rural districts of Southern Thailand with 83 Muslim women (intervention = 42, control = 41). The assessment was conducted through face-to-face interviews at baseline, post-intervention, and at 3-month follow-up. The intervention included four sessions involving video clips, folk songs, and short films. Data analysis was performed using repeated-measures ANOVA (ANOVA = Analysis of Variance) at a significance level of 0.05. Results There were significant differences in the mean score of knowledge and perception between the intervention and control groups post-intervention and at 3-month follow-up (p &lt; 0.001). The mean scores of knowledge and perception in the intervention group significantly increased post-intervention and at 3-month follow-up (p &lt; 0.001). The uptake of cervical cancer screening tests in the intervention group was approximately twice as high as that in the control group (90.47% vs. 51.21%). Conclusion The findings revealed that the Edutainment Program could improve the knowledge, perception, and uptake of cervical cancer screening among Muslim women in Thailand. In future studies, the intervention suggests testing different population groups to improve access to primary care for everyone.

Cervical cancer screening among women with comorbidities: evidence from the 2022 Tanzania demographic and health survey

Abstract Background The aim of this study is to examine cervical cancer screening (CCS) uptake among women living with hypertension and HIV in Tanzania. Methods We used the recently released 2022 Tanzania Demographic and Health Survey. The outcome variable assessed in the study was CCS, whereas chronic morbidities constituted the main explanatory variable. Data analysis was based on observations from 6,298 women aged 30–49 years. Multivariable logistic regression models were used to determine the association between hypertension and HIV status, and CCS uptake. The analyses were computed in STATA 18. Results Out of the 6,298 respondents, only 805 (12.8%) had undergone CCS with higher screening uptake among those living with either one of the disease (28.5%) than among those living with neither hypertension or HIV. The highest proportion was found among those who had ever been diagnosed with hypertension (24.1%) and among women with positive HIV test results (36.7%). There was a significantly higher likelihood of undergoing screening for cervical cancer among women living with at least one of the diseases [AOR = 2.4; 95% CI: 1.4–2.8], compared to those without these conditions. Women diagnosed with hypertension showed increased likelihood of undergoing CCS [AOR = 1.4; 95%CI: 1.1–1.7]. Similarly, women with a positive HIV test result demonstrated higher odds of screening uptake [AOR = 5.2; 95%CI: 4.0-6.7]. Conclusion The study found a positive association between comorbidities and CCS uptake in Tanzanian women. Our findings emphasize the critical importance of ensuring accessibility and adherence to essential screenings for individuals with chronic morbid conditions. Future efforts should focus on strengthening existing integrated services and identifying potential barriers to accessing CCS within these healthcare settings to optimize cervical cancer prevention efforts for individuals with chronic morbidities.

Uptake of human papilloma virus vaccine and its determinants among females in East Africa: a systematic review and meta-analysis

Abstract Introduction Cervical cancer is the most common malignant tumor among women. It is the main cause of death among women in sub-Saharan African countries. Particularly, the incidence and mortality rates are highest in East Africa. Even though the burden of human papilloma virus-related cervical cancer is high in East Africa, there is no conclusive evidence about the prevalence of human papilloma virus vaccine uptake and its predictors. Objective To assess the pooled prevalence of human papilloma virus vaccine uptake and its determinants in East Africa. Method Eligible articles were searched on PubMed, Embase, Scopus, Cochrane Library, Google Scholar, and Google. Those articles incorporating the outcome of interest, both analytical and descriptive study designs, and published or unpublished articles at any time were included. Keywords and Medical Subjects Heading terms or synonyms of human papilloma virus vaccine and Boolean operators were used to retrieve the articles. To assure the quality of articles, Joana Brigg’s Institute critical appraisal checklist for cross-sectional studies was used. Sensitivity analysis was conducted to assess the heterogeneity among the studies, and a random effect model was used to analyze the pooled effect size. Result A total of 29 articles were included, and the pooled prevalence of HPV vaccine uptake in East Africa was 35% (95% CI: 26–45%). Good knowledge (OR = 1.6, 95%CI; 1.43–1.8), positive attitude (OR = 2.54, 95% CI; 2.13–3.03), ever heard about HPV vaccine (OR = 1.41, 95% CI; 1.03–1.94), mother educational status above college (OR = 1.84, 95%CI; 1.03–3.31), middle wealth index (OR = 1.33, 95%CI; 1.04–1.7), ≥ 9 family size (OR = 0.76, 95%CI; 0.68–0.98), availability of promotion (OR = 2.53, 95%CI: 1.51–4.26), availability of adequate vaccine (OR = 4.84, 95%CI; 2.9–8.08), outreach vaccination practice (OR = 1.47, 95%CI; 1.02–2.12) and family support (OR = 4.3, 95% CI; 2.98–6.21) were the significant factors for the uptake of human papilloma virus vaccine. Conclusion As compared to the global strategic plan, the pooled prevalence of HPV vaccine uptake in east Africa was low. The uptake of the HPV vaccine was higher among adolescents than youths. Knowledge about the HPV vaccine, attitude towards the HPV vaccine, ever hearing about the HPV vaccine, residence, mother’s educational status, mother’s occupational status, wealth index, and family size were the significant determinants of HPV vaccine uptake. Therefore, we recommend focusing on awareness creation and behavioral change to expand the uptake of vaccines in East Africa.

Prevalence of high-risk human papillomavirus infection and cervical lesions among female migrant head porters (kayayei) in Accra, Ghana: a pilot cross-sectional study

AbstractBackgroundLittle attention has been given to the risk of high-risk human papillomavirus (hr-HPV) infection and cervical precancerous lesions among female migrant head porters (kayayei) in Ghana, as a vulnerable group, and to promote cervical screening in these women. This pilot study aimed to determine the prevalence of hr-HPV infection and cervical lesions amongkayayeiin Accra, the capital of the Greater Accra Region of Ghana and to describe our approach to triaging and treating these women.MethodsThis descriptive cross-sectional cohort study involved the screening of 63kayayeiaged ≥ 18 years at the Tema Station and Agbogbloshie markets in March 2022 and May 2022. Concurrent hr-HPV DNA testing (with the MA-6000 platform) and visual inspection with acetic acid (VIA) was performed. We present prevalence estimates for hr-HPV DNA positivity and VIA ‘positivity’ as rates, together with their 95% confidence intervals (CIs). We performed univariate and multivariable nominal logistic regression to explore factors associated with hr-HPV infection.ResultsGross vulvovaginal inspection revealed vulval warts in 3 (5.0%) and vaginal warts in 2 (3.3%) women. Overall, the rate of hr-HPV positivity was 33.3% (95% CI, 21.7–46.7), whereas the VIA ‘positivity’ rate was 8.3% (95% CI, 2.8–18.4). In the univariate logistic regression analysis, none of the sociodemographic and clinical variables assessed, including age, number of prior pregnancies, parity, past contraceptive use, or the presence of abnormal vaginal discharge showed statistically significant association with hr-HPV positivity. After controlling for age and past contraceptive use, only having fewer than two prior pregnancies (compared to having ≥ 2) was independently associated with reduced odds of hr-HPV infection (adjusted odds ratio, 0.11; 95% CI, 0.02–0.69).ConclusionIn this relatively young cohort with a high hr-HPV positivity rate of 33.3% and 8.3% of women showing cervical lesions on visual inspection, we posit thatkayayeimay have an increased risk of developing cervical cancer if their accessibility to cervical precancer screening services is not increased.

Selective under-representation of Pacific peoples in population estimates for health indicator measurements in Aotearoa New Zealand misinforms policy making

Abstract Background The Census of Populations and Dwellings’ is the five yearly population count of Aotearoa New Zealand. Best available populations (BAP) are subnational projections based on census data and demographic assumptions developed for healthcare planning and funding allocation but are also used as the denominator for health indicator monitoring. Pacific people are systematically undercounted, but the impact on health statistics is not well studied. For COVID-19 vaccination coverage, health service user (HSU) data were considered a more reliable denominator than BAP but introduced new biases. We aimed to understand how the choice of denominator population impacts estimates of population size and health system performance for Pacific people at a local level. Methods We described how declining census response rates affected population data quality. We compared BAP and HSU data at district level. For the indicators ‘access to primary care’ and ‘cervical cancer screening uptake’ we replaced currently used BAP denominators with HSU and examined the impact for different ethnic groups in different geographic districts. Results Overall Census 2018 response declined by 10%, but for Māori and Pacific people by 21% and 23%, respectively. This inequitably affected BAP accuracy. Census undercount was highest in the district with the largest Pacific populations, where HSU exceeded BAP most. Notably, ‘access to primary care’ for Pacific people in this district consistently exceeds 100%. Using BAP, both health indicators are currently estimated as highest for Pacific people compared to other ethnic groups, but when based on HSU, they dropped to lowest. Similar, but less pronounced trends occurred in other districts. Changes in trends over time for both indicators coincided mostly with adjustments in BAP, rather than changes in the numerators. Conclusions The current use of BAP denominators for health statistics does not enable reliable monitoring of key health indicators for Pacific people. HSU denominators are also unsuitable for monitoring health. Exploring the feasibility of a real-time population register is strongly recommended as a new, transparent, way of obtaining more reliable, timely population data to guide policymaking and underpin a more equitable health system under the health reforms. Meanwhile, reporting of ethnic specific outcomes need to include a clear assessment of the potential for bias due to inaccurate population estimates.

The impact of medical expert-led sex education on sexual health knowledge among Japanese junior high school students: a quantitative study

This study aimed to evaluate the impact of a sex education lecture led by medical professionals on junior high school students' knowledge and attitudes regarding oral contraceptives (OCs), contraception, cervical cancer, and human papillomavirus (HPV) vaccination. The study received approval from Nippon Medical School Hospital's Ethics Committee. Thirty-seven high schools participated in the lecture, which featured a 1-h comprehensive lecture delivered by a gynecologist. Questionnaires were administered both before and after the lecture. A total of 5,833 and 5,383 students responded to the questionnaires before and after the lecture, respectively. Female students were more likely to seek information from teachers and parents, while male students relied on friends or had limited knowledge. Postlecture, awareness of OCs increased, with more students recognizing their benefits beyond contraception, such as relieving menstrual cramps. There was also a marked improvement in understanding contraceptive methods. Knowledge of cervical cancer and HPV saw a significant rise, with more correct responses reported. Additionally, the lecture prompted a greater willingness among students to receive the HPV vaccine. The findings indicate that sex education delivered by gynecologists led to significant gains in knowledge and awareness and may have contributed to more positive attitudes toward sexual and reproductive health among male and female students. These results underscore the potential benefits of involving medical experts in sex education to enhance its impact on adolescents in Japan.

Barriers to cervical cancer screening in Africa: a systematic review

Abstract Introduction Africa has one of the highest burdens of cervical cancer in the world. The unacceptably high incidence and mortality rates could be reduced through implementing a comprehensive approach to its prevention and control that includes screening, which however, is low in most low-and-middle-income countries. Hence, this systematic review aims at exploring factors that prevent women from utilising cervical cancer screening services in the region. Methods A mixed method systematic review was conducted. A search was performed on PubMed (Medline), EMBASE, CINAHL (EBSCOHOST) and Scopus databases for articles published until May 2019 without time, language or study design limits. Two reviewers critically appraised the included studies independently using the standard quality assessment criteria for evaluating primary research papers. Results of the quantitative and mixed methods studies were transformed into qualitative data and synthesised using thematic analysis. Results From a potential 2 365 studies, 24 from 11 countries met the eligibility criteria and were selected; eight qualitative, 13 quantitative, and three that used the mixed-method approach. The primary barriers were identified as poor access to screening services, lack of awareness and knowledge on cervical cancer and screening, and socio-cultural influences. Service providers perceived lack of skills, screening equipment and supplies, and staff shortages as the major barriers to the provision of screening services. Conclusion Barriers to cervical cancer screening in Africa are multifaceted and require a holistic approach that will address them concurrently at the health system, individual, interpersonal, community and structural levels. Political will complimented by stakeholder involvement is required in the development and implementation of strategies that will ensure acceptability, availability, accessibility, and affordability of screening to minimise barriers in accessing the service.

Improving cancer incidence evaluation through local government area matching: a study of the Edo-Benin cancer registry in Nigeria

Abstract Background Cancer registries in Nigeria, as well as in other sub-Saharan African countries, face challenges in adhering to international cancer registration standards. We aimed to improve cancer incidence estimation by identifying under-reporting of new cancers through matching patient-reported local government areas (LGAs) in Edo state, Nigeria, to their respective catchment populations. Methods Information on cancers was obtained from records of hospitals, medical clinics, pathology laboratories, and death certificates according to IARC guidelines. We utilized normalized scores to establish consistency in the number of cancers by calendar time, and standardized incidence ratios (SIR) to assess the variation in cancer incidence across LGAs compared to Edo state average. Subsequently, we estimated sex- and site-specific annual incidence using the average number of cancers from 2016 to 2018 and the predicted mid-year population in three LGAs. Age-standardization was performed using the direct method with the World Standard Population of 1966. Results The number of incident cancers consistent between 2016–2018 in Egor, Oredo, and Uhunmwonde showed a significantly increased SIR. From 2016 to 2018 in these three LGAs, 1,045 new cancers were reported, with 453 (42.4%) in males and 592 (57.6%) in females. The average annual age-standardized incidence rate (ASR) was 50.6 (95% CI: 45.2 – 56.6) per 105. In men, the highest incidence was prostate cancer (ASR: 22.4 per 105), and in women, it was breast cancer (ASR: 16.5 per 105), and cervical cancer (ASR: 12.0 per 105). Microscopically verified cancers accounted for 98.1%. Conclusions We found lower age-standardized incidence rates than those reported earlier for the Edo state population. Collecting information on the local government areas of the cancers allows better matching with the respective target population. We recommend using LGA information to improve the evaluation of population-based cancer incidence in sub-Saharan countries.

Socioeconomic disparities in Papanicolaou test utilization in Western Iran

Abstract Background Cervical cancer remains the fourth most frequently diagnosed cancer among women, and its impact is particularly significant in women residing in less developed countries. This study aims to assess socioeconomic inequality in using Papanicolaou tests, commonly known as Pap tests, which are crucial for detecting cervical cancer. The research also seeks to decompose this inequality, identifying its contributing factors. This investigation is conducted within a sizable population-based study focused on the Kurdish population, with an additional examination of potential variations between urban and rural areas. Method The study utilized baseline data from the Ravansar Non-Communicable Disease Cohort Study (RaNCD), involving 3,074 ever-married women aged 35–65. Asset data was employed to determine socioeconomic status (SES), and Principal Component Analysis was applied. The uptake of Papanicolaou tests was assessed for inequality using the Concentration Index (Cn). Additionally, decomposition analysis was conducted to identify and understand the factors contributing to socioeconomic inequality. Results The study found that overall, 86% of women reported having undergone cervical cancer screening at least once in their lifetime. The Concentration Index (Cn) for the total population was 0.21 (p &lt; 0.0001), indicating a higher concentration of Papanicolaou test uptake among wealthier groups. In urban areas, the Cn was 0.34 (p &lt; 0.0001), reflecting a significant concentration among the rich. However, in rural areas, the Cn was -0.10 (p = 0.3006), suggesting no significant socioeconomic inequality. Factors such as socioeconomic status (SES), education, and age contributed to reducing inequality, explaining 62.7%, 36.0%, and 1.7% of the observed inequality, respectively. Interestingly, place of residence had a negative influence on inequality. Conclusion The uptake of Papanicolaou tests varies across different socioeconomic status levels, with a higher concentration among wealthier groups. The results enable health policymakers and researchers to tailor health intervention toward increasing public awareness, especially among women with lower levels of education women in economically deprived groups.

Exploring self-care and cervical cancer prevention attitudes and practices among Moroccan and Pakistani immigrant women in Catalonia, Spain: a comparative qualitative study

Abstract Background Self-care and preventive health strategies may trigger health inequities when individuals’ cultural values and health beliefs are not fully understood and considered. In the case of cervical cancer (CC) screening programs immigrant women have shown lower attendance compared with native women, which increases the risk of late diagnosis and, consequently, a lower probability of survival. HPV self-sampling for CC screening has been recently added to the World Health Organization’s (WHO) list of self-care interventions as a promising tool to reduce this disparity and improve screening coverage. In Catalonia, Spain, the introduction of HPV self-sampling as a part of the new population-based CC screening program, is a significant step. However, there is a lack of research addressing self-care and prevention among immigrant populations in this region. This study aims to fill this gap exploring self-care and prevention attitudes and practices among Moroccan and Pakistani women. Methods We conducted focus groups and individual interviews with 36 Moroccan and 37 Pakistani women in Barcelona, Spain. The topic guide of the focus groups included case vignettes to stimulate the discussion and a semi-structured questionnaire was used for the interviews. Results Our findings show that most Moroccan and Pakistani women do not prioritize self-care and prevention. They seek care for symptom treatment rather than disease prevention. In this sense, they reported not having the habit of doing regular check-ups and their self-care and prevention attitudes and practices seemed to be conditioned by cultural values. The implementation of an effective call and recall system could enhance the engagement of these populations with CC screening services. Conclusion This study provides evidence on how universal concepts of self-care and prevention may not aligned with more collectivist societies, emphasizing the limited applicability and motivation of global self-care interventions guidelines for individuals with different cultural backgrounds and values. Therefore, the successful implementation of CC screening programs or any other self-care intervention requires the adoption of culturally appropriate strategies.

Impact of health-related behavioral factors on participation in a cervical cancer screening program: the lifelines population-based cohort

Abstract Background Regular participation in cervical cancer screening is critical to reducing mortality. Although certain sociodemographic factors are known to be associated with one-time participation in screening, little is known about other factors that could be related to regular participation. Therefore, this study evaluated the association between health-related behavioral factors and regular participation in cervical cancer screening. Methods The Lifelines population-based cohort was linked to data for cervical cancer screening from the Dutch Nationwide Pathology Databank. We included women eligible for all four screening rounds between 2000 and 2019, classifying them as regular (4 attendances), irregular (1–3 attendances), and never participants. Multinomial logistic regression was performed to evaluate the association between behavioral factors and participation regularity, with adjustment made for sociodemographic factors. Results Of the 48,325 included women, 55.9%, 35.1%, and 9% were regular, irregular, and never screening participants. After adjustment for sociodemographic factors, the likelihood of irregular or never screening participation was increased by smoking, obesity, marginal or inadequate sleep duration, alcohol consumption and low physical activity, while it was decreased by hormonal contraception use. Conclusion An association exists between unhealthy behavioral factors and never or irregular participation in cervical cancer screening.

Cost-utility and budget impact analyses of cervical cancer screening using self-collected samples for HPV DNA testing in Thailand

Abstract Introduction Cervical cancer ranks as the third most prevalent cancer among women in Thailand. However, the effectiveness of cervical cancer screening programs is limited by several factors that impede the screening rate. The utilization of self-collected samples for screening purposes has the potential to alleviate barriers to screening in Thai women. This study assessed the cost-utility and budget impact of implementing cervical cancer screening using self-collected samples for human papillomavirus (HPV) deoxyribonucleic acid (DNA) testing in Thailand. Materials and methods We employed a decision tree integrated with a Markov model to estimate the lifetime costs and health benefits associated with the cervical cancer screening program for women aged 25–65. The analysis was conducted from a societal perspective. Four screening policy options were compared: (1) additional self-collected samples for HPV DNA testing, (2) clinician-collected samples for HPV DNA testing only, (3) clinician-collected samples for cytology test (i.e., status quo), and (4) no screening. The model inputs were based on unvaccinated women. The screening strategies and management in those with positive results were assumed followed to the Thai clinical practice guideline. Costs were reported in 2022 Thai baht. Sensitivity analyses were conducted. The ten-year budget impacts of the additional self-collected samples for HPV DNA testing were calculated from a payer perspective. Results All screening policies were cost-saving compared to no screening. When comparing the additional self-collected samples for HPV DNA testing with the clinician-collected samples policy, it emerged as the dominant strategy. The incremental benefit in cervical cancer prevention achieved by incorporating self-collected samples for screening was observed at any additional screening rate that could be achieved through their use. Sensitivity analyses yielded consistently favorable results for the screening policies. The average annual budget impact of the additional self-collected samples for screening policy amounted to 681 million Thai baht. This budget allocation could facilitate cervical cancer screening for over 10 million women. Conclusions An addition of self-collected samples for HPV DNA testing into the cervical cancer screening program is cost-saving. The benefits of this screening policy outweigh the associated incremental costs. Policymakers should consider this evidence during the policy optimization process.

Between now and later: a mixed methods study of HPV vaccination delay among Chinese caregivers in urban Chengdu, China

Abstract Background Adolescent girls in China have a low HPV vaccination rate. Although vaccination is recommended by the Chinese health authorities, the cost is not covered by the national immunisation programme. Vaccination delay, among other reasons such as supply shortage and poor affordability, may contribute to low uptake. This sequential mixed methods study aimed to identify potential factors of delayed HPV vaccination among Chinese adolescent girls. Methods Quantitative data about the attitudes and perceptions of HPV vaccination were collected from 100 caregivers of 14–18-year-old girls using an online survey in Chengdu, China. The survey data informed a subsequent qualitative study using four focus group discussions. We conducted a descriptive analysis of the survey data and a thematic analysis of the qualitative data. The findings were interpreted using a health behaviour model adapted from the Health Belief Model and the Andersen’s Behavioural Model for Health Services Use. Results A total of 100 caregivers – 85 were mothers and 15 were fathers – participated in the survey; 21 caregivers joined focus group discussions. When asked about their intended course of action if the 9vHPV vaccine was out-of-stock, 74% chose to delay until the 9vHPV vaccine is available while 26% would consider 2vHPV or 4vHPV vaccines or seek alternative ways to procure the vaccine. Qualitative results confirmed that caregivers preferred delaying HPV vaccination for adolescent girls. The intent to delay was influenced by systemic barriers such as supply shortage and individual-level factors such as a preference for the 9vHPV vaccine, safety concerns, inadequate health communication, and the belief that adolescents were unlikely to be sexually active. Conclusion In urban areas, Chinese caregivers’ intent to delay vaccination in favour of 9vHPV vaccine over receiving the more accessible options was influenced by a mix of individual and contextual factors. Focussed health communication strategies are needed to accelerate HPV vaccination among adolescents.

Electronic aggregated data collection on cervical cancer screening in Bangladesh since 2014: what the data tells us?

Abstract Introduction To reduce the high prevalence of cervical cancers among the Bangladeshi women, the Government of Bangladesh established a national cervical cancer screening programme in 2005 for women aged 30 to 60 years. The District Health Information System Version 2 (DHIS2) based electronic aggregated data collection system is used since the year 2013. This study summarises data from the year 2014 to 2022 to assess the effectiveness of the electronic data collection system in understanding the outcome of the screening programme. Methods This is a descriptive study based on secondary data extracted in MS Excel from the DHIS2-based electronic repository of the national cervical cancer screening programme of Bangladesh. The respondents were women aged 30–60 years, screened for cervical cancer using VIA (Visual Inspection of cervix with Acetic acid) method in 465 government health facilities. The data were collected on the participants’ residential location, month and year of screening, name and type of health facilities performing VIA, and VIA screening results. Results The national screening programme reported a total 3.36 million VIA tests from 465 government hospitals in 8 years (2014 to 2022). The national average VIA-positivity rate was 3.6%, which varied from 1.4 to 9.5% among the districts. This national screening programme witnessed an exponential growth, year after year, with 83.3% increase in VIA test from 2014 to 2022. The primary and the secondary care hospitals were the highest collective contributors of VIA tests (86.2%) and positive cases (77.8%). The VIA-positivity rates in different hospital types varied widely, 7.0% in the medical university hospital, 5.7% in the medical college hospitals, 3.9% in the district/general hospitals, and 3.0% in the upazila health complexes. Conclusions A national cervical cancer screening programme using VIA method and a DHIS2-based electronic data collection backbone, is effective, sustainable, and useful to understand the screening coverage, VIA positivity rate and geographic distribution of the participants and case load to initiate policy recommendations and actions. Decentralization of the screening programme and more efforts at the primary and secondary care level is required to increase screening performances.

Myths and common misbeliefs about cervical cancer causation among Palestinian women: a national cross-sectional study

Abstract Background Cervical cancer (CC) myths and beliefs can negatively impact women's preventive behaviors, including vaccination against human papillomavirus and having regular screening tests. This study aimed to examine awareness of Palestinian women about myths related to CC causation and investigated factors associated with good awareness. Methods A national cross-sectional study was conducted to recruit adult Palestinian women from hospitals, primary healthcare facilities, and public areas in 11 Palestinian governorates. A translated-into-Arabic version of the Cancer Awareness Measure-Mythical Causes Scale was used to collect data. Awareness level was determined based on the number of CC myths around CC causation recognized to be incorrect: poor (0–4), fair (5–9), and good (10–13). Results A total of 7058 questionnaires were included. Myths unrelated to food were more commonly recognized as incorrect compared to those related to food. The most recognized food-unrelated myth was ‘having a physical trauma’ (n = 3714, 52.6%), whereas the least recognized was ‘using mobile phones’ (n = 2238, 31.7%). The most recognized food-related myth was ‘drinking from plastic bottles’ (n = 2708, 38.4%), whereas the least recognized was ‘eating food containing additives’ (n = 1118, 15.8%). Only 575 participants (8.1%) displayed good awareness and promptly recognized at least 10 out of 13 myths around CC causation as incorrect. Factors associated with lower likelihood of displaying good awareness of myths around CC causation included living in the West Bank and Jerusalem, being married, widowed or divorced, knowing someone with cancer, and visiting hospitals or primary healthcare centers. Conclusions A very small proportion of Palestinian women recognized 10 or more myths around CC causes as incorrect. Initiatives addressing CC myths are needed in the Palestinian community.

Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria

AbstractBackgroundHigh HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria.MethodsA cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software.ResultsOf 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48,p = 0.009), postmenopausal status (aOR = 7.69,p = 0.000), and women with no history of prior IUCD use (aOR = 5.94,p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17,p = 0.000), prior use of IUCD (aOR = 0.32,p = 0.004), prior use of condom (aOR = 2.50,p = 0.003) and had co-morbidities (aOR = 0.46,p = 0.009) were more likely to have had a Pap test in the past.ConclusionsThe majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.

Older women’s perceptions of HPV self-sampling and HPV-sampling performed by a midwife – a phenomenographic study

Abstract Background Cervical cancer is a global disease and it is well established that cervical cancer is caused by human papillomavirus (HPV). In Sweden self-sampling for HPV is now used as a complement to sampling performed by a midwife. However, there is a lack of knowledge on how older women perceive the self-sampling compared to the sampling performed by a midwife. Therefore, the aim of the study was to describe how women, aged 64 years and older, perceived the process of self-sampling and sampling performed by a midwife for HPV-testing. Methods Eighteen women were included in a qualitative interview study, and a phenomenographic approach was used for the analysis of the interviews. Results Three descriptive categories emerged: Confidence in sampling, Facilitating participation and Being informed. Within the categories, eight conceptions emerged describing the variation relating to how the women perceived the process of self-sampling and sampling performed by a midwife. Conclusions Women in this study describe confidence in self-sampling for HPV-testing and that the self-sampling was saving time and money, both for themselves and for society. Information in relation to an HPV-positive test result is of importance and it must be kept in mind that women affected by HPV may feel guilt and shame, which health care professionals should pay attention to. This knowledge can be used in education of health care staff. Trial registration https://researchweb.org/is/fourol/project/228071. Reg. no 228,071.

Cervical cancer screening outcomes in public health facilities in three states in Nigeria

Abstract Background Cervical cancer continues to generate a significant burden of disease and death in low- and middle-income countries (LMICs). Lack of awareness and poor access to early screening and pre-cancer treatment contribute to the high mortality. We describe here cervical cancer screening outcomes in public health facilities in three states in Nigeria. Methods We conducted an observational study in 177 government health facilities in Lagos, Kaduna, and Rivers State, Nigeria from January to December 2021, in which we reviewed programmatic data collected through the newly introduced Cervical Cancer Prevention Program. Women who received screening and provided consent were enrolled into the study. Data were extracted from registers in the health facilities using SurveyCTO and descriptive statistical analysis was conducted using StataSE 15 (StataCorp, College Station, TX, USA). Results Eighty-three thousand, five hundred ninety-three women were included in the analysis including 6,043 (7%) WLHIV. 67,371 (81%) received VIA as their primary screening while 16,173 (19%) received HPV DNA testing, with 49 (&lt; 1%) receiving both at the same time. VIA positivity was 7% for WLHIV and 3% for general population, while HPV prevalence was 16% for WLHIV and 8% for general population. Following a positive HPV result, 21% of women referred, completed triage examination. 96% of women identified with precancerous lesions, received treatment. 44% of women with suspected cancer were successfully referred to an oncology center for advanced treatment. Following treatment with thermal ablation, seven adverse events were reported. Conclusions The Program has successfully increased women’s access to screening and treatment of precancerous lesions. Almost all women who were eligible for pre-cancerous lesion treatment received it, often on the same day when screened using VIA. However, for women referred for a triage exam or due to suspected cancer, many did not complete their referral visits. More effort is required to ensure HPV positive women and women with suspected cancer are adequately linked to care to further reduce morbidity and mortality associated with cervical cancer in Nigeria. Implementation studies should be conducted to provide insights to improve the utilization of the existing centralized and point of care (POC) platforms to facilitate same day results, and to improve triage and treatment rates.

Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals

Abstract Background Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer. Methodology A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data. Results Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient–physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women’s empowerment. Conclusions The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.

Outcomes from integrating anti-cervical cancer teachings into the curriculum of high schools in a South-Eastern Nigerian State

Abstract Background Quests for the global elimination of cervical cancer and its related SDG goals by 2030 are achievable if realistic approaches for improving outcomes in LMICs are entrenched. Targeting teenage high schoolers in these countries, which largely lack universally-affordable anti-cervical cancer measures, can be a game-changer. This paper evaluates a 2019 Harvard-endorsed measure that integrated relevant teachings into the curricula of some Nigerian high schools, in what was a global-first. Method A 12-month, quasi-experimental (pre-and-post-tests) research that evaluated the impact of the above initiative on three public schools randomly selected from a pool of 261 in South-east Nigeria. The intervention was “exposure” to anti-cervical teachings, which included “repetitions” and “examination/assessments” designed to enhance “engagement”. Both genders were among the 2,498 recruited participants. Data collections with questionnaires were at three different intervals over 12 months. Results At Phase-1 (baseline), there were 1,699 (68.0%) responses, while Phases 2 (one-month post-intervention) and 4 (12-month post-intervention) had 1,797 (71.9%) and 500 (20.0%) responses, respectively. COVID-19 lockdowns washed out Phase-3 (six-month post-intervention). The majority in all groups were aged 15–19 years. Males dominated in phases 1 (55.9%) and 2 (67.3%), and females (65.6%) in Phase 4. Overall, there were increased knowledge on “General Awareness”, “HPV Vaccinations”, “Risk Factors” and “Symptoms”, particularly between Phases 2 and 1. Levels at Phase-4 were higher than at Phase-2, with the exception of “Pap Smears”, as knowledge gained in half of its assessing items became negative (reversed) at Phase-4. These observed changes were non-different between gender, age groups, and classes of high schools. Relative to Phase 2, knowledge changes at Phase-4 for questions associated with established myths (“spiritual attacks”; OR 0.39; CI 0.29–0.52 and “enemy poisons”; OR 0.49; CI 0.37–0.65) were reversed, even though they were originally increased significantly between Phases 2 and 1. Conclusion Anti-cervical cancer enlightenment interventions to teenage high school students were largely effective, but appears guaranteed if engagement-enhancing measures are maintained over time. Extra efforts should be put into debunking prevailing myths.

Factors associated with age at first screening for cervical cancer among adult Cape Verdean women: a cross-sectional study

Cervical cancer ranks third in terms of cancer incidence and mortality in Cape Verde. Understanding the factors associated with the age of cervical cancer screening (CCS) is essential because it helps identify populations at risk of delayed screening, enabling targeted interventions to ensure timely detection and treatment, ultimately reducing the burden of cervical cancer. We examined the factors associated with age at first screening for cervical cancer among adult Cape Verdean women. Data from the 2020 WHO STEPs survey were used. We analyzed data from 1,082 women aged 30-69 years who had ever screened for cervical cancer. Bivariable and multivariable logistic regression models were computed in STATA version 18. Overall, 30.6% of women in the study had their first CCS before or at age 30. Except for visits to the health facility within the last 12 months, all variables significantly predicted women's first age for CCS in the crude model. In the adjusted model, women with tertiary education showed greater odds [AORs = 9.85; 95% CI: 4.12-23.54] compared to those with no formal education. Compared to those who were never married, previously married women had significantly lower odds of screening at an early age [AOR = 0.63; 95% CI: 0.39-0.99]. Women without hypertension had higher odds [AOR = 1.66; 95% CI: 1.18-2.34] of early screening compared to those with hypertension. Also, women who were currently working had significantly higher odds of early screening than those unemployed [AOR = 1.49; 95% CI: 1.09-2.04]. In conclusion, implementing targeted educational campaigns, addressing socio-economic barriers, and integrating cervical cancer screening into routine healthcare services can increase the early screening uptake among Cape Verdean women. There is a need to integrate CCS in the routine healthcare services of women living with hypertension. Also, the positive association between formal education and age at first screening, it is imperative for the Cape Verdean public health departments to implement comprehensive education programs within schools to promote awareness about CCS.

Prevalence and sociodemographic predictors of high-risk vaginal human papillomavirus infection: findings from a public cervical cancer screening registry

AbstractIntroductionHigh-risk human papillomavirus (HPV) screening is vital for early cervical cancer detection and treatment. With the introduction of the national cervical cancer screening programme and screening registry in Malaysia, there is a need to monitor population-based HPV screening uptake and high-risk HPV prevalence as part of cervical cancer surveillance.ObjectiveTo determine the prevalence and sociodemographic factors predicting high-risk HPV infection in Malaysia based on a public, community-based cervical cancer screening registry targeting women at risk of getting HPV infection.MethodsThe study used data from the Malaysian cervical cancer screening registry established by the Family Health Development Division from 2019 to 2021. The registry recorded sociodemographic data, HPV test details and results of eligible women who underwent HPV screening at public primary healthcare facilities. A vaginal sample (via self-sampling or assisted by a healthcare provider) was used for DNA extraction for HPV detection and genotyping. Registry data were extracted and analysed to determine prevalence estimates of high-risk HPV infection. Multifactorial logistic regression analysis was conducted to determine predictors of high-risk HPV infection. All analyses were performed using Stata version 14.ResultsThe programme screened a total of 36,738 women during the study period. Women who attended the screening programme were mainly from urban areas, aged 30–39 years, and of Malay ethnicity. The prevalence of high-risk HPV infection was 4.53% among women screened, with the yearly prevalence ranging from 4.27 to 4.80%. A higher prevalence was observed among urban settling women, those aged 30–49 years, those of Indian ethnicity, and those without children. The results from logistic regression showed that women from urban areas, lower age groups, of Indian or Chinese ethnicity, and who are self-employed were more likely to be infected with high-risk HPV.ConclusionTargeted and robust strategies to reach identified high-risk groups are needed in Malaysia. In addition, the registry has the potential to be expanded for an improved cervical cancer elimination plan.Trial registrationTrial registration number: NMRR ID-22-00187-DJU.

Religious and traditional beliefs and practices as predictors of mental and physical health outcomes and the role of religious affiliation in health outcomes and risk taking

Abstract Background While many studies from sub-Saharan countries, including Zimbabwe, allude to the important role of religion and tradition for young people living with HIV (YPLHIV), most of these studies tend to be descriptive and lack advanced statistical analysis. This study aims to close this gap. Methods Data for this study was collected between July and October 2021 from 804 YPLHIV (aged 14–24) in Zimbabwe. The questionnaire included questions regarding participants’ conceptions of HIV, their health seeking and risk-taking behaviour, current HIV viral load results, the prevalence of opportunistic infections, their mental health status, and demographic characteristics. The analysis was done using multilevel mixed-effects logistic regression. Results We found that Traditional religious affiliation was linked to overall lower viral load (OR: 0.34; CI: 0.12–0.96; P: 0.042), Apostolic to more (OR: 1.52; CI: 1-2.3; P: 0.049) and Pentecostal to less (OR: 0.53; CI: 0.32–0.95; P: 0.033) treatment failure. Additionally, conceptions about HIV without spiritual or religious connotation, such as ‘seeing HIV as result of a weak body’ was associated with lower risk of treatment failure (OR: 0.6; CI: 0.4-1.0; P: 0.063), higher chances for undetectable viral load (OR: 1.4; CI: 1–2; P: 0.061), and overall lower viral load (OR: 0.7; CI: 0.5-1; P: 0.067). Moralizing concepts of HIV, like ‘seeing HIV as a result of sin in the family’, was linked to higher risk of opportunistic infections (OR:1.8; CI:1.1-3; P: 0.018), and higher risk of treatment failure (OR: 1.7; CI: 0.7–1.1; P: 0.066). Religious objections toward certain forms of therapy, like toward cervical cancer screening, was linked to higher risk of mental problems (OR: 2.2; CI: 1.35–3.68; P: 0.002) and higher risk of opportunistic infections (OR:1.6; CI:1.1–2.1; P: 0.008). Religious affiliations significantly influenced conceptions of HIV, health seeking behaviour, and risk taking. Conclusion To our knowledge, this study is the first to provide evidence about the statistically significant associations between religious and traditional beliefs and practices and current health outcomes and health risk factors of YPLHIV in Zimbabwe. It is also the first to identify empirically the role of religious affiliations as predictors of current viral load results. This new knowledge can inform contextualized approaches to support YPLHIV in Zimbabwe.

Differences in breast and cervical cancer screening between West and East Germany: a secondary analysis of a german nationwide health survey

Abstract Background Breast cancer and cervical cancer are among the most common cancers in women in Germany. Early detection examinations such as mammography and the cervical smear test (Pap-test) have been shown to contribute to the reduction in the mortality and/or incidence of these cancers and can be utilised free of charge by women in certain age groups as part of national screening programmes. Analyses show that the use of health services varies regionally, especially when comparing the federal states of the former German Democratic Republic (GDR, Eastern Germany) and the Federal Republic of Germany (FRG, Western Germany). This study investigated to what extent the utilisation of mammography examinations and Pap-tests by women differs in federal states of former GDR and FRG. Methods For this purpose, we analysed data from the nationwide health survey GEDA14/15 conducted by the Robert Koch Institute (RKI) in 2014 and 2015. We calculated weighted proportions and compared attendance between eastern and western German states by a Chi-Square-test. Additionally, we conducted regression analysis to adjust for socio-economic status, living environment and place of birth. Results 2,772 female participants aged 20–34 years were analysed for Pap-test attendance in the last two years and 4,323 female participants aged 50–69 years old were analysed for mammography screening attendance in the last two years. 50–69-year-old women in eastern German states were with 78.3% (95%-CI 75.3%, 81.2%) more likely to attend mammography screening than in western Germany with 73.4% (95%-CI 71.8%, 74.9%). Pap-test uptake was statistically significantly higher in the East of Germany with 83.3% (95%-CI 79.6%, 87.1%) compared to 77.5% (95%-CI 75.8%, 79.3%) in the West of Germany. This relationship was robust to adjusting for socio-economic status, living environment and place of birth. Conclusions Cultural influences and socialization in the GDR might explain the higher utilisation of these cancer screening examinations at least to some extent. This could have many reasons, for example a higher health awareness through education or a possible greater trust in medical structures and the associated higher compliance of women. These hypotheses should be further explored to increase the uptake of screening examinations by women in Germany.

Fine-grained mathematical modeling for cost-effectiveness evaluation of public health policies for cervical cancer, with application to a Colombian case study

Abstract Background Cervical cancer (CC) is globally ranked fourth in terms of incidence and mortality among women. Vaccination against Human Papillomavirus (HPV) and screening programs can significantly reduce CC mortality rates. Hence, executing cost-effective public health policies for prevention and surveillance is crucial. However, defining policies that make the best use of the available resources is not easy, as it requires predicting the long-term costs and results of interventions on a changing population. Since the simpler task of predicting the results of public health policies is difficult, devising those that make the best usage of available resources is an arduous challenge for decision-makers. Methods This paper proposes a fine-grained epidemiological simulation model based on differential equations, to effectively predict the costs and effectiveness of CC public health policies that include vaccination and screening. The model represents population dynamics, HPV transmission within the population, likelihood of infection clearance, virus-induced appearance of precancerous lesions and eventually CC, as well as immunity gained with vaccination and early detection with screening. Results We offer a compartmentalized modeling approach that separates population, epidemics, and intervention concerns. We instantiate models with actual data from a Colombian case study and analyze their results to show how our modeling approach can support CEA studies. Moreover, we implement models in an open-source software tool to simultaneously define and evaluate multiple policies. With the support of the tool, we analyze 54 policies within a 30-year time horizon and use as a comparator the CC policy that has been used until recently. We identify 8 dominant policies, the best one with an ICER of 6.3 million COP (Colombian Pesos) per averted DALY. We also validate the modeling approach against the available population and HPV epidemic data. The effects of uncertainty in the values of key parameters (discount rate, sensitivity of screening tests) is evaluated through one-way sensitivity analysis. Conclusions Our modeling approach can provide valuable support for healthcare decision-makers. The implementation into an automated tool allows customizing the analysis with country-specific data, flexibly defining public health policies to be evaluated, and conducting disaggregate analyses of their cost and effectiveness.

Enhancing long-term smoking abstinence among individuals with a history of cervical intraepithelial neoplasia or cervical cancer (Project ACCESS): protocol for a randomized clinical trial

Abstract Background The prevalence of smoking among cervical cancer survivors is high and evidence-based smoking cessation interventions are critically needed. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial (RCT) designed to evaluate the efficacy of a novel, personally tailored SMS-delivered text-based digital treatment adjuvant designed to enhance the long-term efficacy of a “Motivation And Problem-Solving” (MAPS) approach for smoking cessation among individuals with a history of cervical intraepithelial neoplasia (CIN) or cervical cancer. MAPS is a phone counseling approach designed to facilitate long-term abstinence that comprises 6 counseling calls over 12 months. The current trial is evaluating the efficacy of MAPS+, which comprises all MAPS components plus a 24-month digital treatment adjuvant. This trial represents a logical extension of our previous RCT, which compared the efficacy of MAPS to a quitline control condition and found that MAPS resulted in greater than a 2-fold increase in smoking abstinence at 12 months (i.e., 26.4% vs. 11.9%). This treatment effect was no longer significant at 18 months, suggesting that efficacy dissipated as time from the end of treatment increased. The primary aim of the current trial is to compare the efficacy of MAPS + and ST in facilitating long-term abstinence. Methods Individuals who smoke and have a history of cervical cancer or CIN (N = 340) are recruited throughout Florida and randomly assigned to Standard Treatment [ST] or MAPS+. ST participants are electronically connected with the Florida Quitline. MAPS + consists of 6 proactive MAPS-based counseling calls over 12 months plus the novel, personally tailored, text message-based treatment adjuvant delivered over 24 months. All participants receive 12 weeks of combination nicotine replacement therapy (patch and lozenge) and are followed for 24 months. Participant recruitment commenced in December 2022 and is ongoing. Discussion This study builds on promising results from our recent trial which found that MAPS was associated with substantially higher abstinence from smoking at the end of the 12-month treatment period. Finding that this low-burden, personally tailored digital treatment adjuvant improves the long-term efficacy of MAPS would have important clinical and public health implications. Trial registration Clinical Trials Registry NCT05645146; https://clinicaltrials.gov/ct2/show/NCT05645146; Registered on December 9, 2022.

Human papillomavirus vaccine acceptance among adolescent girls in Ethiopia: a systematic review and meta-analysis

AbstractBackgroundCervical cancer is the fourth most common cancer affecting females. Human papillomavirus vaccination of adolescent girls is the primary strategy for cervical cancer prevention but in Ethiopia, it lacks emphasis. Despite different studies done and found a highly variable level of vaccine acceptance; however, there was no summarized evidence on the issues as a nation. Thus this systematic review and meta-analysis aimed to assess the pooled prevalence of human papillomavirus vaccine acceptance by adolescent girls and its associated factors in Ethiopia.MethodA systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Google Scholar, and African Online Journal databases. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2statistics were computed to assess heterogeneity among studies. Funnel plot and Eggers test were done to assess publication bias. Review manager software was used to identify factors associated with vaccine acceptance.ResultOverall, 157 articles were retrieved and finally 7 articles were included in this review. The pooled prevalence of adolescent human papillomavirus vaccine acceptance was 46.52% (95%CI; 30.47-62.57%). Subgroup analysis showed that adolescent vaccine acceptance was highest in the Oromia region and lowest in Addis Ababa. Knowledge about human papillomavirus vaccination (AOR = 3.89, 95% CI: (2.85–5.32)) and attitude (AOR = 2.65, 95% CI: (2.03– 3.44)) were significantly associated with adolescent’s vaccine acceptance.ConclusionHuman papillomavirus vaccine acceptance of adolescent girls in Ethiopia was low. Knowledge about the vaccine and attitude to vaccination were positively associated with their vaccine acceptance. Therefore, policymakers and program planners should target school-aged adolescents in increasing their awareness and changing their attitudes to enhance their vaccine acceptance in order to prevent and control cervical cancer.

Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review

AbstractBackgroundHuman Papilloma Virus (HPV) is the most common sexually transmitted infection worldwide. Globally, both men and women have a 50% risk of being infected at least once in their life. HPV prevalence is among the highest in sub-Saharan Africa (SSA), at an average of 24%. HPV causes different types of cancers, including cervical cancer (CC), which is the leading cause of cancer deaths among women in SSA. HPV-vaccination has been proven to be effective in reducing HPV induced cancers. SSA countries are delayed in reaching the WHO’s target of fully vaccinating 90% of girls within the age of 15 by 2030. Our systematic review aims to identify barriers and facilitators of HPV-vaccination in SSA to inform national implementation strategies in the region.MethodsThis is a mixed method systematic review based on the PRISMA statement and The Joanna Briggs Institute Reviewers’ Manual. Search strategies were adapted to each selected database: PubMed/MEDLINE, Livivo, Google Scholar, Science Direct, and African Journals Online for papers published in English, Italian, German, French and Spanish between 1 December 2011 and 31 December 2021. Zotero and Rayyan were the software used for data management. The appraisal was conducted by three independent reviewers.ResultsA total of 20 articles were selected for appraisal from an initial 536 articles. Barriers included: limited health system capacities, socio-economic status, stigma, fear and costs of vaccines, negative experience with vaccinations, COVID-19 pandemic, lack of correct information, health education (HE) and consent. Additionally, we found that boys are scarcely considered for HPV-vaccination by parents and stakeholders. Facilitators included: information and knowledge, policy implementation, positive experience with vaccinations, HE, stakeholders’ engagement, women’s empowerment, community engagement, seasonality, and target-oriented vaccination campaigns.ConclusionsThis review synthesizes barriers and facilitators of HPV-vaccinations in SSA. Addressing these can contribute to the implementation of more effective HPV immunization programs targeted at eliminating CC in line with the WHO 90/70/90 strategy.Registration and fundingProtocol ID: CRD42022338609 registered in the International Prospective Register of Systematic Reviews (PROSPERO). Partial funds: German Centre for Infection research (DZIF) project NAMASTE: 8,008,803,819.

Global burden and trends in ovarian cancer attributable to environmental risks and occupational risks in females aged 20–49 from 1990 to 2021, with projections to 2050: a cross-sectional study

Abstract Background Ovarian cancer is the eighth most common cancer globally, with environmental and occupational exposures emerging as critical determinants of ovarian carcinogenesis. Despite accumulating evidence, comprehensive global assessments of the burden of ovarian cancer attributable to these risks remain limited, especially among women aged 20–49 years. Methods We conducted a cross-sectional analysis using data from the Global Burden of Disease (GBD) Study 2021 to evaluate the global burden of ovarian cancer associated with environmental risks and occupational risks among females aged 20–49 years from 1990 to 2021. Outcomes included deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Temporal trends were analyzed using linear regression models, and future projections to 2050 were generated using autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models. Results In 2021, ovarian cancer linked to environmental risks among females aged 20–49 years resulted in 38 deaths (95% uncertainty interval [UI]: 17–69) and 1786 DALYs (95% UI: 781–3233). The age-standardized DALYs rate (ASDAR) was 0.09 per 100,000 population (95% UI: 0.04–0.16). Similar results were observed for occupational risks. From 1990 to 2021, the number of cases and age-standardized rates (ASRs) for ovarian cancer linked to both environmental and occupational risks initially increased and then declined. Regionally, high-middle Sociodemographic Index (SDI) regions exhibited peak ASRs, while middle and low-middle SDI regions showed increasing trends. Projections from 2022 to 2050 indicated an upward trend in the number of cases using the ARIMA model, with decreasing trends for ASDR and ASYLLR. Conclusion Our study highlights the significant burden of ovarian cancer associated with environmental and occupational risks among women aged 20–49 years. The observed trends underscore the need for continued investment in prevention and control strategies, particularly in regions with high ASRs.

Knowledge of ovarian cancer symptoms among women in Palestine: a national cross-sectional study

Abstract Introduction Ovarian cancer (OC) is often diagnosed at advanced stages. This study aimed to assess the Palestinian women’s knowledge about OC symptoms and determine the factors associated with having good knowledge. Methods A cross-sectional study was conducted from July 2019 to March 2020 in the two main areas of Palestine: the West Bank and Jerusalem as well as the Gaza Strip. A translated-into-Arabic version of the validated OC awareness measure (OCAM) was utilized for data collection. Stratified convenience sampling was used to recruit adult women attending hospitals, primary healthcare centers, and public spaces at 11 governorates. The knowledge level was categorized into three categories based on the number of symptoms recognized: poor (0 to 4), fair (5 to 8), and good (9 to 11). Results Of 6095 approached, 5618 participants completed the Arabic OCAM (response rate = 92.1%).A total of 5411 questionnaires were included in the analysis: 2278 from the Gaza Strip and 3133 from the West Bank and Jerusalem. Participants living in the West Bank and Jerusalem were older, of higher monthly income, and with more chronic diseases than those living in the Gaza Strip. The most frequently identified symptoms were ‘extreme generalized fatigue’ (n = 3821, 70.6%), ‘unexplained weight loss’ (n = 3607, 66.7%), and ‘increased abdominal size on most days’ (n = 3252, 60.1%). On the other hand, the least recognized symptoms were ‘feeling full persistently’ (n = 1553, 28.7%) and ‘difficulty eating on most days’ (n = 1971, 36.4%). Only 943 participants (17.4%) displayed good knowledge of OC symptoms. Participants from the Gaza Strip had a higher likelihood than participants from the West Bank and Jerusalem to have a good level of knowledge (21.0% vs. 14.8%). Being married, knowing someone with cancer, and visiting hospitals were all associated with a higher likelihood of having good knowledge level. However, living in the West Bank and Jerusalem was associated with a lower likelihood of having good knowledge. Conclusion The overall knowledge of OC symptoms in this study was low. Educational interventions are needed to improve Palestinian women’s knowledge about OC symptoms.

The feasibility of new HPV/DNA test as a primary cervical cancer screening method among 35- years- old ever-married women in Kalutara district; a cross-sectional study

Abstract Background Cervical cancer is the second commonest female cancer in Sri Lanka. Two major drawbacks of the present cervical cancer screening programme are the suboptimal sensitivity of the pap smear and the low coverage. The objective of the study is to determine the feasibility of a new HPV/DNA test among 35 -years -old ever-married women in a district of Sri Lanka. Method A community based descriptive cross-sectional study was conducted from 1stof July 2018 to 30th November 2018 in the public health divisions called Medical Officer of Health (MOH) areas of Kalutara district. The study population is comprised of ever-married women 35 years of age. Three women from each cluster (n = 413) were selected by consecutive sampling. A total of 918 women were recruited. HPV/DNA cervical specimen collection (n = 822) was carried out. Cervical specimens were tested by two cytoscreeners with the cobas 4800 PCR based screening machine. Clients’ perceptions and prevalence were assessed. The follow-up of women with positive HPV/DNA screening results was carried out. The operational and technical feasibility of the screening test were assessed. Data entry was done by using the statistical package IBM SPSS version 20. Results Overall response rate was 91.1% (n = 836). Clients’ perception was highly positive for HPV/DNA screening test procedure (99.9%, n = 821) and 99.6% (n = 819) of clients had mentioned that the HPV/DNA screening test is worthwhile to be incorporated into the National Cervical Cancer Screening program. The prevalence of HPV was 6.2% (95%CI: 6.18–6.22%). The coverage of the HPV/DNA screening was 89.5%(n = 822). Invalid results reported were 0.12% (n = 1). The percentage of HPV/DNA test positive women who underwent pap test within 3 months of the initial screening was 100% (n = 51), while the percentage of women who attempted to get a colposcopy within the 1 month of referral was 86.7% (n = 13). Conclusions HPV/DNA test implementation as a primary cervical cancer screening method is feasible among the 35- year age cohort of ever- married women in Kalutara district. It is necessary to further attempt alternative methods of cobas 4800 HPV/DNA test, which would be much suitable for resource-limited settings.

Exploring perceived barriers and facilitators to using mobile phone technology for delivering HPV test results in malawi: a qualitative study with HPV-Screened women, healthcare providers, and health officials

Cervical cancer, the fourth most common cancer among women globally, disproportionately affects low- and middle-income countries, such as Malawi, which has the world's highest cervical cancer mortality rate. Efforts to implement human papillomavirus (HPV) testing for primary screening face challenges, including delays in delivering HPV results, hindering the retention of HPV-positive women in the care cascade. We conducted a study to identify the perceived barriers and facilitators to using mobile phones for delivering HPV results, aiming to improve the retention of HPV-positive women in care. We also explored the perspectives of women, health care providers, and health officials in Malawi's cervical cancer screening program to provide a comprehensive view of challenges and opportunities. This exploratory sub-study evaluated the perceived barriers and facilitators to delivering HPV screening results to women via mobile phones at four government-run health facilities in Lilongwe, Malawi. A trained research assistant conducted in-depth interviews (IDIs) with women who underwent HPV-based primary screening and received their HPV results, through a cluster randomized trial that compared two models of HPV-based screening. We also interviewed healthcare providers from these four health facilities and officials from the Lilongwe District Health Office (DHO). Data collected through the IDIs were recorded, transcribed, and translated. The transcripts were coded in NVivo 14 and analyzed using thematic analysis. Between January-March 2022, 35 participants completed the IDIs: 20 women who underwent HPV screening, 13 healthcare providers, and 2 DHO officials. The study findings revealed several critical factors influencing the implementation of HPV result delivery via mobile phone. Key challenges included low literacy and privacy concerns, which complicate the adoption of this method. Additionally, there was a perceived risk of unintended receipt of HPV results by partners or family members, in that many women do not own mobile phones and rely on shared handsets. However, incentives such as airtime, functional phones, and appropriate equipment could support healthcare providers in delivering effective communication and healthcare services. While mobile phone communication has the potential to enhance HPV result delivery, its success relies on overcoming perceived barriers such as low literacy, privacy concerns, inadequate resources, and the need for a supportive implementation environment.

Knowledge of cervical cancer prevention and treatment, and willingness to receive HPV vaccination among college students in China

Abstract Background Cervical cancer is the fourth most common cancer in women. Up to 99% of cervical cancer cases are associated with high-risk human papillomavirus (HPV). Sexual behavior is a direct risk factor for HPV infection, and sexually active college students, therefore, receive attention for HPV vaccination. At present, most Chinese studies lack of in-depth research on influencing factors, and are limited to cervical cancer, HPV, or HPV vaccine, without comprehensive consideration. This study investigated Chinese college students’ cervical cancer prevention and treatment knowledge level, and explored the influencing factors, and understood their willingness to receive HPV vaccination. The findings of this study will lay a foundation for promoting the early screening of cervical cancer and vaccination process. Methods A total of 800 college students from four universities in Zhengzhou, China were selected by multistage random sampling method. A self-administered questionnaire on the knowledge of cervical cancer prevention and treatment, and willingness to receive HPV vaccination was carried out. A logistic regression model was conducted to analyze factors influencing knowledge of cervical cancer prevention and treatment among college students. Results Up to 87.9% of college students said they had heard of cervical cancer. The proportion of college students with good knowledge of cervical cancer prevention and treatment was 46.7%. Logistic regression showed that gender, major, grade, level of education, the father's level of education, premarital sex attitude, and mother cervical cancer screening participation had a significant influence on cervical cancer prevention and treatment knowledge level (P &lt; 0.05). In addition, 589 (74.0%) of college students had heard of HPV vaccine, and 92.8% of college students said they were willing to get vaccinated or recommended that their relatives and friends get vaccinated. Conclusions The knowledge level of cervical cancer prevention and treatment knowledge among college students in Zhengzhou is low. Many of them had poor knowledge about HPV vaccine, but their willingness to vaccination is high. Various health education modes should be carried out for people with different characteristics, to improve their knowledge of cervical cancer prevention and promote the vaccination process.

Beliefs associated with cancer screening behaviors among African Americans and Sub-Saharan African immigrant adults: a cross-sectional study

AbstractBackgroundBeliefs influence cancer screening. However, there are conflicting findings about how belief influence cancer screening among Black adults. The aim of this study was to evaluate the relationships between beliefs (religiosity, fatalism, temporal orientation, and acculturation) and cervical, breast, and colorectal cancer screening behaviors among African Americans and sub-Saharan African immigrants.MethodsWe conducted a cross-sectional survey of 73 African American and 59 English speaking Sub-Saharan immigrant adults recruited from Lexington and surrounding cities in Kentucky. Data collected included sociodemographic variables, cancer screening behaviors, and several instruments that characterize beliefs, including religiosity, fatalism, temporal orientation, and acculturation.ResultsParticipants’ mean age was 43.73 years (SD = 14.0), 83% were females, and 45% self-identified as sub-Saharan immigrants. Based on eligibility for each screening modality, 64% reported having ever had a Pap test, 82% reported ever having mammogram, and 71% reported ever having a colonoscopy. Higher education (OR = 2.62, 95% CI = 1.43—4.80) and being insured (OR = 4.09, 95% CI = 1.10 – 15.18) were associated with increased odds of cervical cancer screening (pap test), while cancer fatalism (OR = 0.24, 95% CI = 0.07 – 0.88) was associated with decreased odds. Increased age (OR = 1.57, 95% CI = 1.06 – 2.32) and reduced present orientation (OR = 0.42, 95% CI = 0.22 – 0.80) were associated with receipt of a mammogram. Nativity was the only factor associated with colonoscopy screening. Compared to African Americans, sub-Saharan African immigrants were 90% less likely to have had a colonoscopy (OR = 0.10, 95% CI = 0.02 – 0.66).ConclusionThis study contributes to the existing literature by confirming that beliefs are important in cancer screening behaviors among African American and sub-Saharan African immigrants. These findings should inform the development of cancer control and prevention programs for Black adults.Trial registrationUS National Library of Science identifier NCT04927494. Registered June 16, 2021,www.clinicaltrials.gov

Barriers and recommendations for a cervical cancer screening program among women in low-resource settings in Lagos Nigeria: a qualitative study

Abstract Background Cervical cancer is the fourth most common cancer in women globally despite being a largely treatable and preventable malignancy. Developing countries account for over 80% of all new cases. Women residing in low-resource settings such as those residing in slums have a higher risk of cervical cancer, and lower uptake of cervical cancer screening. Diverse barriers influence the uptake of cervical cancer screening among women in low-resource settings. Objectives This qualitative study was done prior to the introduction of a cervical cancer screening program in two slum areas in Lagos Nigeria and explored women’s knowledge about cervical cancer, and their perceived barriers and recommendations for the program. Method Four focus group discussions(FGD) were conducted among 35 women between the ages of 21–65 years residing in two urban slums in Lagos, Nigeria from February to April 2019. Each FGD was limited to 8–10 participants of women of similar ages. Voice recordings were transcribed verbatim and thematic analysis was done. Results Most of the women were not aware of cervical cancer and none knew the symptoms or risk factors of cervical cancer. The participants felt that the cervical cancer screening program would be well accepted in the community, however, expressed concerns about the cost of the screening test and the sex of the person performing the test. The recommendations proffered for a successful cervical cancer screening program include; reducing the cost of the test or providing the test free of charge, having people that speak the local language as part of the team, using female health care providers, using a private location within the community or nearby primary health center, and publicizing the program with the use of SMS, phone calls, town crier, and health talks. It was recommended that organizing health education sessions would help improve women’s poorly perceived susceptibility to cervical cancer. Conclusion Interventions to increase uptake of cervical cancer screening among women in low resource settings need to improve knowledge of cervical cancer and address barriers to cervical cancer screening such as cost, distance, and as much as possible, sex of the healthcare provider should be considered.

Self-collected versus medic-collected sampling for human papillomavirus testing among women in Lagos, Nigeria: a comparative study

Abstract Objective To evaluate the feasibility and performance of self-collected vaginal swab samples for HPV screening among women in Lagos, Nigeria. Methods A cross-sectional study was implemented from March to August 2020 among sexually active women. Study participants provided same-day paired vaginal swab samples. Medic-sampling and poster-directed self-sampling methods were used to collect the two samples per participant. A real-time PCR assay detected HPV 16, HPV 18, other-high-risk (OHR) HPV, and the human β-globin gene. The self-collected samples’ sensitivity, specificity, and accuracy were determined against the medic-collected samples using the MedCalc Online Diagnostic Calculator. Results Of the 213 women aged 16 ~ 63-year-old recruited, 187 (88%) participants had concordant results, while 26 (12%) participants had discordant results. Among the 187 concordant results, 35 (19%) were HPV positive, 150 (80%) participants were HPV negative, and two (1%) were invalid. 18 (69%) out of the 26 discordant samples were invalid. The self-collected sample was invalid for 14 (54%) participants. Two (8%) medic-collected samples were invalid. Compared to the medic-collected sample, the self-collected sample was 89.80% (95% CI: 77.77 ~ 96.60%) sensitive and 98.21% (95% CI: 94.87 ~ 99.63%) specific, with an accuracy of 96.31% (95% CI: 92.87 ~ 98.40%). The mean age for HPV positive and negative participants were 39 and 40, respectively, with an ANOVA p-value of 0.3932. The stratification of HPV infection by the age group was not statistically significant (P &gt; 0.05). Conclusions With high accuracy of 96%, self-collected sampling is adequate when tested with real-time PCR and may increase the uptake of HPV testing. Though more self-collected samples were invalid than medic-collected samples, most likely due to poor collection, they could be identified for repeat testing. Future implementation can avoid this error with improved guidance and awareness.

Challenges and lessons from a school-based human papillomavirus (HPV) vaccination program for adolescent girls in a rural Nigerian community

Abstract Background Over 80% of new cervical cancer cases occur in women living in low- and middle-income countries. It is the second highest cause of female cancer deaths in Nigeria. School based vaccination programs are an effective strategy for delivering the HPV vaccine to adolescent girls. This study aims to understand the challenges to implementing school-based HPV vaccination programs, particularly in a remote rural setting where vaccine hesitancy is high. Methods A 22- item interviewer administered questionnaire was used to evaluate HPV knowledge and willingness to get the HPV vaccinate among 100 female secondary school students as part of an HPV vaccination pilot in a rural community in Kebbi State, Nigeria. Additionally, semi-structured interviews were used to assess community knowledge and attitudes on cervical cancer and HPV vaccination. Data collected were analyzed thematically to understand challenges and generate lessons for vaccine delivery in the study setting. Results Knowledge of HPV and cervical cancer among junior secondary school aged girls was fair with a mean score of 66.05%. For senior secondary school aged girls, the knowledge score ranged from 70 to 100% with a mean of 96.25% indicating good knowledge of HPV and cervical cancer. All participants (n = 100) received the first vaccine dose but due to COVID-19, 33 participants were not able to complete the vaccine dosage within the recommended 6-month schedule. Of the parents who provided consent, none could afford the vaccine out of pocket. Challenges to vaccine delivery included operational costs exacerbated by lack of adequate health workforce and infrastructure in the study setting. Conclusion An exploration of sociocultural perspectives and contextual realities is crucial to understanding the complexities of HPV vaccine introduction from the perspective of the target audience, and the local community. Strategies for introducing the HPV vaccine should address community concerns through effective communication, appropriate delivery, and targeted advocacy to make the vaccination program locally relevant. While school-based HPV immunization programs have been shown to be successful, adequate design, planning and monitoring is important. Additionally, considerations must be made to account for the high operational cost of vaccine delivery in rural, hard to reach areas where human resources and infrastructure are limited.

Cervical cancer prevention in countries with the highest HIV prevalence: a review of policies

Abstract Introduction Cervical cancer (CC) is the leading cause of cancer-related death among women in sub-Saharan Africa. It occurs most frequently in women living with HIV (WLHIV) and is classified as an AIDS-defining illness. Recent World Health Organisation (WHO) recommendations provide guidance for CC prevention policies, with specifications for WLHIV. We systematically reviewed policies for CC prevention and control in sub-Saharan countries with the highest HIV prevalence. Methods We included countries with an HIV prevalence ≥ 10% in 2018 and policies published between January 1st 2010 and March 31st 2022. We searched Medline via PubMed, the international cancer control partnership website and national governmental websites of included countries for relevant policy documents. The online document search was supplemented with expert consultation for each included country. We synthesised aspects defined in policies for HPV vaccination, sex education, condom use, tobacco control, male circumcision,cervical screening, diagnosis and treatment of cervical pre-cancerous lesions and cancer, monitoring mechanisms and cost of services to women while highlighting specificities for WLHIV. Results We reviewed 33 policy documents from nine countries. All included countries had policies on CC prevention and control either as a standalone policy (77.8%), or as part of a cancer or non-communicable diseases policy (22.2%) or both (66.7%). Aspects of HPV vaccination were reported in 7 (77.8%) of the 9 countries. All countries (100%) planned to develop or review Information, Education and Communication (IEC) materials for CC prevention including condom use and tobacco control. Age at screening commencement and screening intervals for WLHIV varied across countries. The most common recommended screening and treatment methods were visual inspection with acetic acid (VIA) (88.9%), Pap smear (77.8%); cryotherapy (100%) and loop electrosurgical procedure (LEEP) (88.9%) respectively. Global indicators disaggregated by HIV status for monitoring CC programs were rarely reported. CC prevention and care policies included service costs at various stages in three countries (33.3%). Conclusion Considerable progress has been made in policy development for CC prevention and control in sub Saharan Africa. However, in countries with a high HIV burden, there is need to tailor these policies to respond to the specific needs of WLHIV. Countries may consider updating policies using the recent WHO guidelines for CC prevention, while adapting them to context realities.

Explaining socioeconomic inequality in cervical cancer screening uptake in Malawi

Abstract Background Cervical cancer is a prevalent public health concern and is among the leading causes of death among women globally. Malawi has the second highest cervical cancer prevalence and burden in the world. Due to the cervical cancer burden, the Malawi government scaled up national cancer screening services in 2011, which are free for all women. This paper is the first study to examine the socioeconomic inequality in cervical cancer screening uptake using concentration indices, in Malawi. Furthermore, it decomposes the concentration index to examine how each factor contributes to the level of inequality in the uptake of cervical cancer screening. Methods The data used in this paper were obtained from the nationally representative Malawi Population HIV Impact Assessment (MPHIA) household survey, which was conducted in 2015. Concentration curves were constructed to explore whether there was any socioeconomic inequality in cervical cancer screening and, if so, its extent. This was complemented by concentration indices that were computed to quantify the magnitude of socioeconomic inequality. A decomposition analysis was then conducted to examine the factors that explained/were associated with greater socioeconomic inequality in cervical cancer screening. The methodology in this paper followed that of previous studies found in the literature and used the wealth index to measure socioeconomic status. Results The results showed that the concentration curves lay above the line of equality, implying a pro-rich inequality in cervical cancer screening services. Confirming the results from the concentration curves, the overall concentration index was positive and significant (0.142; %95 CI = 0.127, 0.156; p &lt; 0.01). The magnitude was lower in rural areas (0.075; %95CI = 0.059, 0.090; p &lt; 0.01) than in urban areas (0.195; %95CI = 0.162, 0.228 p &lt; 0.001). After undertaking a decomposition of the concentration index, we found that age, education, rural or urban location, and wealth status account for more than 95% of the socioeconomic inequality in cervical cancer uptake. Conclusion Despite the national scale-up of free cancer care at the point of use, cervical cancer screening uptake in Malawi remains pro rich. There is a need to implement parallel demand-side approaches to encourage uptake among poorer groups. These may include self-testing and mobile screening centres, among others.

Human papillomavirus vaccination at the national and provincial levels in China: a cost-effectiveness analysis using the PRIME model

Abstract Background Human papillomavirus (HPV) vaccines have been proven effective against cervical cancer. However, HPV vaccination is not included in the Chinese immunization program. This study aimed to assess the cost-effectiveness of incorporating different HPV vaccines into immunization programs at the Chinese national and provincial levels. Methods The Papillomavirus Rapid Interface for Modeling and Economics model was used to estimate the possible cost and social and economic benefits of adopting various HPV vaccination immunization strategies in 31 provinces in Mainland China in 2019. Demographic and regional economic data were obtained from the national and provincial Statistical Yearbook. The cost of vaccines was gathered from the centralized procurement information platform of all Chinese provinces. Treatment costs, epidemiological data, and other model parameters were obtained from published literature. The cost of vaccination, treatment costs saved, net costs, cases and deaths averted, life years saved, disability-adjusted life years (DALYs) prevented, and incremental cost-effectiveness ratios were predicted both provincially and nationally. Deterministic sensitivity analyses were used to explore model uncertainty. Results The net cost of vaccinating with the domestic bivalent HPV vaccine was the lowest. At the national level, after bivalent or quadrivalent HPV vaccination, the number of cases and deaths averted due to cervical cancer were 12,545 and 5109, respectively, whereas the 9-valent HPV vaccine averted 28,140 cases and 11,459 deaths. HPV vaccines were cost-effective at a national level (maximum cost US$ 18,165 per DALY gained.) compared to the 3 times GDP per capita (US$ 30,837). Bivalent HPV vaccines were cost-effective in all 31 provinces. Imported quadrivalent and 9-valent HPV vaccines were cost-effective in 29 provinces, except Heilongjiang and Gansu. The univariate sensitivity analysis showed that the results were robust when the model parameters were changed, and that the discount rate was the main factor affecting the baseline results. Conclusions This study provides evidence that the inclusion of HPV vaccination in the immunization program would be cost-effective at a national level and in most provinces. Provinces with a higher population have more prevented cases, deaths, and DALYs. The economics of HPV vaccination at the provincial level differs from that at the national level, and provinces with an inability to pay should seek help from state subsidies.

Recruitment strategies to promote uptake of cervical cancer screening in the West Region of Cameroon

Abstract Objectives The World Health Organization’s (WHO) global strategy for cervical cancer elimination has set the target of 70% of women screened in all countries by 2030. Community sensitization through media is often used, but community health workers’ (CHW) involvement may contribute to improving screening coverage. We aimed to assess effectiveness and costs of two cervical cancer screening recruitment strategies conducted in a low-resource setting. Methods The study was conducted in the West Region of Cameroon, in the Health District of Dschang, a community of 300,000 inhabitants. From September 2018 to February 2020, we recruited and screened women for cervical cancer in a single-visit prevention campaign at Dschang District Hospital. During the first 9 months, recruitment was only based on Community Information Channels (CIC) (e.g.. street banners). From the tenth month, participation of CHW was added in the community after training for cervical cancer prevention counselling. Population recruitment was compared between the two strategies by assessing the number of recruited women and direct costs (CHW costs included recruitment, teaching, certification, identification badge, flyers, transport, and incentives). The intervention’s cost-effectiveness was expressed using an incremental cost-effectiveness ratio (ICER). Results and discussion During the period under study, 1940 women were recruited, HPV positive rate was 18.6% (n = 361) and 39 cases of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were diagnosed. Among included participants, 69.9% (n = 1356) of women were recruited through CIC as compared to 30.1% (n = 584) by CHW. The cost per screened woman and CIN2+ diagnosed was higher in the CHW group. The ICER was 6.45 USD or 16.612021Int’l$ per screened woman recruited by CHW. Recruitment in rural areas increased from 12.1 to 61.4% of all women included between CIC-led and CHW-led interventions. These outcomes highlight the importance of training, preparing, and deploying CHW to screen hard-to-reach women, considering that up to 45% of Cameroon’s population lives in rural areas. Conclusion CHW offer an important complement to CIC for expanding coverage in a sub-Saharan African region such as the West Region of Cameroon. CHW play a central role in building awareness and motivation for cervical cancer screening in rural settings.

Cervical cancer mortality among young women in Latin America and the Caribbean: trend analysis from 1997 to 2030

Abstract Background Cervical cancer continues to show a high burden among young women worldwide, particularly in low- and middle-income countries. Limited data is available describing cervical cancer mortality among young women in Latin America and the Caribbean (LAC). The purpose of this study was to examine the mortality trends of cervical cancer among young women in LAC and predict mortality rates to 2030. Methods Deaths from cervical cancer were obtained from the World Health Organization mortality database. Age-standardized mortality rates per 100,000 women-years were estimated in women aged 20–44 years using the world standard population for 16 countries (and territories) in LAC from 1997 to 2017. We estimated the average mortality rates for the last 4 years (2014–2017). Joinpoint regression models were used to identify significant changes in mortality trends. Nordpred method was used for the prediction of the mortality rates to 2030. Results Between 2014 and 2017, Paraguay and Venezuela had the highest mortality rates of cervical cancer, whereas Puerto Rico had the lowest rates. Overall, most of the LAC countries showed downward trends of cervical cancer mortality over the entire period. Significant decreases were observed in Chile (Average annual percent change [AAPC]: − 2.4%), Colombia (AAPC: − 2.0%), Cuba (AAPC: − 3.6%), El Salvador (AAPC: − 3.1%), Mexico (AAPC: − 3.9%), Nicaragua (AAPC: − 1.7%), Panama (AAPC: − 1.7%), and Peru (AAPC: − 2.2%). In contrast, Brazil (AAPC: + 0.8%) and Paraguay (AAPC: + 3.7%) showed significant upward trends. By 2030, mortality rates are not predicted to further decrease in some LAC countries, including Argentina, Paraguay, and Venezuela. Conclusions Mortality trends of cervical cancer among young women have large variability in LAC countries. Cervical cancer screening programs have a high priority for the region. Primary and secondary prevention in the community are necessary to accelerate a reduction of cervical cancer mortality by 2030.

Health inequality and improvement gap in the prevalence of gynecological cancers among perimenopausal women globally, 1990–2019

Abstract Background Perimenopausal women are a high-risk group for gynecological cancers; however, the spatiotemporal heterogeneity in prevalence and its association with socioeconomic development have not been fully explored. This study aimed to analyze the global burden of cervical, ovarian, and uterine cancers among perimenopausal women, examine health inequalities, and investigate their relationship with socioeconomic levels. Methods We assessed the disease burden of gynecological cancers in perimenopausal women using the 2019 Global Burden of Disease study (GBD2019) data, utilizing prevalence and Years of Life Lost (YLL) rates. Health inequality and frontier analyses were performed based on age-standardized prevalence rates for cervical, ovarian, and uterine cancers, coupled with associated socio-demographic index (SDI) data. Results Over the past thirty years, global prevalence rates of cervical, ovarian, and uterine cancers among perimenopausal women have risen, while the number of YLLs has declined. Correlation analysis with the SDI showed that ovarian and uterine cancer prevalence rates positively correlated with SDI, whereas cervical cancer prevalence was inversely related to it. Moreover, the burden of these cancers demonstrated marked inequalities in relation to SDI, with cervical cancer disparities intensifying—the absolute value of the inequality slope index rose from 100.98 in 1990 to 170.17 in 2019. Ovarian cancer experienced a slight decrease in inequalities, while uterine cancer saw a significant increase, with its inequality slope index jumping from 176.51 in 1990 to 226.01 in 2019. Additionally, there existed regional health disparities in the disease burden of ovarian cancer among perimenopausal women; notably, in regions where YLLs rates for ovarian cancer were increasing, economically developed areas actually exhibited a decline. Conclusion Globally, the prevalence of gynecological cancers in perimenopausal women showed an increasing trend. The health inequality gap for cervical and uterine cancer has widened, while disparities in ovarian cancer are particularly pronounced across regions. There remains scope for improvement in managing the prevalence of gynecological cancers among perimenopausal women across countries with varying SDI levels.

Implementing a chatbot to promote hereditary breast &amp; ovarian cancer genetic screening in women’s health: identifying barriers and facilitators to screening adoption

To promote genetic screening among women at risk for hereditary breast and ovarian cancer (HBOC), the American College of Obstetricians and Gynecologists recommends that risk assessment be integrated into practice. Chatbots like the Genetic Information Assistant (Gia®) are increasingly implemented to expand access to hereditary genetic screening. Factors that impact chatbot implementation for HBOC risk screening and women's uptake are not fully realized. To refine implementation strategies prior to full scale implementation, we sought to identify women's perceived facilitators/barriers to adopting Gia screening in a rural population within a large healthcare system in the southern United States. We recruited both women who agreed to screen using Gia (and then recommended for genetic testing based on National Comprehensive Cancer Network guidelines) as well as women who opted not to do the screen from three Women's Health clinics (OB/GYN) in a northern rural region of Florida. We conducted in-depth, semi-structured interviews with 17 women (nine adopted the screen, eight did not). We conducted a thematic analysis to identify and further define barriers/facilitators to women's uptake of Gia for HBOC cancer risk screening in obstetrics/gynecology care. Women identified six factors that inhibited and/or facilitated their willingness to use Gia for screening: 1) cancer risk perception, 2) communication with their clinician, 3) feasibility of screening, 4) fiscal and insurance concerns, 5) technology trust/distrust, and 6) previous genetic testing experience. Findings illustrate how each factor functioned as a facilitator and/or barrier in women's uptake (e.g., technology being trusted for accuracy versus concerns for data privacy and security). While chatbots can extend women's cancer risk screening access, particularly in rural regions and with college-educated women, systems-level (cost) and individual-level factors (perceived risk, misconceptions about repeating genetic testing) should be addressed to promote adoption. Women's interaction with a clinician may be a key implementation strategy for addressing these factors to personalize the screening opportunity and promote their chatbot screening adoption.

The association between energy-adjusted dietary inflammatory index (E-DII) and lung cancer in 101,755 participants aged 55 years and above: a large prospective cohort

Cancer incidence in the vicinity of open landfills in Guadeloupe, French West Indies

Information needs of ethnically diverse, vaccine-hesitant parents during decision-making about the HPV vaccine for their adolescent child: a qualitative study

Abstract Background The English schools-based human papillomavirus (HPV) vaccination programme has the potential to eliminate HPV-related cancers if high uptake is achieved. However, unmet information needs among some parents may contribute to persisting lower uptake among minority ethnic groups. Through this study we aimed to understand the information needs of vaccine-hesitant, ethnically diverse parents during decision-making about the HPV vaccine for their adolescent child, to inform the future development of tailored communication materials. Methods Recruitment was facilitated thorough healthcare and community organisations within London and the South West of England. Semi-structured interviews took place between April and August 2023. Thematic analysis was undertaken, assisted by NVivo software. Results Of the 29 parents interviewed, the majority were mothers (79%), belonged to a minority ethnic group (88%), and had an adolescent child unvaccinated against HPV (72%). Five of the interviews were undertaken in the participants’ primary language with translation support. Most parents interviewed had limited knowledge about the HPV vaccine and appeared conflicted as to whether vaccines could offer benefits to health. Misunderstanding around the potential of developing serious side-effects (e.g. fertility issues, developing cancer) were factors that could negatively impact decision-making by parents. Stigma associated with the sexual transmissibility of HPV did not always negatively impact decision-making. However, some parents chose not to vaccinate on the basis of perceptions of low risk and a preference to provide education about sexual behaviours to their adolescent child. Conclusions Tailoring communication materials to address misunderstandings could support informed decision-making by vaccine hesitant parents for their adolescent children to be vaccinated against HPV. Future communication materials about the HPV vaccine should highlight the benefits of protection against cancer to increase parents’ motivation for protect their adolescent child; provide accurate convincing information in relation to the excellent safety profile; and emphasise the importance of providing HPV vaccine at the recommended age, all alongside communicating the universality and commonality of HPV infection. Trial registration N/A.

Barriers to cervical cancer screening faced by immigrant Muslim women: a systematic scoping review

Abstract Background Uptake for cervical cancer screening (CCS) is extremely low among immigrant women, particularly Muslim women, because of barriers related to religious values, beliefs, and fatalism. This scoping review aimed to summarize and analyze the findings of previous studies regarding perceived barriers to CCS among Muslim immigrant women. Methods A search of electronic databases of peer-reviewed articles, including MEDLINE, CINAHL, PubMed, and Scopus was conducted. The following criteria were used for the selection of the articles: (a) the study population consisted of immigrant Muslim women, (b) CCS barriers were the main focus of the study, (c) the articles were original research articles, (d) the research was conducted within the last 10 years, and (d) the study was reported in English language. Results Barriers included sociodemographic factors, economic, language, cognitive, and emotional reactions. The healthcare system was classified as a community barrier, whereas culture and religion were categorized as social barriers. Beliefs that becoming ill and dying is the will of Allah and that health problems are a punishment from God were considered to be major barriers to CCS among immigrant Muslim women. Conclusion Access to health service centers and CCS among Muslim immigrant women is challenging. Information dissemination by health care workers is needed to increase awareness of CCS and access to CCS service points among immigrant Muslim women. Physician recommendations to attend CCS also play an important role.

Improvement of Parent’s awareness, knowledge, perception, and acceptability of human papillomavirus vaccination after a structured-educational intervention

Abstract Background Regardless of the disease burden of human papillomavirus (HPV), the vaccine has not been included in the Indonesia National Immunization Program. Since 2017 there was a demonstration program of the HPV vaccination in Yogyakarta Province. This vaccine was given free to female primary school students in the 5th and 6th grades (11–13 years old). This study aimed to assess whether a structured-educational intervention focus on HPV increases the parental awareness, knowledge, and perceptions toward HPV and the vaccine acceptability. Methods We conducted a pre-post structured-educational intervention study from July to August 2017 before the implementation of the HPV vaccination demonstration program, in Kulon Progo District, Yogyakarta Province, Indonesia. Parents of female primary school students grades 5th and 6th were selected using a school-based proportional random sampling. A pediatric resident provided a structured-educational intervention, which consists of the burden and risk of HPV disease, as well as the benefit and safety of the vaccine. Parents were required to complete validated self-administered questionnaires before and after the structured-educational intervention. Results A total of 506 parents participated. Before receiving the structured-educational intervention, parents’ awareness of HPV infection and the vaccines were low. Only 49.2% of parents had heard HPV infection, and 48.8% had heard about the vaccine. After the structured-educational intervention, there were significant improvements in parent’s awareness, knowledge, and perceptions of HPV infection, cervical cancer, and HPV vaccination (all p  &lt; 0.001). HPV vaccine’s acceptability increased from 74.3 to 87.4% ( p  &lt; 0.001). There was a significant correlation between increasing HPV vaccine acceptability with the improvement of awareness, knowledge, and perception toward HPV infection, cervical cancer and HPV vaccination (r = 0.32 to 0.53, p  &lt; 0.001). After the structured-educational intervention, better knowledge and positive perceptions of HPV vaccination were predictive of HPV vaccine’s acceptability with OR 1.90 (95%CI:1.40–2.57) and OR 1.31(95%CI,1.05–1.63), respectively. Conclusions A structured-educational intervention may improve parental awareness, knowledge, and perceptions toward HPV and the acceptability of the vaccine. Further study, a randomized control trial with longer follow-up are needed to evaluate the long-term and actual effectiveness of improving parents’ knowledge, perceptions and HPV vaccine acceptability .

Incidence, cost and gender differences of oropharyngeal and noncervical anogenital cancers in South Korea

Abstract Background Human papillomavirus (HPV) is associated with a significant public health burden, yet few studies have been conducted in Asia, especially on noncervical cancers. We estimated the incidence and cost of oropharyngeal and noncervical anogenital (anal, vulvar, vaginal, penile) cancer in Korea. Methods We conducted a retrospective cohort study using Korea’s National Health Insurance (NHI) claim database from 2013 to 2016. The main outcome measures were the number of respective cancer incidences during the study period and the annual costs per patient in the first year after diagnosis, which was adjusted by relevant variables based on the regression analysis. Results During the study period, 8022 patients with these cancers were identified, and oropharyngeal cancer comprised 46% of them. The crude incidence rate for male oropharyngeal cancer was significantly higher than that of females (3.1 vs. 0.7 per 100,000 as of 2016, respectively). Additionally, the crude incidence of male oropharyngeal cancer increased from 2.7 in 2013 to 3.1 in 2016, whereas that of female and other cancers was stable during the study period. The mean annual incidence-based cost per patient in 2016 was highest for oropharyngeal cancers (21,870 USD), and it was significantly higher in males than in females based on then regression analysis ( p  &lt; .001). Conclusions Oropharyngeal cancer comprises the highest number of HPV-associated noncervical cancer incidences in Korea, and the incidence and cost of oropharyngeal cancer was significantly higher among males than females. More aggressive public health policy toward males may decrease gender gap of oropharyngeal cancer.

Young women’s autonomy and information needs in the schools-based HPV vaccination programme: a qualitative study

Abstract Background Until 2019, the English schools-based human papillomavirus (HPV) vaccination programme was offered to young women (but not young men) aged 12 to 13 years to reduce HPV-related morbidity and mortality. The aim of this study is to explore the extent to which young women were able to exercise autonomy within the HPV vaccination programme. We consider the perspectives of young women, parents and professionals and how this was influenced by the content and form of information provided. Methods Recruitment was facilitated through a healthcare organisation, schools and community organisations in a local authority in the south-west of England. Researcher observations of HPV vaccination sessions were carried out in three schools. Semi-structured interviews took place with 53 participants (young women, parents of adolescent children, school staff and immunisation nurses) during the 2017/18 and 2018/19 programme years. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was undertaken, assisted by NVivo software. Results Young women’s active participation and independence within the HPV vaccination programme was constrained by the setting of vaccination and the primacy of parental consent procedures. The authoritarian school structure influenced the degree to which young women were able to actively participate in decisions about the HPV vaccination programme. Young women exercised some power, either to avoid or receive the vaccine, by intercepting parental consent forms and procedures. Reliance on leaflets to communicate information led to unmet information needs for young women and their families. Communication may be improved by healthcare professional advocacy, accessible formats of information, and delivery of educational sessions. Conclusions Strategies to improve communication about the HPV vaccine may increase young people’s autonomy in consent procedures, clarify young people’s rights and responsibilities in relation to their health care services, and result in higher uptake of the HPV vaccination programme. Trial registration ISRCTN 49086105 ; Date of registration: 12 January 2018; Prospectively registered.

Disparities in cervical cancer screening participation in Iran: a cross-sectional analysis of the 2016 nationwide STEPS survey

Abstract Background One of the most important concerns in every healthcare system is the elimination of disparities in health service utilization and achievement of health equity. This study aimed to investigate the disparities in cervical cancer screening participation in Iran. Methods A cross-sectional study was conducted using data from the National Non-Communicable Risk Factors Survey in 2016 (STEPs 2016). Data on cervical cancer screening in addition to demographic and socio-economic factors from 15,975 women aged 18 and above were analyzed. The distribution of surveyed women with regard to cervical cancer screening practice was described. Chi square and logistic regression were used to assess the association of demographic and socio-economic factors with cervical cancer screening participation. Results Overall, 52.1% of women aged 30–59 years, had undergone cervical cancer screening at least once in their lifetime. Participation rate in cervical cancer screening programs varied between provinces; ranging from 7.6% in Sistan and Baluchestan to 61.2% in Isfahan. Single marital status, illiteracy, being employed, and having no insurance coverage were associated with lower participation. Age and area of residence were insignificant predictors for participating in cervical cancer screening program. Analysis of the cervical cancer uptake rates across the socio-economic levels revealed that the service is less utilised by high income groups. Conclusions Participation in cervical cancer screening program in Iran is not optimal and could be improved. With regard to the distribution of cervical cancer screening practice, social and geographical disparities indicate the need for further research and more comprehensive strategies in order to reduce them.

Never and under cervical cancer screening in Switzerland and Belgium: trends and inequalities

Abstract Background Research on inequalities in cervical cancer screening (CCS) participation has overlooked the distinction between ‘never-’ and ‘under-screeners’ while different socioeconomic and demographic determinants may underlie ‘non-’ and ‘under-’ screening participation. This study examines socioeconomic and demographic inequalities in never and under CCS participation. We compare cross-national prevalence and trends among these two groups in Switzerland and Belgium, two countries with similar opportunistic CCS strategy but different healthcare systems. Methods Data on 38,806 women aged 20–70 from the Swiss Health Interview Survey (1992–2012) and 19,019 women aged 25–64 from the Belgian Health Interview Survey (1997–2013), both population-based cross-sectional nationally representative surveys, was analysed. Weighted adjusted prevalence ratios were estimated with multivariate Poisson regressions. Results Over the studied period, never screening prevalence was about 15% in both Switzerland and Belgium and under screening prevalence about 14.0%. Socioeconomic gradients were found among both never- and under-screeners. Higher income women had lower never and under screening prevalence in Switzerland and a similar gradient in education was observed in Belgium. Importantly, distinct socioeconomic and demographic determinants were found to underlie never and under screening participation. Never screening was significantly higher among foreign nationals in both countries and this association was not observed in under screening. Never screening prevalence was lower among older age groups, while under screening increased with older age. Over time, age inequalities diminished among never- and under- screeners in Switzerland while educational inequalities increased among never-screeners in Belgium. Conclusion Findings revealed that determinants of screening inequalities differed among never- and under-screeners and hence these should be addressed with different public health strategies. Crucially, socioeconomic and demographic inequalities were more pronounced among never-screeners who appeared to face more structural and persistent inequalities. Differences between the two countries should also be noted. The more liberal-type Swiss healthcare systems appeared to shape income-related screening inequalities, while education appeared to be a stronger determinant of never- and under-screening in Belgium.

“A loving man has a very huge responsibility”: A mixed methods study of Malawian men’s knowledge and beliefs about cervical cancer

Abstract Background In Malawi, numerous barriers may prevent women from accessing cervical cancer screening services — including social factors such as male partner involvement. We conducted surveys that included open- and closed-ended questions with married Malawian men to evaluate their knowledge and beliefs about cervical cancer. Methods HIV-positive adult (≥18 years) men (married or in a stable relationship) were recruited from an antiretroviral therapy clinic in Lilongwe, Malawi. Men were asked a series of survey questions to assess their knowledge about cervical cancer, experience with cervical cancer, their female partner’s screening history, and their beliefs about gender norms and household decision-making. Following the survey, participants responded to a set of open-ended interview questions about cervical cancer screening, and men’s role in prevention. Results One hundred-twenty men were enrolled with average age 44 years and 55% having completed secondary school or higher education. Despite only moderate knowledge about cervical cancer and screening (average assessment score of 62% correct), all men expressed support of cervical cancer screening, and most (86%) believed they should be involved in their female partner’s decision to be screened. Over half (61%) of men said their female partner had previously been screened for cervical cancer, and this was positively correlated with the male respondent having more progressive gender norms around sexual practices. Some men expressed concerns about the screening process, namely the propriety of vaginal exams when performed by male clinicians, and whether the procedure was painful. Conclusions Male partners in Malawi want to be involved in decisions about cervical cancer screening, but have limited knowledge about screening, and hold rigid beliefs about gender norms that may affect their support for screening. Messaging campaigns addressing men’s concerns may be instrumental in improving women’s adoption of cervical cancer screening services in Malawi and similar settings.

Years of life lost due to premature death and their trends in people with malignant neoplasm of female genital organs in Shanghai, China during 1995–2018: a population based study

Abstract Background The increasing aging population has been posing a significant challenge to disease burden in developing countries. In particular, the contribution of population aging to and long term changes of disease burden of malignant neoplasm of female genital organs (MNFGO) have not been quantitatively demonstrated. Methods Data were collected from the Shanghai Vital Statistics System of Pudong New Area (PNA). Crude mortality rate (CMR), age-standardized mortality rate by Segi’s world standard population (ASMRW), and years of life lost (YLL) of MNFGO as the underlying cause of death in age and pathology types from 1995 to 2018 were calculated. The joinpoint regression was used to estimate the trends of those rates by identifying the annual percent changes (APCs), and the decomposition method was used to calculate the increased rates and the contribution resulting from demographic and non-demographic factors. Results From 1995 to 2018, a total of 2869 MNFGO-specific deaths were reported in PNA, accounting for 0.64% of the total deaths. The CMR and ASMRW of MNFGO were 9.23/105 person-years and 4.80/105 person-years, respectively. Ovary cancer was the most common cause of MNFGO death, accounting for 43.9% (1260/2869) of all MNFGO death. Other common causes of MNFGO death included cervix uteri cancer, uterus unspecified cancer, and corpus uteri cancer. With the increase of age, the mortality rate of MNFGO in residents had shown an upward trend ([APC (95%CI) = 3.46 (2.74, 4.18), P &lt; 0.001)] for each five-year age group from 0 to 4 to 85+ years. From 1995 to 2018, YLL of MNFGO in Shanghai PNA was 42,152.82 years, and the rate of YLL was 135.56 /105. The top three MNFGO types in YLLs were ovary cancer, cervix uteri cancer and uterus unspecified cancer. Demographic factors contributed significantly to the upward trends of CMR, ASMRW, and YLL rates of MNFGO. Conclusion With aggravated population aging in Shanghai, MNFGO is and will continue to be a serious threat to women’s health. More precise and effective prevention strategies are needed to target high risk population, to achieve efficient health resource allocation and to improve women’s health in particular.

Using self-collection HPV testing to increase engagement in cervical cancer screening programs in rural Guatemala: a longitudinal analysis

Abstract Background Cervical cancer is a leading cause of death in low- and middle-income countries. Self-collection testing for human papillomavirus (HPV) is an alternative form of cervical cancer screening that can be completed privately and at home. Understanding how the use of HPV testing influences follow-up care in low-resourced settings is crucial before broad implementation. This study aimed to identify if access to self-collection HPV testing impacts participation in established cervical cancer screening programs among women in two rural communities in Guatemala. Methods A cohort of 956 women was recruited in 2016 and followed for 2 years for the HPV Multiethnic Study (HPV MES). At baseline, women answered a questionnaire assessing cervical cancer screening history and were offered self-collection HPV testing. Women were re-contacted yearly to determine receipt of additional screening. Statistical changes in screening behavior before and throughout study participation, stratified by self-collection status, were assessed using McNemar pair tests for proportions. Alluvial plots were constructed to depict changes in individual screening behavior. The odds of changes in Pap-compliance (screened in past 3 years), given collection status, were assessed using multivariate logistic regressions. Results Reported screening rates increased 2 years after enrollment compared to rates reported for the 3 years before study entry among women who collected a sample (19.1% increase, p &lt; 0.05), received results of their test (22.1% increase, p &lt; 0.05), and received positive (24.2% increase, p &lt; 0.1) or negative results (21.7% increase, p &lt; 0.05). However, most increases came from one community, with minimal changes in the other. The adjusted odds of becoming Pap compliant were higher for women who collected a sample vs. did not (OR: 1.48, 95% CI: 0.64, 3.40), received their result vs. did not (OR: 1.29, 95% CI: 0.52, 3.02), and received a positive result vs. negative (OR: 2.43, 95% CI: 0.63, 16.10). Conclusions Participation in self-collection HPV testing campaigns may increase likelihood of involvement in screening programs. However, results varied between communities, and reporting of screening histories was inconsistent. Future work should identify what community-specific factors promote success in HPV testing programs and focus on improving education on existing cervical cancer interventions.

The quadrivalent HPV vaccine is protective against genital warts: a meta-analysis

AbstractBackgroundThe quadrivalent human papillomavirus (HPV) vaccine has been assumed to give protection against genital warts (GW) as well as cervical cancer. Our main question was whether HPV vaccine has any effects on the prevention of GW reported in randomised controlled clinical trials (RCTs) and time-trend analyses.MethodsThis meta-analysis was performed according to the PRISMA guidelines using the PICO format. We searched in three electronic databases (PubMed, Embase, Cochrane Trials), and assessed heterogeneity using the Q-test and I-squared statistics, meta-regression was also performed. Odds ratios (OR) and their confidence intervals (CI) were calculated. The sensitivity was tested by leave-one-out method. We evaluated the presence of publication bias using the funnel plot graph and the Copas selection model. The strength of evidence was assessed using the GRADE approach.ResultsEight RCTs (per-protocol populations) and eight time-trend ecological studies were included in this meta-analysis. A significant reduction (pooled OR = 0.03, 95% CI: 0.01–0.09; I-squared = 53.6%) of GW in young women was recorded in RCTs, and in time-trend analyses both in young women (pooled OR = 0.36, CI 95% = 0.26–0.51; I-squared = 98.2%), and in young men (pooled OR = 0.69, 95% CI = 0.61–0.78; I-squared = 92.7%). In subgroup analysis, a significant reduction of the number of GW events was observed especially in women under 21 years (pooled OR = 0.33, 95% CI = 0.17–0.63). Leave-one-out analysis showed that similar results could be obtained after excluding one study, meta-regression did not show significant difference.ConclusionsProphylactic, quadrivalent HPV vaccination can prevent GW in healthy women and men, therefore, it should be included in routine immunization programme.

Assessing the epidemiological impact on cervical cancer of switching from 4-valent to 9-valent HPV vaccine within a gender-neutral vaccination programme in Switzerland

Abstract Background An infection with high-risk human papillomavirus (HPV) is the obligatory aetiological factor for the development of cervical cancer. In Switzerland, the prevention strategy for cervical cancer is based on primary prevention via HPV vaccination and secondary prevention with an opportunistic screening programme for precancerous lesions. Vaccination is recommended to 11–26 years old male and female persons. The objective of the study was to assess the epidemiological impact on cervical cancer of switching from the currently implemented programme with the 4-valent vaccine to the 9-valent vaccine, in an 11–26 years old gender-neutral vaccination programme in Switzerland. Methods A previously validated dynamic transmission model of HPV infections was adapted and calibrated to the Swiss setting assuming an 80% coverage rate in HPV-vaccination and lifelong vaccine type-specific protection. A gender-neutral vaccination programme (males and females) for 11–26 years old with a 9-valent HPV vaccine was compared with the current 11–26 years old gender-neutral 4-valent vaccination programme. Sensitivity analyses were conducted in order to test the impact of lower vaccination coverage rates and a shorter duration of protection on the model outcomes. Results In Switzerland, a 9-valent gender-neutral vaccination programme would result in an additional prevention of 2979 cervical cancer cases, 13,862 CIN3 and 15,000 CIN2 cases, compared with the 4-valent gender-neutral vaccination programme over 100 years. These additional disease cases avoided would correspond to a 24, 36 and 48% cumulative incidence decrease in cervical cancer, CIN3 and CIN2 cases, respectively. It would also prevent additional 741 cervical cancer-related deaths over 100 years. A substantial additional reduction in cervical cancer and precancerous lesions burden is still observed when varying the vaccination coverage rate from 30 to 60% or reducing the duration of protection from lifelong to 20 years. Conclusions The switch to the 9-valent vaccine in Switzerland to prevent cervical diseases showed an important contribution in terms of public health impact compared with the 4-valent vaccine in an 11–26 years old gender-neutral population, even with very conservative assumptions such as low coverage rates or low duration of protection and limiting analysis to only cervical disease.

Knowledge about cervical cancer and HPV immunization dropout rate among Brazilian adolescent girls and their guardians

Abstract Background Infections with Human Papillomavirus (HPV) are the main cause of cervical cancer. Since 2014, the HPV vaccine was introduced in the Brazilian National Vaccination Calendar. The purpose of this study was to assess the knowledge of adolescent girls and their mothers/guardians about HPV and HPV vaccine, identify the factors associated with this knowledge, and evaluate immunization dropout rate. Methods This was a cross-sectional study involving adolescent girls and their mothers/guardians. Participants underwent an interview that addressed sociodemographic data, sexual and gynecological history, and knowledge about HPV, HPV vaccine and cervical cancer. The third quartile of the total score was established as a cutoff for assessing knowledge. Adolescents who correctly answered more than four questions and mothers/guardians who obtained more than five correct responses were categorized into high knowledge. Poisson regression analysis was performed to identify variables associated with low knowledge. Vaccination records were used to assess immunization dropout rates. Any adolescent who did not complete the two-dose vaccination schedule was considered dropout. Results A total of 666 adolescent girls and 623 mothers/guardians were interviewed. Low knowledge was observed in 76.7% of adolescents and 79.8% of mothers/guardians. Most were unaware of the causal relationship between HPV and cervical cancer, signs and symptoms of HPV infection, and had limited knowledge about the HPV vaccine. Factors associated with low knowledge of adolescents were aged 12 years [IRR 1.2 (95% CI 1. 1-1.3)] or less [IRR 1.3 (95% CI (1. 2-1.4)]; household income lower than US$750 [IRR 1.7 (95% CI 1. 1-2.6)] and household income between US$751 and US$1500 [IRR 1.6 (95% CI 1.0–2.6)]. Among mothers/guardians, low knowledge was related to having completed elementary school or less [IRR 1.5 (95% CI 1. 2-2.0)]; and household income lower than US$750 [IRR 1.2 (95% CI 1.0–1.4)]. Knowledge of adolescents and mothers/guardians was not associated with vaccine uptake. HPV immunization dropout rate was considered high (32.3%). Conclusion Knowledge about HPV and cervical cancer as well as vaccine uptake was low. Results highlight the need for educational interventions about HPV and cervical cancer. These actions may contribute to improve adherence to HPV vaccination.

Utilization of cervical cancer screening among migrants and non-migrants in Germany: results from a large-scale population survey

Abstract Background Studies from European and non-European countries have shown that migrants utilize cervical cancer screening less often than non-migrants. Findings from Germany are inconsistent. This can be explained by several limitations of existing investigations, comprising residual confounding and data which is restricted to only some regions of the country. Using data from a large-scale and nationwide population survey and applying the Andersen Model of Health Services Use as the theoretical framework, the aim of the present study was to examine the role that different predisposing, enabling and need factors have for the participation of migrant and non-migrant women in cervical cancer screening in Germany. Methods We used data from the ‘German Health Update 2014/2015’ survey on n = 12,064 women ≥20 years of age. The outcome of interest was the participation in cancer screening (at least once in lifetime vs. no participation). The outcome was compared between the three population groups of non-migrants, migrants from EU countries and migrants from non-EU countries. We employed multivariable logistic regression to examine the role of predisposing, enabling and need factors. Results Non-EU and EU migrant women reported a lower utilization of cervical cancer screening (50.1 and 52.7%, respectively) than non-migrant women (57.2%). The differences also remained evident after adjustment for predisposing, enabling and need factors. The respective adjusted odds ratios (OR) for non-EU and EU migrants were OR = 0.67 (95%-CI = 0.55–0.81) and OR = 0.80 (95%-CI = 0.66–0.97), respectively. Differences between migrants and non-migrants were particularly pronounced for younger age groups. Self-rated health was associated with participation in screening only in non-migrants, with a poorer health being indicative of a low participation in cancer screening. Conclusions The disparities identified are in line with findings from studies conducted in other countries and are indicative of different obstacles this population group encounters in the health system. Implementing patient-oriented health care through diversity-sensitive health services is necessary to support informed decision-making.

Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis

Abstract Background Cervical cancer is the fourth most common cancer affecting women worldwide, with 85% of the burden estimated to occur among women in low and middle-income countries (LMICs). Recent developments in cervical cancer screening include a novel self-collection method for the detection of oncogenic HPV strains in the collected samples. The purpose of this review is to synthesise qualitative research on self-collection for HPV-based testing for cervical screening and identify strategies to increase acceptability and feasibility in different settings, to alleviate the burden of disease. Methods This review includes qualitative studies published between 1986 and 2020. A total of 10 databases were searched between August 2018 and May 2020 to identify qualitative studies focusing on the perspectives and experiences of self-collection for HPV-based cervical screening from the point of view of women, health care workers and other key stakeholders (i.e., policymakers). Two authors independently assessed studies for inclusion, quality, and framework thematic synthesis findings. The Socio-Ecological Model (SEM) was used to synthesize the primary studies. Results A total of 1889 publications were identified, of which 31 qualitative studies were included. Using an adapted version of SEM, 10 sub-themes were identified and classified under each of the adapted model’s constructs: (a) intrapersonal, (b) interpersonal, and (c) health systems/public policy. Some of the themes included under the intrapersonal (or individual) construct include the importance of self-efficacy, and values attributed to self-collection. Under the intrapersonal construct, the findings centre around the use of self-collection and its impact on social relationships. The last construct of health systems focuses on needs to ensure access to self-collection, the need for culturally sensitive programs to improve health literacy, and continuum of care. Conclusion This review presents the global qualitative evidence on self-collection for HPV-based testing and details potential strategies to address socio-cultural and structural barriers and facilitators to the use of self-collection. If addressed during the design of an HPV-based cervical cancer screening testing intervention program, these strategies could significantly increase the acceptability and feasibility of the intervention and lead to more effective and sustainable access to cervical screening services for women worldwide.

Gaps and opportunities for cervical cancer prevention, diagnosis, treatment and care: evidence from midterm review of the Zimbabwe cervical Cancer prevention and control strategy (2016–2020)

Abstract Background Cervical cancer is the fourth most common cancer amongst women globally and it accounts for the majority of cancer deaths among females in Zimbabwe. The objective of this midterm review analysis was to identify the gaps and opportunities for cervical cancer prevention, diagnosis, treatment, and care to inform the next cervical cancer strategy in Zimbabwe. Methods A mixed methods approach was used for the midterm review. Secondary data was collected from programme documents, published and grey literature. Primary data was collected in six provinces through key informant interviews with officials and focus group discussions with beneficiaries. After data analysis, a draft report was presented to a technical working group to validate the findings and to fill in any gaps. Results This midterm review revealed a myriad of gaps of the strategy particularly in diagnosis, treatment and care of cervical cancer and the primary focus was on secondary prevention. There was no data to quantify the level of awareness and advocacy for cervical cancer prevention. Our results revealed that there was no data on the proportion of women who ever tested for cervical cancer which existed nationally. Our findings suggest that some health facilities were screening women above 50 years old using VIAC, which is an inappropriate approach for those women. Quality control of VIAC and treatment of precancers were not part of the strategy. Pathological services were not efficient and effective due to lack of resources and additionally data on investigations were not routinely collected and available at the national level. Other gaps identified were limited funding, human resources, equipment, and commodities as well as lack of leadership at the national level to coordinate the various components of the cervical cancer programme. There are also numerous opportunities identified to build upon some successes realized to date. Conclusions Our findings emphasized the importance of effective and holistic planning in cervical cancer screening programmes in low-resource settings. In addition, huge investments are required in cervical cancer programmes and governments need to take centre role in mobilizing the requisite resources.

Trends in cervical cancer mortality in China from 1989 to 2018: an age-period-cohort study and Joinpoint analysis

Abstract Background Worldwide, cervical cancer is the second-most-common malignancy of the female reproductive system. Due to its large population, China accounted for 11.9% of cervical cancer deaths, and 12.3% of global cervical cancer DALYs in 2017. In 2009, China launched a nationwide screening program, yet mortality from cervical cancer has shown an upward trend in recent years. The aim of this study was to explore factors affecting cervical cancer mortality rates in China, and contribute to their future reduction. Methods In this descriptive study, a Joinpoint regression analysis and age-period-cohort (APC) model based on the intrinsic estimator (IE) algorithm were utilized. Data from the period 1989–2018 were extracted from the International Agency for Research on Cancer (IARC) Database of WHO (1989–2000) and China Health Statistical Yearbook database (2002–2018). Results Our study found mortality from cervical cancer to have initially declined, but increase thereafter over the entire observation period in both rural and urban China. The influence of age, period and cohort effect on the mortality rate had statistical significance. The effect of age increased with years, becoming a contributing factor in women aged over 45 years countrywide. Conversely, the cohort effect became a protective factor for women born after 1938 in urban areas, and for women born after 1958 in rural areas. The period effect was relatively less impactful. Conclusions The study indicates that organized cervical screening projects facilitated the identification of potential patients, or patients with comorbidities. Correspondingly, mortality was found to increase with incidence, particularly among elderly women, indicating that newly diagnosed patients were at an advanced stage of cervical cancer, or were not receiving appropriate treatment. Therefore, the coverage of cervical cancer screening should be improved, and women’s health awareness promoted. Early diagnosis and treatment is critical to reduce the disease burden and improve outcomes.

Higher insoluble fiber intake is associated with a lower risk of prostate cancer: results from the PLCO cohort

AbstractStudies regarding the relationship between fiber intake and prostate cancer (PCa) have conflicting results. Therefore, this study examined the relationship between fiber intake and the risk of PCa by using data from Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. A total of 54,336 participants in the United States, consisting of 6,414 patients with PCa, were included in this study. Multivariate Cox regression models were applied to estimate adjusted hazard ratios (aHRs) and corresponding 95% confidence intervals (CIs). Compared with individuals in the lowest quartile, individuals in the highest quartile of insoluble fiber intake had a significantly lower risk of PCa (aHR, 0.87; 95% CI, 0.78–0.98). By contrast, no significant associations were detected between total fiber intake (aHR, 0.90; 95% CI, 0.80–1.01) or soluble fiber intake (aHR, 0.90; 95% CI, 0.80–1.02). Subgroup analyses showed that insoluble fiber was related to a decreased risk of PCa in subjects with the following characteristics: age &gt; 65 years, nonsmoking or former smokers, education level ≤ high school, non-Hispanic white ethnicity, or without a family history of PCa. In addition, significant combined effects of insoluble fiber intake, age and family history of PCa on the risk of PCa were observed, but no combined effects of smoking status and insoluble fiber intake were observed. In addition, total fiber, insoluble fiber, and soluble fiber intake had no influence on the mortality of PCa patients. These results show that all 3 measures of fiber suggest a protective association, but insoluble fiber may have a stronger association with the risk of PCa. Future studies are warranted to further investigate these relationships.

Impact of HPV vaccination on HPV infection and cervical related disease burden in real-world settings (HPV-RWS): protocol of a prospective cohort

Abstract Background Cervical cancer is one of the most common cancers in women and could be prevented by human papilloma virus (HPV) vaccination. Cervarix, the first available HPV vaccine, has been widely administrated to Chinese women, while little was known about its effect on the prevention and control for HPV related diseases in China. The study aims to assess the impact of Cervarix on HPV infection and cervical related diseases in real world. Methods This is a prospective, multi-age birth cohort study to investigate the incidence and continuous status of HPV infection, and relevant cervical diseases by exposure status (with Cervarix vaccination history or without any HPV vaccination history). It is planned to recruit 12,118 eligible women at age of 9 to 45 years from vaccination clinics or hospital outpatient clinics, and then follow up them for three years. The standard questionnaire will be used to collect information such as demographic characteristics, menstruation and obstetrical histories, history of sexual behavior, personal behavior history, history of disease and pathogen infection, medication history, and family history at baseline. After three years, the changes of these behaviors will be investigated again, and other related health status information will be retrieved from the electronic health records during the follow-up period. If available physically and legally, the cervical cancer screening will be performed, including type-specific HPV deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) testing and contingent thinprep cytologic test (TCT) and colposcopy. The free cervical cancer screening will be captured and uploaded timely to the Yinzhou Regional Health Information Platform (YRHIP); therefore, the long-term outcomes of participants will be monitored. Discussion This prospective cohort study will assess the impact of HPV vaccine on HPV infection and related cervical diseases in women aged 9–45 years, which makes up for the lack of evidence in Chinese women. The results of this study will provide support for understanding the impact of HPV vaccination in China, and make a contribution to increasing HPV vaccination and cervical cancer screening coverage in China. Trial registration This study has been retrospectively registered on clinicaltrials.gov (NCT05341284) on April 22, 2022.

Experiences of women awaiting cervical CANCER screening results from selected hospitals in Accra, Ghana

Abstract Background The rate at which cervical cancer is diagnosed among women worldwide is alarming, nevertheless, millions of women have never undergone cervical cancer screening, and many more with cervical cancer die prematurely without accessibility to quality healthcare or effective treatment. Women’s experiences following cervical cancer screening have not been extensively studied especially in advancing countries like Ghana. Hence, the researchers aim to explore the experiences of women awaiting cervical cancer results at selected hospitals in Accra. Methods An exploratory-descriptive qualitative design was adopted to purposively sample 48 participants engaged in face-face in-depth interviews, which were audio-taped and transcribed verbatim after. The interviews were guided by semi-structured interviews. Findings The findings revealed 3 themes and 10 subthemes. The themes were pre-screening experience, intra-screening experience, and post-screening experience. Participants narrated the challenges they face before the screening, during the screening, and as they waited for their results to get ready. Despite some challenges reported, most of the participants indicated that they were willing to come for a retesting if recommended. Conclusion In conclusion, participants who have undergone CCS have several experiences that may either motivate or discourage them from subsequent screening. Being aware of such experiences could help the nurses address them in order to increase the interest of the women in CCS.

Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations: PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC)

Abstract Background High-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women’s participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence. Methods PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy. Discussion PRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization’s recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid. Trial registration ClinicalTrials.gov, NCT05234112. Registered 10 February 2022