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International Journal of Environmental... Apr 2021In Southeast Asia, cervical cancer is the second most common cancer in women. Low coverage for cervical cancer screening (CCS) becomes a roadblock to disease detection... (Review)
Review
In Southeast Asia, cervical cancer is the second most common cancer in women. Low coverage for cervical cancer screening (CCS) becomes a roadblock to disease detection and treatment. Existing reviews on CCS have limited insights into the barriers and facilitators for SEA. Hence, this study aims to identify key barriers and facilitators among women living in SEA. A systematic literature review was conducted on Pubmed, Embase, PsycINFO, CINAHL, and SCOPUS. Primary qualitative and quantitative studies published in English that reported barriers and facilitators to CCS were included. The Mix Methods Appraisal Tool was used for the quality assessment of the included studies. Among the 93 included studies, pap smears (73.1%) were the most common screening modality. A majority of the studies were from Malaysia (35.5%). No studies were from Timor-Leste and the Philippines. The most common barriers were embarrassment (number of articles, = 33), time constraints ( = 27), and poor knowledge of screening ( = 27). The most common facilitators were related to age ( = 21), receiving advice from healthcare workers ( = 17), and education status ( = 11). Findings from this review may inform health policy makers in developing effective cervical cancer screening programs in SEA countries.
Topics: Asia, Southeastern; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Mass Screening; Philippines; Uterine Cervical Neoplasms
PubMed: 33926019
DOI: 10.3390/ijerph18094586 -
Journal of Midwifery & Women's Health May 2016Probiotics are a complementary and integrative therapy useful in the treatment and prevention of urogenital infections in women. This study extends the work of... (Review)
Review
INTRODUCTION
Probiotics are a complementary and integrative therapy useful in the treatment and prevention of urogenital infections in women. This study extends the work of researchers who systematically investigated the scientific literature on probiotics to prevent or treat urogenital infections.
METHODS
A systematic review was conducted to determine the efficacy of probiotics for prevention and/or treatment of urogenital infections in adult women from January 1, 2008, through June 30, 2015. We searched in CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Dissertations and Theses, and Alt-HealthWatch. After removing duplicates and studies that did not meet inclusion criteria, 20 studies were reviewed. All included at least one species of Lactobacillus probiotic as an intervention for treatment or prevention of urogenital infections. Data extracted included samples, settings, study designs, intervention types, reported outcomes, follow-up periods, and results. We evaluated all randomized controlled trials for risk of bias and made quality appraisals on all studies.
RESULTS
Fourteen of the studies focused on bacterial vaginosis (BV), 3 on urinary tract infections (UTIs), 2 on vulvovaginal candidiasis, and one on human papillomavirus (HPV) as identified on Papanicolaou test. Studies were heterogeneous in terms of design, intervention, and outcomes. Four studies were of good quality, 9 of fair, and 7 poor. Probiotic interventions were effective for treatment and prevention of BV, prevention of recurrences of candidiasis and UTIs, and clearing HPV lesions. No study reported significant adverse events related to the probiotic intervention.
DISCUSSION
The quality of the studies in this systematic review varied. Although clinical practice recommendations were limited by the strength of evidence, probiotic interventions were effective in treatment and prevention of urogenital infections as alternatives or co-treatments. More good quality research is needed to strengthen the body of evidence needed for application by clinicians.
Topics: Candidiasis, Vulvovaginal; Female; Humans; Papillomavirus Infections; Probiotics; Treatment Outcome; Urinary Tract Infections; Vaginosis, Bacterial
PubMed: 27218592
DOI: 10.1111/jmwh.12472 -
Gynecologie, Obstetrique, Fertilite &... Dec 2018To provide national clinical guidelines focusing on intrauterine contraception.
OBJECTIVE
To provide national clinical guidelines focusing on intrauterine contraception.
METHODS
A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well.
RESULTS
Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B).
CONCLUSION
Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
Topics: Adolescent; Adult; Contraception; Device Removal; Female; France; Humans; Intrauterine Devices; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Sexually Transmitted Diseases; Uterine Hemorrhage
PubMed: 30429071
DOI: 10.1016/j.gofs.2018.10.004 -
Annals of Saudi Medicine 2016The Papanicolaou (Pap) test is one screening strategy used to prevent cervical cancer in developed countries. The p16/Ki-67 immunocytochemistry is a triage test... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The Papanicolaou (Pap) test is one screening strategy used to prevent cervical cancer in developed countries. The p16/Ki-67 immunocytochemistry is a triage test performed on Pap smears in women with atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesion.
OBJECTIVE
Our objective was to review studies investigating the diagnostic performance of p16/Ki-67 dual stain for triage of women with abnormal Pap tests.
DESIGN
We conducted a systematic review and meta-analysis of diagnostic test accuracy studies.
SETTINGS
We followed the protocol of systematic review of diagnostic accuracy studies.
PATIENTS AND METHODS
We searched PubMed, The Cochrane Library, BioMed Central, and ClinicalTrials.gov for relevant studies. We included research that assessed the accuracy of p16/Ki-67 dual stain and high risk human papillomavirus testing for triage of abnormal Pap smears. Review articles and studies that provided insufficient data to construct 2.2 tables were excluded. Data synthesis was conducted using a random-effects model.
MAIN OUTCOME MEASURES
Sensitivity and specificity.
RESULTS
In seven studies encompassing 2628 patients, the pooled sensitivity and specificity of p16/Ki-67 for triage of abnormal Pap smear results were 0.91 (95% CI, 0.89 to 0.93) and 0.64 (95% CI, 0.62 to 0.66), respectively. No study used a case-control design. A subgroup analysis involving liquid-based cytology showed a sensitivity of 0.91 (95%CI, 0.89 to 0.93) and specificity of 0.64 (95%CI, 0.61 to 0.66).
CONCLUSIONS
Our meta-analysis of p16/Ki-67 dual stain studies showed that the test achieved high sensitivity and moderate specificity for p16/Ki-67 immunocytochemistry for high-grade squamous intraepi.thelial lesion and cervical cancer. We suggest that p16/Ki-67 dual stain might be a reliable ancillary method identifying high-grade squamous intraepithelial lesions in women with abnormal Pap tests.
LIMITATIONS
No study in the meta-analysis examined the accuracy of the p16/Ki-67 dual stain for inter.pretation of glandular neoplasms.
Topics: Atypical Squamous Cells of the Cervix; Cyclin-Dependent Kinase Inhibitor p16; Early Detection of Cancer; Female; Humans; Ki-67 Antigen; Papanicolaou Test; Predictive Value of Tests; Squamous Intraepithelial Lesions of the Cervix; Triage; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 27478909
DOI: 10.5144/0256-4947.2016.245 -
BMJ Global Health 2019Human papillomavirus (HPV) self-sampling test kits may increase screening for and early detection of cervical cancer and reduce its burden globally. To inform WHO...
INTRODUCTION
Human papillomavirus (HPV) self-sampling test kits may increase screening for and early detection of cervical cancer and reduce its burden globally. To inform WHO self-care guidelines, we conducted a systematic review and meta-analysis of HPV self-sampling among adult women on cervical (pre-)cancer screening uptake, screening frequency, social harms/adverse events and linkage to clinical assessment/treatment.
METHODS
The included studies compared women using cervical cancer screening services with HPV self-sampling with women using standard of care, measured at least one outcome, and were published in a peer-reviewed journal. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CNIAHL), Latin American and Caribbean Health Sciences Literature (LILACS) and Embase through October 2018. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-randomised studies. Meta-analysis was conducted using random-effects models to generate pooled estimates of relative risk (RR).
RESULTS
33 studies in 34 articles with 369 017 total participants met the inclusion criteria: 29 RCTs and 4 observational studies. All studies examined HPV self-sampling; comparison groups were standard of care (eg, Pap smear, visual inspection with acetic acid, clinician-collected HPV testing). 93% of participants were from high-income countries. All 33 studies measured cervical cancer screening uptake. Meta-analysis found greater screening uptake among HPV self-sampling participants compared with control (RR: 2.13, 95% CI 1.89 to 2.40). Effect size varied by HPV test kit dissemination method, whether mailed directly to home (RR: 2.27, 95% CI 1.89 to 2.71), offered door-to-door (RR: 2.37, 95% CI 1.12 to 5.03) or requested on demand (RR: 1.28, 95% CI 0.90 to 1.82). Meta-analysis showed no statistically significant difference in linkage to clinical assessment/treatment between arms (RR: 1.12, 95% CI 0.80 to 1.57). No studies measured screening frequency or social harms/adverse events.
CONCLUSION
A growing evidence base, mainly from high-income countries and with significant heterogeneity, suggests HPV self-sampling can increase cervical cancer screening uptake compared with standard of care, with a marginal effect on linkage to clinical assessment/treatment.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO CRD42018114871.
PubMed: 31179035
DOI: 10.1136/bmjgh-2018-001351 -
Journal of Immigrant and Minority Health Aug 2020Indigenous women have higher rates of cervical cancer and cervical cancer mortality compared to non-Indigenous women, as well as unique challenges to accessing screening...
Indigenous women have higher rates of cervical cancer and cervical cancer mortality compared to non-Indigenous women, as well as unique challenges to accessing screening services. Human papillomavirus (HPV) self-sampling has been demonstrated as an effective measure to reach under-screened women. A scoping review identified 19 sources matching selection criteria through a systematic search of PubMed and Scopus completed in May 2018. Analysis revealed that this is a limited field of research; albeit one that has undergone growth in the last 7 years. HPV self-sampling is identified as easy, convenient, comfortable and private and is often preferred over Papanicolaou (Pap) testing. Despite largely positive experiences, several studies indicated that some women lacked confidence in their ability to adequately self-sample. HPV self-sampling may be an effective intervention where Pap testing adherence is low but should include supporting resources and community input so as to best tailor implementations to each community.
Topics: Alphapapillomavirus; Gender Role; Humans; Indigenous Peoples; Mass Screening; Papanicolaou Test; Privacy; Self Care; Self Efficacy; Sexuality; Specimen Handling
PubMed: 31828485
DOI: 10.1007/s10903-019-00954-x -
Women & Health 2016Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However,... (Review)
Review
Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However, contextual factors, such as service organization, as well as healthcare providers' training and practices, are more feasibly altered to increase health service use. The objective of the authors in this study was to perform a critical systematic review of the literature to identify contextual factors at the provider- and system-level that were associated with breast and cervical cancer screening uptake. Studies published from 2000 to 2013 were identified through PubMed and PsycInfo. Methodologic quality was assessed, and studies were examined for themes related to provider- and system-level factors associated with screening uptake. Thirteen studies met the inclusion criteria. Findings revealed a positive association between patients' receipt of provider recommendation and uptake of breast and cervical cancer screening. Uptake was also higher among patients of female providers. Facilities with flexible appointment times and reminders had higher mammography and Pap test uptake. Similarly, greater organizational commitment to quality and performance had higher breast and cervical cancer screening rates. Knowledge provided in this review could be used in future research to inform the development of public health policy and clinical programs to improve screening uptake.
Topics: Adult; Attitude of Health Personnel; Breast Neoplasms; Early Detection of Cancer; Female; Health Services Accessibility; Humans; Mammography; Mass Screening; Middle Aged; Papanicolaou Test; Patient Acceptance of Health Care; Surveys and Questionnaires; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 26812962
DOI: 10.1080/03630242.2016.1145169 -
BMJ Open Jul 2018The aim of this review was to identify the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening...
OBJECTIVES
The aim of this review was to identify the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance in South Asian populations, in order to improve uptake and propose priorities for further research.
DESIGN
A systematic review of the literature for inductive, comparative, prospective and intervention studies. We searched the following databases: MEDLINE/In-Process, Web of Science, EMBASE, SCOPUS, CENTRAL, CDSR, CINAHL, PsycINFO and PsycARTICLES from database inception to 23 January 2018. The review included studies on the cultural, social, structural and behavioural factors that influence asymptomatic breast and cervical cancer screening attendance and cervical smear testing (Papanicolaou test) in South Asian populations and those published in the English language. The framework analysis method was used and themes were drawn out following the thematic analysis method.
SETTINGS
Asymptomatic breast or cervical screening.
PARTICIPANTS
South Asian women, including Bangladeshi, Indian, Pakistani, Sri Lankan, Bhutanese, Maldivian and Nepali populations.
RESULTS
51 included studies were published between 1991 and 2018. Sample sizes ranged from 25 to 38 733 and participants had a mean age of 18 to 83 years. Our review showed that South Asian women generally had lower screening rates than host country women. South Asian women had poorer knowledge of cancer and cancer prevention and experienced more barriers to screening. Cultural practices and assumptions influenced understandings of cancer and prevention, emphasising the importance of host country cultures and healthcare systems.
CONCLUSIONS
High-quality research on screening attendance is required using prospective designs, where objectively validated attendance is predicted from cultural understandings, beliefs, norms and practices, thus informing policy on targeting relevant public health messages to the South Asian communities about screening for cancer.
PROSPERO REGISTRATION NUMBER
CSD 42015025284.
Topics: Acculturation; Asian People; Bangladesh; Bhutan; Breast Neoplasms; Cultural Characteristics; Culturally Competent Care; Early Detection of Cancer; Emigrants and Immigrants; Female; Health Education; Health Knowledge, Attitudes, Practice; Humans; India; Nepal; Pakistan; Sri Lanka; Uterine Cervical Neoplasms
PubMed: 29982210
DOI: 10.1136/bmjopen-2017-020892 -
Journal of Virological Methods Mar 2022Genital infection with certain types of human papillomaviruses (HPVs) is a major cause of premalignant dysplasia and cervical cancer globally. Identification of 14... (Review)
Review
INTRODUCTION
Genital infection with certain types of human papillomaviruses (HPVs) is a major cause of premalignant dysplasia and cervical cancer globally. Identification of 14 high-risk human papillomaviruses (HR-HPV) is immensely important in elucidating molecular epidemiology, patient monitoring, and evidence-based treatment. HPVs testing has become an essential part of current clinical practice in the management of cervical cancer and precancerous lesions. Thus, HPV assays are increasingly used for primary cervical screening and HPV genotyping, for monitoring vaccination-effect and determining changes in the epidemiology of viral genotypes across the globe. Testing for high-risk HPV is more effective in primary cervical cancer screening than in the cytological examination of a Pap smear. Separate genotyping may be useful for triage in both HPV-based and cytology-based screening. It should be used only for clinically validated tests.
AIMS
To evaluate the concordance of Anyplex™ II HPV HR with other HPV assays in cervical cancer screening.
METHODS
Validation studies of Anyplex™ II HPV HR assay from PubMed, google scholar, google database and Scopus were used to search articles. Articles published in English from 2013 onwards were systematically searched using keywords. Besides, other databases like Google Scholar and the Google database were searched manually for grey literature. The last search was done in December 2020. Then study eligibility, extracted data, and assessed risk of bias were assessed. Due to the great clinical heterogeneity of the included articles, the diagnostic performance of the anyplex II ™ HR HPV test was unlikely to be pooled. Rather, I did a descriptive presentation of the test performance to gather the best synthesis of evidence for the anyplex II ™ HR HPV test for the detection of CIN2+. Studies that evaluate the performance of the assay in terms of its sensitivity, specificity, reproducibility and positive and negative predictive values to comparator assays and/or histology were included in this review.
RESULTS
Anyplex™ Ⅱ HPV HR showed consistently high absolute clinical sensitivity for CIN2+ and CIN3+, as well as comparative clinical sensitivity relative to the currently most widely used HPV test. Because of the significantly diff ;erent composition of the referral populations, Anyplex™ Ⅱ HPV HR absolute clinical specificity for CIN2+ and CIN3+ varied across studies but was comparable relative to reference assays.
CONCLUSION
Five validation studies of Anyplex™ Ⅱ HPV HR performance in cervical cancer screening settings showed its consistently high absolute clinical sensitivity for both CIN2+ and CIN3+, still comparative clinical sensitivity and specificity relative to HC2 and GP5+/6 + PCR. Anyplex™ Ⅱ has evaluated HPV HR in several settings and population groups. It is considered clinically validated for primary cervical cancer screening and triage in referral population settings.
Topics: Early Detection of Cancer; Female; Humans; Papillomaviridae; Papillomavirus Infections; Reproducibility of Results; Sensitivity and Specificity; Uterine Cervical Neoplasms
PubMed: 34919974
DOI: 10.1016/j.jviromet.2021.114435 -
BJOG : An International Journal of... Jan 2015Screening for cervical cancer precursors by Papanicolaou cytology is a public health success story; however, its low sensitivity entails unnecessary referrals to... (Review)
Review
BACKGROUND
Screening for cervical cancer precursors by Papanicolaou cytology is a public health success story; however, its low sensitivity entails unnecessary referrals to colposcopy of healthy women with equivocal (ASCUS) or mild dysplasia (LSIL) cytology.
OBJECTIVE
We assessed the accuracy of p16/Ki-67 immuno-testing for triage of low grade cervical cytology.
SEARCH STRATEGY
We systematically searched Medline, Embase, CRD and Cochrane databases, and handsearched key references.
SELECTION CRITERIA
Eligible studies included women with ASCUS or LSIL cervical cytology who had undergone p16/Ki-67 testing and subsequent verification by colposcopy-directed biopsies and histologic analysis.
DATA COLLECTION AND ANALYSIS
We extracted data on patient characteristics and test conduct, diagnostic accuracy measures and assessed the methodological quality of the studies. R software was used to perform a bivariate analysis of test performance data.
MAIN RESULTS
Five eligible studies were identified. Four of the studies had high risk of bias. In the LSIL subgroup, the sensitivity of p16/Ki-67 testing ranged from 0.86 to 0.98, compared with 0.92-0.96 of high-risk HPV testing (hrHPV); specificity ranged from 0.43 to 0.68 versus 0.19 to 0.37, respectively. In the ASCUS subgroup, sensitivity ranged from 0.64 to 0.92 (p16/Ki67 test) versus 0.91 to 0.97 (hrHPV); specificity ranged from 0.53 to 0.81 versus 0.26 to 0.44, respectively.
AUTHORS' CONCLUSIONS
p16/Ki-67 testing cannot be recommended for triage women with ASCUS or LSIL cytology due to insufficient high-quality evidence. Further studies on test performance and the impact of p16/Ki-67-based triage on health outcomes are needed for a definitive evaluation of its clinical utility.
Topics: Atypical Squamous Cells of the Cervix; Cyclin-Dependent Kinase Inhibitor p16; Early Detection of Cancer; Female; Humans; Immunohistochemistry; Ki-67 Antigen; Neoplasm Proteins; Papanicolaou Test; Prognosis; Risk Assessment; Squamous Intraepithelial Lesions of the Cervix; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 25208923
DOI: 10.1111/1471-0528.13076