To determine the factors associated with inadequate follow-up for abnormal Pap smears among a cohort of Boston women from urban academic clinics. Subjects were women > 18 years with abnormal cervical cytology between February 1999 and... more
To determine the factors associated with inadequate follow-up for abnormal Pap smears among a cohort of Boston women from urban academic clinics. Subjects were women > 18 years with abnormal cervical cytology between February 1999 and April 2000. Inadequate follow-up was defined as lack of subsequent cervical cytology or pathology specimen within four months of the initial abnormal specimen for high-grade lesions or within 7 months for low-grade lesions. Of the 423 subjects, the mean age was 33 years. Sixty percent were black, 23% Hispanic, 15% white, 2% Asian. The population was largely uninsured or publically insured. The overall inadequate follow-up rate was 38%. In bivariate analysis, age was a significant risk factor; 46% of women ages 18-29 had inadequate follow-up (p < 0.01). In multivariate analysis, women aged 18-29 years were more likely than women 50 years and older to have inadequate follow-up (OR 2.7, 95% CI 1.1-6.4), as were women with Medicaid insurance compared...
Background A cross sectional study to investigate HPV prevalence according to age and cytology. Methods Women presenting to a gynaecological outpatient clinic for a Pap smear test were included in the study (n=3177). All women had... more
Background A cross sectional study to investigate HPV prevalence according to age and cytology. Methods Women presenting to a gynaecological outpatient clinic for a Pap smear test were included in the study (n=3177). All women had cervical cytology and HPV testing. Results Overall prevalence of any 24 HPV type analysed was 33.1% (95% CI 31.5% to 34.7%) and HPV 16 and HPV 42 were the most frequent (6.7% (95% CI 5.8% to 7.6%), 6.8% (95% CI 5.9% to 7.6%)), in total samples. Multiple HPV infection rate was 12.9% (95% CI 11.8% to 14.1%). High risk HPV (hrHPV) types were present in 27.4% (95% CI 25.8% to 28.9%) of the samples. HPV prevalence was highest among 14 to 19 y.o (46.6% (95% CI 40.7%-52.4%)) and second highest among 30–34 y.o. (39.7%, 95% CI 35.4%–44%). HPV 16 was highest among 20–24 (9.0% (95% CI 6.4%–11.6%)) and second highest among 50 to 54 y.o. (6.3% (95% CI 2.9% to 9.8%). In Low-grade Squamous Intraepithelial Lesions (LgSIL) cytology samples, the most frequently detected hrH...
Women comprise nearly one-quarter of all people living with human immunodeficiency virus (HIV) in the U.S. and 20 percent of incident annual cases. Though women overall are more likely than men to be diagnosed with HIV and engage in care,... more
Women comprise nearly one-quarter of all people living with human immunodeficiency virus (HIV) in the U.S. and 20 percent of incident annual cases. Though women overall are more likely than men to be diagnosed with HIV and engage in care, they are as unlikely to successfully achieve viral suppression with antiretroviral therapy, suggesting gender-based disparities that should be addressed by gender-responsive policies and programs. Using the socioecological model of health and syndemics theory, we comprehensively reviewed published literature to evaluate reasons for and ways to address gender differences in HIV risk and treatment. We discuss the biologic, sociocultural, interpersonal, and behavioral contexts of HIV risk that affect women, comprehensive healthcare for women with HIV that includes pregnancy planning or prevention, and policy implications.
Cervical cancer incidence in the US-Affiliated Pacific Islands (USAPIs) is double that of the US mainland. American Samoa, Commonwealth of Northern Mariana Islands (CNMI), Guam and the Republic of Palau receive funding from the Centers... more
Cervical cancer incidence in the US-Affiliated Pacific Islands (USAPIs) is double that of the US mainland. American Samoa, Commonwealth of Northern Mariana Islands (CNMI), Guam and the Republic of Palau receive funding from the Centers for Disease Control (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to implement cervical cancer screening to low-income, uninsured or under insured women. The USAPI grantees report data on screening and follow-up activities to the CDC. We examined cervical cancer screening and follow-up data from the NBCCEDP programs in the four USAPIs from 2007 to 2015. We summarized screening done by Papanicolaou (Pap) and oncogenic human papillomavirus (HPV) tests, follow-up and diagnostic tests provided, and histology results observed. A total of 22,249 Pap tests were conducted in 14,206 women in the four USAPIs programs from 2007-2015. The overall percentages of abnormal Pap results (low-grade squamous intraepithelial lesions or worse...
Cervical cytology remains the principal screening method to detect pre-invasive and invasive cervical lesions. Management of abnormal cervical cytology depends on the risk of encountering a significant cervical lesion or high-grade... more
Cervical cytology remains the principal screening method to detect pre-invasive and invasive cervical lesions. Management of abnormal cervical cytology depends on the risk of encountering a significant cervical lesion or high-grade cervical disease. These risks may vary in different areas across the country. Thus, determining the rate of significant cervical lesion associated with each type of abnormal cervical cytology in each area is of critical importance for designing area-specific management approach. This review was conducted to evaluate the rate of high-grade cervical disease among Thai women with abnormal cervical cytology. A relatively high incidence of underlying significant lesions including invasive disease was demonstrated even in those having only minimal smear abnormality. This baseline information is crucial and must be taken into consideration in management of women with abnormal cytological screening to achieve the goals of comprehensive cervical cancer control in ...
The aim of this report is to demonstrate the Barretos Cancer Hospital initiative of organizational, laboratorial, and human resources training in the implementation of an organized cervical screening program in low-resource settings. We... more
The aim of this report is to demonstrate the Barretos Cancer Hospital initiative of organizational, laboratorial, and human resources training in the implementation of an organized cervical screening program in low-resource settings. We developed a computational program to report all epidemiological, clinical, and laboratorial findings, and to trace all necessary information to recruit women for regular screening or for referral for complementary exams after liquid-based Pap test analyses. All Pap tests were collected in liquid medium and in 2014 more than 160,000 tests were analyzed and 2,900 colposcopy examinations were performed. From 2012 to 2015, the percentage of exams collected increased from 54.6% in 2012 to 62.4% in 2013, 68.4% in 2014, and 71% in 2015. Per 1,000 Pap tests, 0.4 cases of invasive cancer were diagnosed; for in situ carcinoma, 1.9 cases were identified. More importantly, between 2011 and 2015, 89.4% of all carcinomas were detected at clinical stage 0 or I (in ...
The "see and treat" approach, proceeding without a biopsy directly to uterine cervix conization in women diagnosed with high grade squamous intraepithelial lesion (HGSIL) on Pap smear, shortens the treatment duration, lessens... more
The "see and treat" approach, proceeding without a biopsy directly to uterine cervix conization in women diagnosed with high grade squamous intraepithelial lesion (HGSIL) on Pap smear, shortens the treatment duration, lessens patient anxiety, and reduces health care costs. To evaluate the level of diagnostic accuracy and the over-treatment rate in the "see and treat" versus conventional management of women diagnosed with HGSIL. We retrospectively reviewed all women with HGSIL who had undergone the "see and treat" approach during 2001-2011 at Soroka University Medical Center. Similar cohorts, who were managed conventionally with a cervical biopsy prior to the conization, served as a comparison group. The study population consisted of 403 women: 72 (18%) had undergone the "see and treat" approach and 331 (82%) conventional management. The false positive rate was 11% for the "see and treat" group, compared to 6% for the conventional man...
We examined patterns of cervical and breast cancer screening among Asian American women in California and assessed their screening trends over time. We pooled weighted data from 5 cycles of the California Health Interview Survey (2001,... more
We examined patterns of cervical and breast cancer screening among Asian American women in California and assessed their screening trends over time. We pooled weighted data from 5 cycles of the California Health Interview Survey (2001, 2003, 2005, 2007, 2009) to examine breast and cervical cancer screening trends and predictors among 6 Asian nationalities. We calculated descriptive statistics, bivariate associations, multivariate logistic regressions, predictive margins, and 95% confidence intervals. Multivariate analyses indicated that Papanicolaou test rates did not significantly change over time (77.9% in 2001 vs 81.2% in 2007), but mammography receipt increased among Asian American women overall (75.6% in 2001 vs 81.8% in 2009). Length of time in the United States was associated with increased breast and cervical cancer screening among all nationalities. Sociodemographic and health care access factors had varied effects, with education and insurance coverage significantly predic...
Cervical cancer is the second most common malignancy in women worldwide with a high incidence in under-developed countries and Nigeria is one of these countries. This study aimed at screening for cervical cancer using Papanicolaou smear... more
Cervical cancer is the second most common malignancy in women worldwide with a high incidence in under-developed countries and Nigeria is one of these countries. This study aimed at screening for cervical cancer using Papanicolaou smear and to identify risk factors for cervical cancer among women in Olufadi community, Kwara State, North-central Nigeria. This was a cross-sectional study involving the screening of women aged 25-64 years for cervical cancer using Papanicolaou smear. Respondents were selected through systematic random sampling of households. Interviewer- administered questionnaire and clinical report form were also used to collect data. In addition, Pap smear samples were taken. Data was analyzed using SPSS version 15. Only 10 (5.0%) respondents had positive cytology result, while the rest were normal. Of the 10 positive cytology results, 1 (10.0%) was high grade squamous intraepithelial lesion (HGSIL) while the remaining 9 (90.0%) were low grade squamous intraepithelia...
the objective of this study is to explore the perceptions of medical students regarding the Pap smear test. Focus group discussion was held with twenty three medical students. The students were divided into three focus groups; two groups... more
the objective of this study is to explore the perceptions of medical students regarding the Pap smear test. Focus group discussion was held with twenty three medical students. The students were divided into three focus groups; two groups of female participants consisting of 9 and 8 students; respectively. The third group consisted of 6 male students. Questions regarding Pap smear testing included barriers that prevented women from taking the test, gender preference for the physician to conduct the cervical screening test, willingness to suggest Pap smear test to the family or friends. The data obtained were classified into various categories and analyzed manually. Most of the study participants mentioned that the main barriers for women to not perform Pap smear test is lack of awareness 16 (70%), followed by shyness 12 (52%) and the cost of the test 12 (52%). Most agreed that the gender of the physician will affect the women decision to do Pap smear test. All mentioned that the adva...
Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. There are few to no initial symptoms and signs. This study was conducted to assess... more
Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. There are few to no initial symptoms and signs. This study was conducted to assess the awareness level of young Pakistani women about cervical cancer and to educate them about this deadly disease. A detailed questionnaire regarding demographic data and information about cervical cancer was distributed in different cities of Punjab. A total of 873 women took part in this survey and 70.1 percent were totally unaware of this cancer. Only 8.5% of the whole surveyed population knew accurately about cancer of cervix, 7% of the surveyed respondents correctly specified the human papilloma virus as the causative agent. Only 5.2% respondents were able to identify the Pap smear test as a diagnostic measure. Out of all the surveyed population only 4.3% of individuals were found to be vaccinated against this disease and the majority was found fr...
BACKGROUND Cervical cancer is the second most common cancer type seen among women in most countries and an important cause of mortality. Although it is a preventable disease, most women living in developing countries cannot reach... more
BACKGROUND Cervical cancer is the second most common cancer type seen among women in most countries and an important cause of mortality. Although it is a preventable disease, most women living in developing countries cannot reach effective screening programs. It is essential that appropriate education about cervical cancer is provided. OBJECTIVE This experimental field study was performed with the aim of evaluating the efficacy of training given to women about cervical cancer risk factors and primary and secondary prevention precautions. METHODS The research focused on women between 25 and 29 years of age, literate, married and having social security. The study was conducted in the district of Evka 4 Health Care Center between the dates of April to August 2005. The women were given survey forms and questionnaires in order to determine their socio-demographic features and knowledge level about cervical cancer in the course of home visits. They were trained and given a manual at the d...
The implementation of cervical cancer screening strategies has reported different rates of success in different countries due to population specific factors that limit women's participation. We report observations and the development... more
The implementation of cervical cancer screening strategies has reported different rates of success in different countries due to population specific factors that limit women's participation. We report observations and the development of a community-based specimen collection strategy which resulted from interactions with women in the study communities, following an initial low response to a hospital based cervical cancer screening strategy. Women were recruited by a house survey and invited to report at a hospital either within a week or after a week for self and health-personnel specimen collections. However, due to the very low response and subsequent interactions with the women of the communities, another strategy was developed that required recruited women report at a central location within their respective communities for specimen collections at times that did not interfere with their daily routines. For specimen collection, of the 156 participants who opted to report after...
OBJECTIVE To see if refugee women at a community health centre (CHC) in Toronto, Ont, are appropriately screened for cervical cancer and if there are any demographic characteristics that affect whether they are screened. DESIGN Chart... more
OBJECTIVE To see if refugee women at a community health centre (CHC) in Toronto, Ont, are appropriately screened for cervical cancer and if there are any demographic characteristics that affect whether they are screened. DESIGN Chart review. SETTING A CHC in downtown Toronto. PARTICIPANTS A total of 357 eligible refugee women attending the CHC. MAIN OUTCOME MEASURES Papanicolaou test received or documented reason for no Pap test. RESULTS Ninety-two percent of women in the study sample were either appropriately screened for cervical cancer or had been approached for screening. Eighty percent of women were appropriately screened. Demographic variables including pregnancy, being uninsured, not speaking English, recent migration to Canada, and being a visible minority did not affect receipt of a Pap test after migration in multivariate analyses. Not speaking English was associated with a delay to receiving a first Pap test after migration. CONCLUSION The clients at our centre are demogr...
This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A... more
This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty's registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13. The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents...
The Bhutanese Screening Programme recommends a Pap smear every 3 years for women aged 25-65 years, and coverage ranges from 20% to 60%, being especially challenging in rural settings. The 'REACH-Bhutan' study was conducted to... more
The Bhutanese Screening Programme recommends a Pap smear every 3 years for women aged 25-65 years, and coverage ranges from 20% to 60%, being especially challenging in rural settings. The 'REACH-Bhutan' study was conducted to assess the feasibility and outcomes of a novel approach to cervical cancer screening in rural Bhutan. Cross-sectional, population-based study of cervical cancer screening based on the careHPV test on self-collected samples. Women were recruited in rural primary healthcare centres, that is, Basic Health Units (BHU), across Bhutan. Overall, 3648 women aged 30-60 were invited from 15 BHUs differing in accessibility, size and ethnic composition of the population. Participants provided a self-collected cervicovaginal sample and were interviewed. Samples were tested using careHPV in Thimphu (the Bhutanese capital) referral laboratory. Screening participation by geographic area, centre, age and travelling time. Previous screening history and careHPV positivity...
Despite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening for cervical cancer... more
Despite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening for cervical cancer among young Koreans. Nationwide cross-sectional study. Republic of Korea. 3734. The Korea National Health and Nutrition Examination Survey (KNHANES V: 2010-2012) was used to evaluate factors associated with attendance for cervical cancer screening among women aged 15-39. After excluding those who were previously diagnosed with cervical cancer and those with incomplete responses to questionnaires, a total of 3734 subjects were eligible. Multi-dimensional covariates as potential predictors of cervical cancer screening were adjusted in multiple logistic regression analysis. The participation rate for cervical cancer screening was 46% among women aged 40 or younger. The logistic analyses showed that age, education, total household income, smoking and job ...
The "see and treat" approach, proceeding without a biopsy directly to uterine cervix conization in women diagnosed with high grade squamous intraepithelial lesion (HGSIL) on Pap smear, shortens the treatment duration, lessens... more
The "see and treat" approach, proceeding without a biopsy directly to uterine cervix conization in women diagnosed with high grade squamous intraepithelial lesion (HGSIL) on Pap smear, shortens the treatment duration, lessens patient anxiety, and reduces health care costs. To evaluate the level of diagnostic accuracy and the over-treatment rate in the "see and treat" versus conventional management of women diagnosed with HGSIL. We retrospectively reviewed all women with HGSIL who had undergone the "see and treat" approach during 2001-2011 at Soroka University Medical Center. Similar cohorts, who were managed conventionally with a cervical biopsy prior to the conization, served as a comparison group. The study population consisted of 403 women: 72 (18%) had undergone the "see and treat" approach and 331 (82%) conventional management. The false positive rate was 11% for the "see and treat" group, compared to 6% for the conventional man...
This extensive Handbook addresses a range of contemporary issues related to arts education across the world. It is divided into six sections; Contextualising Arts Education, Globally and Locally; Arts Education, Curriculum, Policy and... more
This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A... more
This study examined the level of knowledge and barriers towards cervical cancer screening of female university students. A cross-sectional design was used for 287 female students at a tertiary institution located in Selangor, Malaysia. A name list of all students in the all faculties were obtained from each faculty's registrar and the ethics committee of the Faculty of Health and Life Sciences, approved the study. Respondents completed a consent form before they were given the questionnaire consisting of four sections: socio-demographic characteristics (six questions); risk factor of cervical cancer (six); knowledge about cervical cancer and the Pap smear test (ten); and finally barriers to Pap screening (eleven). Data were analyzed using SPSS version 13. The prevalence of ever having had a Pap test was 6%. Majority of the participants had adequate knowledge about risk factors of cervical cancer. The highest knowledge about cervical cancer risk factor reported by the respondents...
Cervical cancer incidence in the US-Affiliated Pacific Islands (USAPIs) is double that of the US mainland. American Samoa, Commonwealth of Northern Mariana Islands (CNMI), Guam and the Republic of Palau receive funding from the Centers... more
Cervical cancer incidence in the US-Affiliated Pacific Islands (USAPIs) is double that of the US mainland. American Samoa, Commonwealth of Northern Mariana Islands (CNMI), Guam and the Republic of Palau receive funding from the Centers for Disease Control (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to implement cervical cancer screening to low-income, uninsured or under insured women. The USAPI grantees report data on screening and follow-up activities to the CDC. We examined cervical cancer screening and follow-up data from the NBCCEDP programs in the four USAPIs from 2007 to 2015. We summarized screening done by Papanicolaou (Pap) and oncogenic human papillomavirus (HPV) tests, follow-up and diagnostic tests provided, and histology results observed. A total of 22,249 Pap tests were conducted in 14,206 women in the four USAPIs programs from 2007-2015. The overall percentages of abnormal Pap results (low-grade squamous intraepithelial lesions or worse...
To assess the efficacy of an educational skit on improving knowledge and decision making/behavior toward obtaining a Pap smear. Ninety-two Hispanic high school female volunteers participated in an intervention, single-sample,... more
To assess the efficacy of an educational skit on improving knowledge and decision making/behavior toward obtaining a Pap smear. Ninety-two Hispanic high school female volunteers participated in an intervention, single-sample, preintervention/postintervention survey. Data were collected prior to (T(0)), immediately after (T(1)), and seven weeks after (T(2)) the intervention. The intervention was a live, 15-minute, English-language skit. Fifty percent reported sexual intercourse. Viewing the skit was associated with 29% of those who needed a Pap smear done, actually scheduling or having a Pap smear done between T(0) and T(2). However, a causal relationship was not proven (P = 0.09). Knowledge was greater at T(1) and T(2) compared to T(0) (P < 0.00001). However, there was a decrease in knowledge at T(2) compared to T(1). More subjects agreed that females their age were at risk for cancer at T(2) compared to T(0) (P = 0.0001). There was an improvement in and retention of knowledge ab...
Past studies suggested an association between human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN). In 1987, University of North Carolina (UNC) Hospitals Family Practice Center clinicians were approached for a control... more
Past studies suggested an association between human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN). In 1987, University of North Carolina (UNC) Hospitals Family Practice Center clinicians were approached for a control population to study this association. One hundred five patients attending the UNC Hospitals Neoplasia Clinic with biopsy-proven CIN 2 or 3 and 268 control patients attending the UNC Family Practice Center for a routine Papanicolaou smear were enrolled in this case-control study. Case and control patients consented to having an additional cervical specimen taken and to being interviewed. The cervical specimens were classified by the Southern blot and polymerase chain reaction techniques for HPV. Early results suggested the control patients who had HPV were at high risk of developing CIN. Interventions were made to inform these patients of this risk and need for closer follow-up, causing a wide range of patient reactions. The final results showed no as...
Parity is well established as a risk factor for cervical cancer. It is not clear, however, how pregnancy influences the natural history of HPV infection and cervical neoplasia. Our objective was to study the risk of HPV infection and... more
Parity is well established as a risk factor for cervical cancer. It is not clear, however, how pregnancy influences the natural history of HPV infection and cervical neoplasia. Our objective was to study the risk of HPV infection and cervical squamous intraepithelial lesions (SIL) after pregnancy. We used the Ludwig-McGill cohort study which includes 2462 women recruited in Sao Paulo, Brazil in 1993-97 and followed for up to 10 years. Cellular specimens were collected every 4-6 months for Pap cytology and HPV detection and genotyping by a polymerase chain reaction protocol. Study nurses recorded pregnancy occurrence during follow-up. HPV and Pap results from pregnant women were available before and after, but not during pregnancy. The associations between pregnancy and post-partum HPV infection/SIL were studied using generalized estimating equation models with logistic link. Adjusted odds ratios (OR) were estimated with empirical adjustment for confounding. We recorded 122 women wit...
To evaluate the acceptability and performance of cervical cancer (CC) screening using visual inspection with acetic acid (VIA) integrated into a rural immunization clinic in Uganda. We conducted a cross-sectional pilot study in rural... more
To evaluate the acceptability and performance of cervical cancer (CC) screening using visual inspection with acetic acid (VIA) integrated into a rural immunization clinic in Uganda. We conducted a cross-sectional pilot study in rural Uganda. We explored associations between women's characteristics and acceptance of VIA testing. We collected samples for Papanicolaou (Pap) smear testing in a random subset of women and used results from this test as a comparator for assessing VIA performance. We enrolled 625 women of whom 571 (91.4%) accepted and 54 (8.6%) refused CC screening. In the univariate model, age (Odds Ratio (OR)=1.10; p-value<0.001) and employment status (OR 2.00; p-value=0.019) were significantly associated with acceptance of VIA screening. In the multivariate model, no characteristic was independently associated with acceptance of VIA screening after adjusting for other factors. Compared to reference Pap smear, CC screening with VIA had a sensitivity of 50% and a sp...
We examined patterns of cervical and breast cancer screening among Asian American women in California and assessed their screening trends over time. We pooled weighted data from 5 cycles of the California Health Interview Survey (2001,... more
We examined patterns of cervical and breast cancer screening among Asian American women in California and assessed their screening trends over time. We pooled weighted data from 5 cycles of the California Health Interview Survey (2001, 2003, 2005, 2007, 2009) to examine breast and cervical cancer screening trends and predictors among 6 Asian nationalities. We calculated descriptive statistics, bivariate associations, multivariate logistic regressions, predictive margins, and 95% confidence intervals. Multivariate analyses indicated that Papanicolaou test rates did not significantly change over time (77.9% in 2001 vs 81.2% in 2007), but mammography receipt increased among Asian American women overall (75.6% in 2001 vs 81.8% in 2009). Length of time in the United States was associated with increased breast and cervical cancer screening among all nationalities. Sociodemographic and health care access factors had varied effects, with education and insurance coverage significantly predic...
