-
International Journal of Environmental... Aug 2022It is well established that access to preventative care, such as breast or cervical cancer screening, can reduce morbidity and mortality. Certain groups may be missed... (Meta-Analysis)
Meta-Analysis Review
It is well established that access to preventative care, such as breast or cervical cancer screening, can reduce morbidity and mortality. Certain groups may be missed out of these healthcare services, such as women with disabilities, as they face many access barriers due to underlying inequalities and negative attitudes. However, the data have not been reviewed on whether women with disabilities face inequalities in the uptake of these services. A systematic review and meta-analysis were conducted to compare the uptake of breast and cervical cancer screening in women with and without disabilities. A search was conducted in July 2021 across four databases: PubMed, MEDLINE, Global Health, and CINAHL. Quantitative studies comparing the uptake of breast or cervical cancer screening between women with and without disabilities were eligible. Twenty-nine studies were included, all from high-income settings. One third of the 29 studies (34.5%, 10) were deemed to have a high risk of bias, and the remainder a low risk of bias. The pooled estimates showed that women with disabilities have 0.78 (95% CI: 0.72-0.84) lower odds of attending breast cancer screening and have 0.63 (95% CI: 0.45-0.88) lower odds of attending cervical cancer screening, compared to women without disabilities. In conclusion, women with disabilities face disparities in receipt of preventative cancer care. There is consequently an urgent need to evaluate and improve the inclusivity of cancer screening programs and thereby prevent avoidable morbidity and mortality.
Topics: Breast Neoplasms; Disabled Persons; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Uterine Cervical Neoplasms
PubMed: 35954824
DOI: 10.3390/ijerph19159465 -
Public Health Sep 2022To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically appraise the existing published literature on cervical cancer screening utilization, and associated barriers and facilitators, in Nepal.
STUDY DESIGN
Systematic literature review and meta-analysis.
METHODS
PubMed/MEDLINE, CINAHL, Scopus, Embase, and, Google Scholar were systematically searched using Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. All quantitative and qualitative studies reporting cervical cancer screening (using the Pap smear test or visual inspection with acetic acid or human papillomavirus test) utilization, barriers, and facilitators for screening were identified. A meta-analysis was performed to estimate Nepal's pooled cervical cancer screening utilization proportion.
RESULTS
The search yielded 97 records, of which 17 studies were included. Fifteen studies were quantitative and two were qualitative. Of the 17 studies, six were hospital-based and six were community-based. The pooled cervical cancer screening utilization proportion (using Pap smear test) among Nepalese women was 17% from the studies in the hospital settings, and 16% in the community. Six studies reported barriers to cervical cancer screening, of which four reported embarrassments related to the gynecological examination and a low level of knowledge on cervical cancer. Three (of four) studies reported health personnel, and two studies reported screening services-related facilitators for cervical cancer screening.
CONCLUSION
Our review reported that cervical cancer screening utilization (16%) is more than four times lower than the national target (70%) in Nepal. Multiple barriers such as low levels of knowledge and embarrassment are associated with cervical cancer screening utilization. Health personnel's gender, counseling, and privacy of screening services were commonly reported facilitators. These findings could help to inform future research, and policy efforts to increase cervical cancer screening utilization in Nepal.
Topics: Early Detection of Cancer; Female; Humans; Mass Screening; Nepal; Papanicolaou Test; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 35863158
DOI: 10.1016/j.puhe.2022.06.007 -
Cervical Cancer Prevention, Its Challenges and Solutions in Iran and Worldwide: A Systematic Review.Iranian Journal of Public Health Nov 2023Widespread use of screening in high-income countries has led to significant reductions in mortality from cervical cancer. However, in Iran, the main reason for the late... (Review)
Review
BACKGROUND
Widespread use of screening in high-income countries has led to significant reductions in mortality from cervical cancer. However, in Iran, the main reason for the late diagnosis of cervical cancer was the failure to perform a Pap smear (Papanicolaou). We aimed to investigate the status of cervical cancer prevention and its challenges and solutions in Iran.
METHOD
We conducted a systematic review of literature published from 1974 to 2021 in the electronic databases, including PubMed, Web of Science, Embase, Scopus, and Google Scholar, and retrieved all English-language articles. Following the application of the inclusion and exclusion criteria, full-text articles were identified and evaluated for eligibility. Finally, these publications were analyzed as part of the synthesis.
RESULTS
Lower social-economic level, inadequate knowledge of screening tests and health centers for Pap test performance leading to worse outcomes such as lower screening participation or coverage.
CONCLUSION
By addressing these challenges through increasing education, increasing service accessibility, expanding screening programs, improving public awareness, improving insurance coverage, and establishing a control protocol for follow-up, it is possible to reduce cervical cancer incidence and mortality.
PubMed: 38106838
DOI: 10.18502/ijph.v52i11.14031 -
Systematic Reviews Aug 2022The aims of this systematic review were to (1) identify primary- and model-based economic evaluations of cervical cancer screening methods and to (2) provide a...
OBJECTIVE
The aims of this systematic review were to (1) identify primary- and model-based economic evaluations of cervical cancer screening methods and to (2) provide a contextual summary of valuation outcomes associated with three types of cervical cancer screening tests: visual inspection with acetic acid, human papillomavirus deoxyribonucleic acid, and Papanicolaou smear.
INTRODUCTION
Cervical cancer screening is an important public health priority with the potential to improve the detection of precancerous lesions in high-risk females for early intervention and disease prevention. Test performance and cost-effectiveness differ based on the specific screening method used across different platforms. There is a need to appraise existing economic evaluations of cervical cancer screening methods.
METHODS
This review considered primary-based and model-based full economic evaluations of cervical cancer screening methods. The evaluation methods of interest included cost-effectiveness analysis, cost-utility analysis, cost-minimization analysis, cost-benefit analysis, and cost-consequence analysis. We searched Scopus, PubMed, National Health Economic Evaluation Database (NH EED), Cochrane, and the Health Economic Evaluation Database for full economic evaluations of cancer screening methods. No formal date restrictions were applied. Model-based and primary-based full economic evaluations were included. A critical appraisal of included studies was performed by the main investigator, while a second independent reviewer assessed critical appraisal findings for any inconsistencies. Data were extracted using a standardised data extraction tool for economic evaluations. The ultimate outcomes of costs, effectiveness, benefits, and utilities of cervical cancer screening modalities were extracted from included studies, analysed, and summarised.
RESULTS
From a total of 671 screened studies, 44 studies met the study inclusion criteria. Forty-three studies were cost-effectiveness analyses, one study reported both cost-utility and cost-effectiveness outcomes, and another study reported cost utilities of cervical cancer screening methods only. Human papillomavirus (HPV) DNA testing was reported as a dominant stand-alone screening test by 14 studies, while five studies reported visual inspection with acetic acid (VIA) as a dominant stand-alone screening test. Primary HPV screening strategies were dominant in 21 studies, while three studies reported cytology-based screening strategies as the dominant screening method.
CONCLUSIONS
Existing evidence indicates that HPV-based and VIA testing strategies are cost-effective, but this is dependent on setting. Our review suggests the limited cost-effectiveness of cytology-based testing, which may be due in part to the need for specific infrastructures and human resources.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42020212454 .
Topics: Cost-Benefit Analysis; Early Detection of Cancer; Female; Humans; Mass Screening; Papillomavirus Infections; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 35945642
DOI: 10.1186/s13643-022-02017-z -
European Review For Medical and... Nov 2022Cervical cancer (CC) is a preventable women's cancer. Vaccination and routine Pap smear screening have reduced cervical cancer-related mortality by 70-80% in the world....
OBJECTIVE
Cervical cancer (CC) is a preventable women's cancer. Vaccination and routine Pap smear screening have reduced cervical cancer-related mortality by 70-80% in the world. The eradication of CC depends on identifying the disease early and removing barriers to its timely detection. This review study was designed to determine diagnostic delay and factors related to delayed CC diagnosis in the world.
MATERIALS AND METHODS
A comprehensive search was carried out in databases including Medline, Web of Science, Core Collection (Indexes = SCI-EXPANDED, SSCI, A & HCI Timespan), and Scopus for articles published up to December 2021. Publications were included if they reported data on the delayed CC, and factors related to diagnosis of CC in women. There was no time restriction in this review.
RESULTS
In total, 45 articles were entered into the study. In studies, advanced stages of CC (IIB to IV) varied from 10.2% to 87.9% due to delayed diagnosis. A delayed CC diagnosis was reported in 4.3%-89.1% of patients. The median and mean days of delayed diagnosis were 59-210 days and 2.92-10.5 months, respectively. Factors related to delayed CC diagnosis were categorized into three components including patient, medical history, and health system delay. Patient delay included socio-demographic, husband/ partner, and knowledge. Medical history included medical issues, obstetrics, and family history. Health system delays included health facilities and levels of accessibility.
CONCLUSIONS
There is an urgent need to shorten the diagnostic journey of CC patients by addressing all the components of diagnostic delay and developing strategies to modify the factors associated with these delays.
Topics: Pregnancy; Humans; Female; Uterine Cervical Neoplasms; Delayed Diagnosis; Vaccination; Obstetrics; Databases, Factual
PubMed: 36459029
DOI: 10.26355/eurrev_202211_30382 -
Asian Pacific Journal of Cancer... Jun 2021Although cervical cancer screening has been performed as a national program since 1983 in Japan, the participation rate has remained below 20%. Equity of access is a... (Review)
Review
BACKGROUND
Although cervical cancer screening has been performed as a national program since 1983 in Japan, the participation rate has remained below 20%. Equity of access is a basic requirement for cancer screening. However, taking smears from the cervix has been limited to gynecologists or obstetricians in Japan and it might be a barrier for accessibility. We examined the current access and its available human resources for cervical cancer screening in Japan.
METHODS
We analyzed the number of gynecologists and obstetricians among 47 prefectures based on a national survey. A systematic review was performed to clarify disparity and use of human resources in cervical cancer screening, diagnosis, and treatment for cervical cancers in Japan. Candidate literature was searched using Ovid-MEDLINE and Ichushi-Web until the end of January 2020. Then, a systematic review regarding accessibility to cervical cancer screening was performed. The results of the selected articles were summarized in the tables.
RESULTS
Although the total number of all physicians in Japan increased from 1996 to 2016, the proportion of gynecologists and obstetricians has remained at approximately 5% over the last 2 decades. 43.6% of municipalities have no gynecologists and obstetricians in 2016. Through a systematic review, 4 English articles and 1 Japanese article were selected. From these 5 articles, the association between human resources and participation rates in cervical cancer screening was examined in 2 articles.
CONCLUSIONS
The human resources for taking smears for cervical cancer screening has remained insufficient with a huge disparity among municipalities in Japan. To improve accessibility for cervical cancer screening another option which may be considered could be involving general physicians as potential smear takers.
Topics: Data Analysis; Female; Health Services Accessibility; Humans; Japan; Mass Screening; Uterine Cervical Neoplasms; Vaginal Smears; Workforce
PubMed: 34181323
DOI: 10.31557/APJCP.2021.22.6.1695 -
Journal of the International AIDS... May 2023Women living with HIV (WLWH) are more likely to develop cervical cancer. Screening and available healthcare can effectively reduce its incidence and mortality rates. We... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Women living with HIV (WLWH) are more likely to develop cervical cancer. Screening and available healthcare can effectively reduce its incidence and mortality rates. We aimed to summarize the lifetime prevalence and adherence rate of cervical cancer screening among WLWH across low- and middle-income countries (LMICs), and high-income countries (HICs).
METHODS
We systematically searched PubMed, Web of Science and Embase for studies published between database inception and 2 September 2022, without language or geographical restrictions. Those reporting the lifetime prevalence and/or adherence rate of cervical cancer screening among WLWH were included. Pooled estimates across LMICs and HICs were obtained using DerSimonian-Laird random-effects models. When the number of eligible studies was greater than 10, we further conducted stratified analyses by the World Health Organization (WHO) region, setting (rural vs. urban), investigation year, screening method, type of cervical cancer screening programme, age and education level.
RESULTS
Among the 63 included articles, 26 provided data on lifetime prevalence, 24 on adherence rate and 13 on both. The pooled lifetime prevalence in LMICs was 30.2% (95% confidence interval [CI]: 21.0-41.3), compared to 92.4% in HICs (95% CI: 89.6-94.6). The pooled adherence rate was 20.1% in LMICs (95% CI: 16.4-24.3) and 59.5% in HICs (95% CI: 51.2-67.2).
DISCUSSION
There was a large gap in cervical cancer screening among WLWH between LMICs and HICs. Further analysis found that those in LMICs had higher lifetime prevalence in subgroups with urban settings, with older age and with higher education levels; and those in HICs had higher adherence in subgroups with younger age and with higher education levels.
CONCLUSIONS
Cervical cancer screening among WLWH falls considerably short of the WHO's goal. There should be continuous efforts to further increase screening among these women, especially those residing in the rural areas of LMICs and with lower education levels.
Topics: Humans; Female; HIV Infections; Developing Countries; Early Detection of Cancer; Uterine Cervical Neoplasms; Developed Countries; Treatment Adherence and Compliance; Educational Status; Rural Population; Papanicolaou Test
PubMed: 37247380
DOI: 10.1002/jia2.26090 -
Journal of Immigrant and Minority Health Aug 2021African immigrant (AI) women remain burdened by cervical cancer, but the prevalence and correlates of Pap testing remains unclear in this population. (Review)
Review
BACKGROUND
African immigrant (AI) women remain burdened by cervical cancer, but the prevalence and correlates of Pap testing remains unclear in this population.
OBJECTIVE
To review studies on the prevalence and determinants of Pap testing among AI women living in developed countries.
METHODS
PubMed, CINAHL, Embase, and Scopus were searched for relevant articles that included African-born immigrant participants; were published in English; addressed the prevalence of Pap testing; conducted in a developed country; and identified correlates of Pap testing behavior. The Andersen Behavioral Model guided synthesis of the key findings.
RESULTS
Sixteen studies met the inclusion criteria. The prevalence of Pap testing ranged from 4.6% to 73.0%. Having a female provider and access to primary care facilitated Pap testing. Barriers to Pap testing included low income, male healthcare providers, and no history of gynecological exam.
CONCLUSIONS
Healthcare providers and social determinants-particularly income and healthcare access, play an important role in improving Pap testing among AI women. Larger qualitative and mixed methods studies are needed to explore other important determinants of Pap testing such as disease knowledge, self-efficacy, health literacy to reduce the burden of cervical cancer among AI women.
Topics: Developed Countries; Early Detection of Cancer; Emigrants and Immigrants; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Papanicolaou Test; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 33165711
DOI: 10.1007/s10903-020-01119-x -
Factors Associated with the HPV Vaccination among Korean Americans and Koreans: A Systematic Review.International Journal of Environmental... Dec 2021Koreans and Korean Americans (KAs) have limited HPV knowledge and awareness. KAs share a culture with Koreans, and this culture has affected their behavior around HPV.... (Review)
Review
Koreans and Korean Americans (KAs) have limited HPV knowledge and awareness. KAs share a culture with Koreans, and this culture has affected their behavior around HPV. This systematic review aimed to synthesize the factors associated with HPV vaccination among Koreans and KAs. The literature search was done with four databases. The vaccination rate, awareness and knowledge of HPV, and factors associated with vaccination intention were identified. Eighteen articles were selected. Koreans and KAs had low levels of HPV knowledge and awareness. Perceived benefits and seriousness were associated with vaccination intention. Cervical cancer history, beliefs that their daughters need a pap smear test, sexual intercourse experiences, occupation, low education, and income were associated with vaccination intention. This systematic review discovered that HPV vaccination behavior is associated with HPV vaccine awareness, perceived benefits of the vaccine, and the perceived seriousness of HPV infection among Koreans and KAs. Based on the results, we suggest healthcare providers provide a HPV vaccine recommendation by emphasizing the benefits of the vaccination to Koreans and KAs. This study can be the basis for developing interventions to increase HPV vaccination by guiding the target population and variables, as well as the intervention content.
Topics: Asian; Female; Health Knowledge, Attitudes, Practice; Humans; Papillomavirus Infections; Papillomavirus Vaccines; Patient Acceptance of Health Care; Republic of Korea; Uterine Cervical Neoplasms; Vaccination
PubMed: 35010311
DOI: 10.3390/ijerph19010051 -
BMC Women's Health Mar 2021Though cervical cancer is one of the leading causes of cancer-related death globally, its incidence is nearly entirely preventable. Young people have been an...
BACKGROUND
Though cervical cancer is one of the leading causes of cancer-related death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening as this population has historically been under-screened. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines. The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening (CCS) among adolescents and young people globally.
METHODS
We conducted a systematic review following PRISMA guidelines of three key databases: Medline-OVID, EMBASE, and CINAHL. Supplementary searches were done through ClinicialTrials.Gov and Scopus. Databases were examined from 1946 until the date of our literature searches on March 12th 2020. We only examined original, peer-reviewed literature. Articles were excluded if they did not specifically discuss CCS, were not specific to individuals under the age of 35, or did not report outcomes or evaluation. All screening, extraction, and synthesis was completed in duplicate with two independent reviewers. Outcomes were summarized descriptively. Risk of bias for individual studies was graded using an adapted rating scale based on the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices.
RESULTS
Of the 2177 original database citations, we included 36 studies that met inclusion criteria. The 36 studies included a total of 14,362 participants, and around half (17/36, 47.2%) of studies specifically targeted students. The majority of studies (31/36, 86.1%) discussed barriers and facilitators to Pap testing specifically, while one study analyzed self-sampling (1/36, 2.8%), one study targeted HPV DNA testing (1/36, 2.8%), and the remainder (4/36, 11.1%) were not specified. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and systemic barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy.
CONCLUSION
There are unique barriers and facilitators that affect CCS rates in adolescents and young people. Health systems and healthcare providers worldwide should address the challenges for this unique population.
Topics: Adolescent; Cross-Sectional Studies; Early Detection of Cancer; Female; Health Personnel; Humans; Mass Screening; Uterine Cervical Neoplasms
PubMed: 33757512
DOI: 10.1186/s12905-021-01264-x