Gaceta Sanitaria

Implantación del cribado poblacional de cáncer de cérvix con autotoma. Estudio piloto en la Comunidad Valenciana

To evaluate the processes and outcomes of a pilot study designed for the implementation of the Population-Based Cervical Cancer Prevention Program in the Valencian Community, based on human papillomavirus (HPV) detection through self-sampling, conducted between November 2022 and June 2023. A pilot study was conducted, inviting 4293 women aged 35-65 years through direct mailing of self-sampling kits (FlowSWAB®, Copan). To encourage participation, reminder SMS messages were sent, including a survey on reasons for non-participation. Women with incorrect addresses were contacted by phone. Exclusion criteria identified through the survey or follow-up led to the exclusion of some participants, resulting in a final sample of 4170 women. A descriptive and rate-based analysis was conducted on participation and pathology, assessing process and outcome indicators. The overall prevalence of HPV was 7.01% (2.0% for genotype 16 and 5.17% for other genotypes). Colposcopies detected 9 cases of CIN1 (0.42%), 3 cases of CIN2+(0.16%), and 2 adenocarcinomas (0.11%). The highest proportion of detected pathology was associated with genotype 16. Participation was 45.49%, lower among younger age groups, foreign-born individuals, employed women, those with chronic diseases, those without a residential unit, and those with lower income levels, with statistically significant differences observed. SMS reminders increased participation by 10.84% after the first SMS, with a greater effect among women aged 55-65 years. The most common reason for non-participation was lack of information (13.3%). Contacting a healthcare professional significantly improved participation among women with incorrect addresses (71.42% participation rate). The study results confirm the proper functioning of screening procedures, supporting the feasibility of the pilot model, although participation was lower than expected. Key deficiencies were identified, including challenges in reaching the eligible population, inefficient processes, and data management complexities. Implementing an interoperable information system could optimize these aspects. To improve participation, raising awareness of the program and screening techniques is crucial. Strategies such as reminder SMS messages and direct contact with healthcare professionals have proven effective.

Integración social y cribado del cáncer ginecológico de las mujeres inmigrantes en España

To explore the association between immigrant status and performance of pap-smear and mammography, and to study the potential effect of social integration on that association. Secondary analysis of the National Health Survey of Spain 2012. Individual data from 8944 women aged 18-75 were analyzed. Dependent variables were the performance of pap-smear tests and mammographies according to the guidelines of the state of residence. The level of integration in Spain was estimated through perceived social support (Duke-UNC scale) and the number of years living in Spain. Logistic regressions were used in order to obtain odds ratios (OR) and their 95% confidence intervals (95%CI), adjusted for confounders (sociodemographic and health-status). Compared to natives, immigrant women were more likely to not adhere to cervical cancer screening (OR: 1.31; 95%CI: 1.06-1.63) or breast cancer screening (OR:=3.13; 95%CI: 2.14-4.58). Additional adjustment by social support and length of residence in Spain attenuated the association, consequently losing statistical significance (OR: 1.08, 95%CI: .77-1.52 for pap-smear; OR: 1.62, 95%CI: .97-2.74 for mammographies). The probability of participating in the screening programs for gynecological cancer was lower if women were born abroad. Perceived social support and time living in Spain of immigrant women explained to a large extent the differences between immigrants and natives.

Supervivencia por estadio del cáncer de cuello uterino en Mallorca y factores asociados recogidos por el Registro de Cáncer

To ascertain the survival by stage of cervical cancer in Mallorca (Spain), to explore factors collected by the Mallorcan Cancer Registry associated with survival, and to determine the distribution of cervical cases by stage. Retrospective follow-up study of cases diagnosed with cervical cancer between 2006 and 2012 through the Mallorcan Cancer Registry. Cases identified only by death certificate were excluded. age; date and method of diagnosis; histology (ICD-O 3rd ed.); TNM and stage (UICC 7th ed.); date of follow-up or death and cause of death. Follow-up ended on 31 of December 2015. Multiple imputation was used for missing stage cases. Actuarial and Kaplan-Meier methods were used for survival analysis and Cox regression models to identify factors that explain and predict survival. 321 cases were identified. The stage was missing in 8.4% of cases. After multiple imputation, 42.63% were stage I, 24.01% stage II, 19.94% stage III and 13.42% stage IV. Survival was 63% at 5 years: 92% for women diagnosed in stage I, 59% in stage II, 37% in stage III and 18% in stage IV. Stage and age were associated to survival. Diagnosis of cervical cancer in stage I is essential. Less than half of the women were diagnosed in stage I. Cervical cancer screening programmes must be improved.