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Journal of Clinical Nursing Aug 2017To present a systematic review of papers published on the relationship between violence against women and cervical cancer screening. (Review)
Review
AIMS AND OBJECTIVES
To present a systematic review of papers published on the relationship between violence against women and cervical cancer screening.
BACKGROUND
Violence against women is a serious public health problem. This phenomenon can have negative effects on victims' health and affect the frequency at which they receive cervical cancer screening.
DESIGN
A systematic literature review.
METHODS
This study was carried out in October 2015 with searches of the Lilacs, PubMed and Web of Science databases using the following keywords: violence, domestic violence, battered women, spouse abuse, Papanicolaou test, vaginal smears, early detection of cancer and cervix uteri.
RESULTS
Eight papers published between 2002-2013 were included in this review, most of which were cross-sectional studies. Three studies found no association between victimisation and receiving Pap testing, and five studies reported an association. These contradictory results were due to higher or lower examination frequencies among the women who had experienced violence.
CONCLUSION
The results of this study indicate that the association between violence against women and cervical cancer screening remains inconclusive, and they demonstrate the need for more detailed studies to help clarify this relationship.
RELEVANCE TO CLINICAL PRACTICE
Professionals who aid women should be knowledgeable regarding the perception and detection of violence so that they can interrupt the cycle of aggression, which has harmful impacts on victims' health.
Topics: Battered Women; Cross-Sectional Studies; Female; Humans; Intimate Partner Violence; Papanicolaou Test; Patient Acceptance of Health Care; Uterine Cervical Neoplasms; Women's Health Services
PubMed: 27195898
DOI: 10.1111/jocn.13328 -
Psycho-oncology Feb 2017As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical... (Review)
Review
OBJECTIVE
As uptake of cervical screening continues to decline, this systematic review synthesises the qualitative literature on women's perceptions and experiences of cervical screening in the context of an organised call-recall programme, in order to understand the barriers to informed uptake.
METHODS
We searched nine databases for English language peer-reviewed publications reporting on qualitative data from screening-eligible women, exploring barriers to cervical screening in countries that offer a nationally organised call-recall programme. Evidence was integrated using thematic synthesis.
RESULTS
Thirty-nine papers from the UK, Australia, Sweden and Korea were included. The majority of participants had attended screening at least once. Two broad themes were identified: (a) should I go for screening? and (b) screening is a big deal. In considering whether to attend, women discussed the personal relevance and value of screening. Women who had previously attended described how it was a big deal, physically and emotionally, and the varied threats that screening presents. Practical barriers affected whether women translated screening intentions into action.
CONCLUSIONS
The variation in women's understanding and perceptions of cervical screening suggests that interventions tailored to decisional stage may be of value in increasing engagement with the invitation and uptake of screening in those who wish to take part. There is also a need for further research with women who have never attended screening, especially those who remain unaware or unengaged, as their perspectives are lacking in the existing literature. © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.
Topics: Australia; Comprehension; Female; Health Knowledge, Attitudes, Practice; Humans; Mass Screening; Patient Compliance; Patient Participation; Republic of Korea; Sweden; Uterine Cervical Neoplasms; Vaginal Smears; Women's Health
PubMed: 27072589
DOI: 10.1002/pon.4126 -
International Journal of Gynaecology... Mar 2016Cervical cancer screening is offered to women to identify and treat cervical intraepithelial neoplasia (CIN). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cervical cancer screening is offered to women to identify and treat cervical intraepithelial neoplasia (CIN).
OBJECTIVES
To support WHO guidelines, a systematic review was performed to compare test accuracy of the HPV test, cytology (cervical smear), and unaided visual inspection with acetic acid (VIA); and to determine test accuracy of HPV and colposcopy impression.
SEARCH STRATEGY
Medline and Embase were searched up to September 2012, and experts were contacted for references.
SELECTION CRITERIA
Studies of at least 100 nonpregnant women (aged ≥18years) not previously diagnosed with CIN were included.
DATA COLLECTION AND ANALYSIS
Two investigators independently screened and collected data. Pooled sensitivity and specificity, and absolute differences were calculated, and the quality of evidence assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).
MAIN RESULTS
High to moderate quality evidence was found. The greatest difference in overtreatment occurred with VIA instead of the cervical smear (58 more per 1000 women). Differences in missed treatment ranged from 2-5 per 1000 women. For 1000 women screened positive and then sent to colposcopy, 464 would be falsely diagnosed with CIN grade 2-3 and treated.
CONCLUSIONS
Although differences in sensitivity between tests could be interpreted as large, absolute differences in missed diagnoses were small. By contrast, small differences in specificity resulted in fairly large absolute differences in overtreatment.
Topics: Acetic Acid; Colposcopy; Early Detection of Cancer; Female; Humans; Papanicolaou Test; Papillomaviridae; Sensitivity and Specificity; Uterine Cervical Neoplasms; Vaginal Smears; Uterine Cervical Dysplasia
PubMed: 26851054
DOI: 10.1016/j.ijgo.2015.07.024 -
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 -
Preventive Medicine Dec 2015To assess the inequalities in adherence to breast and cervical cancer screening according to educational level. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the inequalities in adherence to breast and cervical cancer screening according to educational level.
METHODS
A systematic review was carried out between 2000 and 2013 by querying an electronic database using specific keywords. Studies published in English reporting an estimation of the association between level of education and adherence to breast and/or cervical cancer screening were included in the study. Two different meta-analyses were carried out for adherence to breast and cervical cancer screening, respectively: women with the highest level of education and women with the lowest level of education were compared. The level of heterogeneity was investigated and subgroup analyses were carried out.
RESULTS
Of 1231 identified articles, 10 cross-sectional studies were included in the analysis. The meta-analyses showed that women with the highest level of education were more likely to have both screenings with an overall OR=1.61 (95% CI 1.36-1.91; I(2)=71%) for mammography and OR=1.96 (95% CI 1.79-2.16; I(2)=0%) for Pap test, respectively. Stratified meta-analysis for breast cancer screening included only studies that reported guidelines with target age of population ≥50 years and showed a reduction in the level of heterogeneity and an increase of 36% in the adherence (95% CI 1.19-1.55; I(2)=0%).
CONCLUSIONS
This study confirms and reinforces evidence of inequalities in breast and cervical cancer screening adherence according to educational level.
Topics: Adult; Breast Neoplasms; Early Detection of Cancer; Educational Status; Female; Guideline Adherence; Humans; Mammography; Mass Screening; Middle Aged; Papanicolaou Test; Patient Acceptance of Health Care; Uterine Cervical Neoplasms
PubMed: 26408405
DOI: 10.1016/j.ypmed.2015.09.011 -
Human Vaccines & Immunotherapeutics 2014In Brazil, almost 16,000 new cases of cervical cancer (CC), the type of neoplasia that claims the more lives of young women than any other, are expected in 2014.... (Review)
Review
In Brazil, almost 16,000 new cases of cervical cancer (CC), the type of neoplasia that claims the more lives of young women than any other, are expected in 2014. Although the vaccine against HPV has been developed, the application of this strategies to large populations is costly, and its use in Brazil is limited. Studies of the economic implications of new preventive technologies for CC may support rational and evidence-based decisions in public health. A systematic search of articles published between 2000 and 2014 was conducted using MEDLINE, EMBASE, the Cochrane Collaboration of Systematic Reviews, and LILACS. The aim of this search was the identification of original articles that evaluated the cost-effectiveness of vaccination against HPV in Brazil. A total of 6 articles are included in this review, evaluating the addition of a vaccine against HPV in comparison to population screening. Although the vaccine against HPV increases the cost of preventing cervical cancer, this new preventive technology presents favorable cost-effectiveness profiles in the case of Brazil. Failure to utilize the newly available preventative technologies against CC can lead to misguided and perverse consequences in a country in which programs based on the Papanicolaou test have been only partially successful.
Topics: Brazil; Cost-Benefit Analysis; Female; Humans; Papillomavirus Vaccines; Uterine Cervical Neoplasms; Vaccination
PubMed: 25483692
DOI: 10.4161/hv.34410 -
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 -
Journal of the Advanced Practitioner in... Jan 2014Cervical cancer incidence rates have decreased dramatically since the implementation of the Papanicolaou (Pap) smear. Nevertheless, the American Cancer Society (ACS)... (Review)
Review
Cervical cancer incidence rates have decreased dramatically since the implementation of the Papanicolaou (Pap) smear. Nevertheless, the American Cancer Society (ACS) estimates for 2013 predicted more than 12,000 new cases of cervical cancer in the United States. Given that some subpopulations in the United States are at a higher risk for cervical cancer than others, efforts to increase screening adherence are warranted. Many studies have explored the demographics of underscreened women, but no systematic reviews of screening demographics in adult US women were identified in the past 10 years, after release of the 2002 ACS cervical cancer screening guidelines. Knowledge of adherence to these guidelines becomes important as new guidelines were developed and released in 2012. The purpose of this systematic review of relevant studies was to identify factors that predict the use of cervical cancer screening in US women. Variables found to be significantly associated with adherence to screening included education, financial status, acculturation, psychosocial issues, and marital status. Using this information, nurse practitioners and other providers can target specific at-risk populations to increase screening by educating women about the need for cervical cancer screening and ensuring access to methods for prevention and early detection of the disease.
PubMed: 25032031
DOI: No ID Found -
PloS One 2013Although the importance of the Pap smear in reducing cancer incidence and mortality is known, many countries in Africa have not initiated yet widespread national... (Meta-Analysis)
Meta-Analysis Review
Factors affecting compliance with clinical practice guidelines for pap smear screening among healthcare providers in africa: systematic review and meta-summary of 2045 individuals.
BACKGROUND
Although the importance of the Pap smear in reducing cancer incidence and mortality is known, many countries in Africa have not initiated yet widespread national cervical cancer screening programs. The World Health Organization (WHO) has published Clinical Practice Guidelines (CPGs) on cervical cancer screening in developing countries; however, there is a gap between expectations and clinical performance. Thus, the aim of this study was to conduct a systematic review and meta-summary to identify factors affecting compliance with CPGs for Pap screening among healthcare providers in Africa.
METHODS
And Findings: MEDLINE, Scirus, Opengate and EMBASE databases were searched in January 2012. Studies involving medical personnel practicing in Africa, whose outcome measured any factors that affect medical personnel from using a Pap smear to screen for cervical cancer, were included. Two reviewers independently evaluated titles and abstracts, then full-texts, extracted data and assessed quality of the included studies. A descriptive analysis of the included studies was conducted. We calculated Frequency effect sizes (FES) for each finding and Intensity effect sizes (IES) for each article to represent their magnitudes in the analyses. Of 1011 studies retrieved, 11 studies were included (2045 individuals). Six different themes related to the factors affecting compliance with CPGs were identified: Insufficient Knowledge/Lack of awareness (FES = 82%), Negligence/Misbeliefs (FES = 82%), Psychological Reasons (FES = 73%), Time/Cost Constraint (FES = 36%), Insufficient infrastructure/training (FES = 45%) and also no reason given (FES = 36%). IES for articles ranged between 33 and 83%.
CONCLUSIONS
These results suggest that prevention initiatives should be comprehensive to include education and resources needs assessments and improvement, Pap smear test training, strategies on costing, and practitioner time studies.
Topics: Africa; Female; Health Personnel; Humans; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 24069156
DOI: 10.1371/journal.pone.0072712 -
Women's Health Issues : Official... 2013Research has found some disparities between U.S. women with and without disabilities in receiving clinical preventive services. Substantial differences may also exist... (Review)
Review
BACKGROUND
Research has found some disparities between U.S. women with and without disabilities in receiving clinical preventive services. Substantial differences may also exist within the population of women with disabilities. The current study examined published research on Pap smears, mammography, and clinical breast examinations across disability severity levels among women with disabilities.
METHODS
Informed by an expert panel, we followed guidelines for systematic literature reviews and searched MEDLINE, PsycINFO, and Cinahl databases. We also reviewed in-depth four disability- or preventive service-relevant journals. Two reviewers independently extracted data from all selected articles.
FINDINGS
Five of 74 reviewed publications of met all our inclusion criteria and all five reported data on Pap smears, mammography, and clinical breast examination. Articles classified disability severity groups by functional and/or activity levels. Associations between disability severity and Pap smear use were inconsistent across the publications. Mammography screening fell as disability level increased according to three of the five studies. Results demonstrated modestly lower screening, but also were inconsistent for clinical breast examinations across studies.
CONCLUSION
Evidence is inconsistent concerning disparities in these important cancer screening services with increasing disability levels. Published studies used differing methods and definitions, adding to concerns about the evidence for screening disparities rising along with increasing disability. More focused research is required to determine whether significant disparities exist in cancer screening among women with differing disability levels. This information is essential for national and local public health and health care organizations to target interventions to improve care for women with disabilities.
Topics: Adult; Aged; Breast Neoplasms; Disabled Persons; Early Detection of Cancer; Female; Healthcare Disparities; Humans; Mammography; Mass Screening; Middle Aged; Papanicolaou Test; Physical Examination; Uterine Cervical Neoplasms; Vaginal Smears
PubMed: 23816150
DOI: 10.1016/j.whi.2013.04.002