Percepção de mulheres residentes em Barreiras (BA) quanto ao rastreamento do câncer de colo do útero / Perception of women living in Barreiras regarding cervical cancer screening / Percepción de las mujeres residentes en Barreiras, Bahía, sobre el cribado de cáncer del cuello uterino

O rastreamento do câncer de colo do útero (CCU) é uma das estratégias para diminuição da incidência e morbimortalidade dessa neoplasia. Portanto, é necessário estudar os fatores que estão associados à sua realização. Este estudo visa analisar a adesão ao rastreamento do CCU na cidade de Barreiras (BA), com vistas às ações de educação em saúde e ao papel dos profissionais de saúde nessa prevenção. A abordagem da pesquisa foi descritiva qualitativa, com utilização de questionário. Os dados coletados foram organizados pelo software Excel 2016. Na análise inferencial, foi utilizado o software GraphPad Prism 5.0 e o teste de Spearman. A maioria da amostra (37%) tem entre 30 e 40 anos e possui ensino médio completo (65%). Ademais, 71% consideram realizar regularmente o preventivo. A maior parcela iniciou o Papanicolau antes dos 20 anos, principalmente devido ao aconselhamento do profissional de saúde (58%). Constatou-se correlação positiva entre frequência e presença de educação em saúde na Unidade Básica de Saúde (r = 0,2982; p = 0,0122); e entre realização do exame regular e incentivo pelo profissional de saúde (r = 0,4284; p = 0,0015). Conclui-se que a maioria das questionadas possuía conhecimento prévio a respeito do preventivo, sendo importante ressaltar a educação em saúde e o incentivo do profissional como fundamentais para essa adesão.

Since cervical cancer (CC) screening is a major strategy used to decrease the morbidity and mortality rate of this neoplasm, research on its associated factors is necessary. This study analyzes adherence to CC screening in the municipality of Barreiras, Bahia, focusing on health education actions and the role of health professionals in CC prevention. A qualitative and descriptive research was conducted by means of a questionnaire. Collected data were organized using the Excel 2016 software. Inferential analysis was performed using the GraphPad Prism 5.0 software and Spearman's test. Most research participants (37%) are between 30 and 40 years, have completed high school (65%), and considered doing pap smear regularly (71%). Most (58%) started pap smear before 20, mainly due to advice from health professionals. Results showed a positive correlation between frequency and health education actions offered at the Basic Health Unity (r = 0.2982; p = 0.0122), and between regular examination and incentive by a health professional (r = 0.4284; p = 0.0015). In conclusion, most of the respondents have previous knowledge about preventive screening, highlighting the prominent role played by health education and professional incentive for this adherence.

El cribado del cáncer de cuello uterino (CCU) es una de las estrategias para reducir la incidencia y la morbimortalidad por esta neoplasia. En este sentido, es necesario estudiar los factores que están asociados a su prevención. Este estudio tuvo por objetivo analizar la adherencia a la prevención de CCU en la ciudad de Barreiras (Bahía, Brasil), teniendo en cuenta las acciones de educación en salud y la función de los profesionales de la salud en esa prevención. La investigación fue descriptiva y cualitativa, utilizando un cuestionario. Los datos recolectados se organizaron mediante el software Excel 2016. En el análisis de inferencia, se utilizó el software GraphPad Prism 5.0 y la prueba de Spearman. La mayoría de la muestra (37%) tiene edad entre 30 y 40 años, y la secundaria completa (65%). Además, el 71% informaron realizar el Papanicolaou con regularidad. Gran parte de las participantes dijeron que empezaron a realizar el PAP antes de cumplir los 20 años, sobre todo, por recomendaciones de un profesional de la salud (58%). Se constató correlación positiva entre frecuencia y presencia de educación en salud en la Unidad Básica de Salud (UBS) (r = 0,2982; p = 0,0122); y entre la realización de estudios regulares y el estímulo a hacerlo por parte del profesional de la salud (r = 0,4284; p = 0,0015). Se concluye que la mayoría de las encuestadas tiene conocimientos previos acerca de cuidados preventivos, lo que demuestra que la educación en salud y el estímulo de los profesionales son importantes para la adherencia al cribado del CCU.

Atitudes e crenças de médicos ginecologistas- -obstetras e de pacientes do Hospital Universitário de Brasília sobre o rastreamento cervical e o exame pélvico / Attitudes and beliefs of obstetrician-gynecologists and patients at the University Hospital of Brasília about cervical screening and pelvic examination

Objetivo: Avaliar as atitudes e crenças de pacientes e médicos ginecologistas-obstetras sobre o rastreamento cervical e o exame pélvico no Hospital Universitário de Brasília (HUB). Métodos: Foram realizadas entrevistas com pacientes que aguardavam por uma consulta previamente agendada no ambulatório de ginecologia e com médicos ginecologistas-obstetras que atuavam no HUB. Cada grupo respondeu a um questionário que enfocava a realização do rastreamento cervical e do exame pélvico (EP). Resultados: No total, 387 pacientes responderam ao questionário. Dessas, apenas 4,13% sabiam que, de acordo com as diretrizes brasileiras, o rastreamento cervical deveria ser iniciado aos 25 anos de idade, 5,17% sabiam que ele deveria ser encerrado aos 64 anos e 97,93% esperavam um intervalo menor do que o trienal recomendado. Após serem informadas sobre as diretrizes, 66,93% acreditavam que o início aos 25 anos é tardio, 61,5%, que o encerramento aos 64 anos é precoce, 88,37%, que o intervalo trienal é muito longo e 94,06% ficaram com receio de que problemas de saúde pudessem aparecer nesse intervalo. Dos 44 médicos que responderam ao questionário, embora a maioria concordasse com as diretrizes, somente 31,82%, 38,64% e 34,1% as seguia com relação à frequência, à idade de início e à idade de encerramento, respectivamente. Quanto ao EP, aproximadamente metade dos participantes de cada grupo considerava que o exame deveria ser realizado nas consultas regulares com o ginecologista. Conclusão: Foi observada uma discrepância entre as expectativas das pacientes e as diretrizes para o rastreamento de câncer cervical. A maior parte das pacientes não as conhecia e, quando informadas, não concordava com elas. Quanto aos médicos ginecologistas- obstetras, a maioria não as seguia, apesar de conhecê-las. Quanto ao EP, grande parte dos médicos e pacientes considerava-o importante e acreditava que ele deveria ser realizado de forma rotineira nas consultas ginecológicas.

Objective: Evaluate the attitudes and beliefs of patients and obstetrician-gynecologists about cervical screening and pelvic examination in the University Hospital of Brasília (HUB). Methods: Face-to-face interviews with patients waiting for a previously scheduled consultation at the gynecology outpatient clinics and attending obstetrician-gynecologists at the HUB. Each group answered a questionnaire addressing cervical screening and pelvic examination (PE). Results: 387 patients answered the questionnaire. Of these, only 4.13% were aware that, according to Brazilian guidelines, cervical screening should begin at age 25, 5.17% that it should stop at age 64 and 97.93% expected a shorter interval than the recommended triennial. After being informed of the guidelines, 66.93% believed that starting at age 25 is late, 61.5% that stopping at 64 is early, 88.37% that the triennial interval is too long, and 94.06% would be afraid that health problems could appear during the interval. Of the 44 participating physicians, although most agreed with the guidelines, only 31.82%, 38.64% and 34.1% followed them regarding frequency, starting and stopping age, respectively. As for EP, approximately half of the participants in each group believed that it should be performed in regular consultations with the gynecologist. Conclusion: There was a discrepancy between patients' expectations and cervical screening guidelines. Most patients didn't know and, when informed, didn't agree with them. As for Ob-Gyn physicians, most did not follow these guidelines, despite knowing them. As for pelvic exam, most physicians and patients considered it important and believed it should be routinely performed during gynecological consultations.

Factors Associated with Presence of Human Papillomavirus Infection among Women: Findings from New Cervical Cancer Screening in Kelantan, Malaysia

@#Introduction: Human papillomavirus (HPV) infection is known to cause cervical cancer worldwide. Recently, Malaysia introduced HPV DNA detection testing for cervical cancer screening program. However, knowledge regarding factors for HPV infection among women still limited. Thus, this study aimed to determine the prevalence and factors associated with HPV infection among women in Kelantan, a north-eastern state of Malaysia. Methods: This study used secondary data extracted from HPV DNA test registry book and HPV DNA laboratory request forms. Data on all Malaysian women aged 30 to 49 years old in 2019 reported in registry book were included. Simple random sampling was applied. All information from book and forms were collected using proforma and analysed using SPSS. The outcomes were categorised into HPV infection and non-HPV infection. The parameters related to factors associated with HPV infection were determined using multivariable logistic analysis. Results: The prevalence of HPV infection among women attending the new cervical screening was 8.4% (95% CI 6.4%, 10.3%). Those aged between 30 and 39 years old (AdjOR 2.09; 95% CI 1.16, 3.78, p=0.014), had 5 or more parities (AdjOR 2.82; 95% CI 1.58, 5.06, p<0.001) and hormonal contraception users (AdjOR 7.48; 95% CI 4.07, 13.76, p<0.001) were significantly associated with HPV infection. Conclusion: Overall, the prevalence of HPV infection from this study is comparable to the local and international studies. Age, number of parities and hormonal contraception users influence the HPV infection. This finding could help in designing more targeted screening for cervical cancer.

Willingness and influencing factors for cervical cancer screening among women in Chizhou / 公共卫生与预防医学

Objective To investigate the influencing factors of willingness to screen for cervical cancer in women in Chizhou. Methods A cross-sectional web-based survey of 3,058 migrant women living in Chizhou was conducted through a social media platform. The survey included questionnaires on socioeconomic characteristics, history of cervical cancer screening, knowledge of cervical cancer prevention and treatment, and attitude. The χ2 test and logistic regression were used to analyze the influencing factors of willingness to screen. Results Under 60 years of age, having a spouse or sexual partner (OR=1.368), having a junior high school education or above, living in urban areas (OR = 1.501), local household registration (OR=1.363), high monthly income, and high knowledge of cervical cancer prevention and control (OR=1.198) were positively associated with the rate of willingness to undergo cervical screening. Among attitude barriers, there were statistically significant differences in fear of seeing male doctors (38.23%), fear of seeing poor results (31.92%), belief that screening was painful (23.56%), shyness or embarrassment (20.18%), and belief that they did not need to participate in screening due to asymptomatic (17.56%), having received HPV vaccine (15.86%), or ages at which screening was not considered necessary (15.14%) between the groups (P<0.05). Conclusion Socioeconomic characteristics, knowledge of prevention and treatment, fear of screening experience, and lack of motivation are related factors affecting cervical cancer screening willingness. Achieving cervical cancer elimination requires action to improve screening coverage in socio-economic, health education and women's attitudes.

Determining the relationship between serum acute phase reactants and cervical premalignant lesions: a cohort study

Abstract BACKGROUND: Acute phase reactants play a role in the progression and prognosis of many malignant and premalignant tumors. This study investigated the diagnostic value of certain reactants as markers for cervical premalignant lesions. OBJECTIVES: Despite advanced screening and vaccination programs, cervical cancer remains a serious health problem worldwide. We aimed to determine the possible relationship between premalignant cervical disease and serum acute phase reactant levels. DESIGN AND SETTING: This study included 124 volunteers who underwent cervical cancer screening. We divided the patients into three groups according to cervical cytology and histopathological findings as follows: no cervical lesion, low-grade neoplasia, or high-grade neoplasia. METHODS: We included women aged 25-65 years with benign smear or colposcopy results, low- and high-grade squamous intraepithelial lesions. The benign group was based only on cytology findings, whereas the other groups were based on histopathology findings. Demographic data and serum albumin, fibrinogen, ferritin, and procalcitonin levels were evaluated in the three groups. RESULTS: We found significant differences among the three groups in terms of age, albumin level, albumin/fibrinogen ratio, and procalcitonin level. The regression analysis revealed lower serum albumin levels in the low- and high-grade squamous intraepithelial lesion groups compared with the benign group. CONCLUSION: This is the first study to evaluate the importance of serum inflammatory markers in cervical intraepithelial lesions. Our results indicate that serum albumin level, albumin/fibrinogen ratio, procalcitonin level, and neutrophil values differ among cervical intraepithelial lesions.

Knowledge of cervical cancer among women of reproductive age in Ibadan north lga, Oyo State, Nigeria

Nigeria has one of the highest rates of cervical cancer morbidity and mortality in Sub-Saharan Africa. Both the human papillomavirus vaccine (HPV) and cervical screening are effective prevention strategies against both HPV infection and cervical cancer. Lack of awareness, limited knowledge, limited decision-making agency, lack of spousal support and stigma are barriers to uptake of these preventive measures. Cervical cancer is a deadly disease claiming the lives of many women in developing countries due to late presentation which might be influenced by a lack of knowledge of the disease and its prevention. Method: This descriptive study examined the knowledge assessment of cervical cancer among women of reproductive age (15-49), about cervical cancer, its prevention, and their utilization of Pap smear screening; using a convenience sample of 426 women in Ibadan North Local Government Area of Oyo State, Nigeria. Women voluntarily completed a structured questionnaire. Result: Results showed that women who participated in the study were aware of cervical cancer (77%; n=328) but many (62.9%; n= 268) were unaware of Pap smears as the screening tests for cervical cancer. Although 41.3% (n=176) were knowledgeable about cervical cancer, risk factors and prevention, only 9.4% (n=40) had Pap smear tests done. Conclusion: Health care professionals, need to intensify efforts to increase awareness about cervical cancer screening, and encourage women through the different clinics to use these services. The benefits of screening and early diagnosis of cervical cancer should be emphasized to enhance the utilization of cervical cancer screening services.

Knowledge of cervical cancer among women of reproductive age in Ibadan North LGA, Oyo State, Nigeria

Background: Nigeria has one of the highest rates of cervical cancer morbidity and mortality in Sub-Saharan Africa. Both the human papillomavirus vaccine (HPV) and cervical screening are effective prevention strategies against both HPV infection and cervical cancer. Lack of awareness, limited knowledge, limited decision-making agency, lack of spousal support and stigma are barriers to uptake of these preventive measures. Cervical cancer is a deadly disease claiming the lives of many women in developing countries due to late presentation which might be influenced by a lack of knowledge of the disease and its prevention. Method: This descriptive study examined the knowledge assessment of cervical cancer among women of reproductive age (15-49), about cervical cancer, its prevention, and their utilization of Pap smear screening; using a convenience sample of 426 women in Ibadan North Local Government Area of Oyo State, Nigeria. Women voluntarily completed a structured questionnaire. Result: Results showed that women who participated in the study were aware of cervical cancer (77%; n=328) but many (62.9%; n= 268) were unaware of Pap smears as the screening tests for cervical cancer. Although 41.3% (n=176) were knowledgeable about cervical cancer, risk factors and prevention, only 9.4% (n=40) had Pap smear tests done. Conclusion: Health care professionals, need to intensify efforts to increase awareness about cervical cancer screening, and encourage women through the different clinics to use these services. The benefits of screening and early diagnosis of cervical cancer should be emphasized to enhance the utilization of cervical cancer screening services.

Fatores Associados à não Realização de Colpocitologia Oncótica nas Capitais da Região Sul do Brasil / Factors Associated with not Performing Oncotic Colpocytology in the Capital Cities of the Southern Region of Brazil

Introdução: A colpocitologia oncótica é um meio de rastreamento do câncer de colo uterino. O estudo objetivou analisar os fatores associados à não realização desse rastreamento no sul do Brasil. Métodos: Realizou-se um estudo transversal com mulheres entrevistadas pela VIGITEL nas capitais do sul do Brasil, envolvendo 1847 registros. Foram incluídas mulheres de 25 a 64 anos de idade. A variável dependente foi a não realização de colpocitologia oncótica nos três anos anteriores à pesquisa, enquanto as independentes foram características sociodemográficas e clínicas da população disponíveis. Análises bivariada e multivariada foram feitas por meio de Regressão Logística, em que foram estimadas as razões de chance com nível de significância p<0,05. Resultados: Do total, 1710 registros foram incluídos, com 250 (14,6%) mulheres que responderam não terem realizado, e 1460 (85,4%) terem realizado o procedimento nos últimos três anos. Resultados da análise multivariada evidenciaram que mulheres de 40 a 64 anos apresentaram chance 2,24 maior (IC 95% 1,52; 2,78) (p < 0,001) e aquelas com diabetes mellitus, 1,74 chance (IC 95% 1,13; 2,67) (p = 0,012) de não realização do exame nos últimos três anos. Conclusão: A chance de não realização de colpocitologia oncótica esteve associada à faixa etária de 40 a 64 anos e por apresentar diabetes mellitus na população estudada.

Introduction: Oncotic colpocytology is a method of screening for cervical cancer. The study aimed to analyze the factors associated with not performing this screening in Southern Brazil. Methods: A cross-sectional study was carried out with women interviewed by VIGITEL in the capitals of Southern Brazil involving 1847 records. The participants included were women aged 25 to 64 years. The dependent variable was not performing oncotic colpocytology in the three years before the survey, while the independent variables were sociodemographic and clinical characteristics of the population available. Bivariate and multivariate analyses were performed using Logistic Regression, in which odds ratios were estimated with a significance level of p<0.05. Results: Of the total, 1710 records were included, with 250 (14.6%) women responding that they had not performed and 1460 (85.4%) having performed the procedure in the last three years. Results of multivariate analysis showed that women aged 40 to 64 years had a 2.24 greater chance (95% CI 1.52; 2.78) (p < 0.001) and those with diabetes mellitus a 1.74 chance (95% CI 1.13; 2.67) (p = 0.012) of not having had the exam in the last three years. Conclusion: The chance of not performing oncotic colpocytology was associated with the age range of 40 to 64 years and diabetes mellitus in the studied population.

Preventing Uterine Cervix Cancer: The Clinical Meaning of Atypical Glandular Cells / Prevenção do câncer do colo uterino: Significado clínico das células glandulares atípicas

Abstract Objective To determine the prevalence of the atypical glandular cells (AGCs) cytology and to analyze its clinical significance in different age ranges. Methods Retrospective observational study using computerized data from the Brazilian National Cancer Institute, including women screened between January 2002 and December 2008. The women included were those with an AGC result who were properly followed-up with colposcopy and a second cytology. Results A total of 132,147 cytopathological exams were performed during the study period. Five-hundred and thirty-three (0.4%) women with AGC cytology were identified and, of these, 69.41% (370/533) were properly referred for colposcopy and a new cytology. Most of the women (79.2%) with a 1st or 2nd AGC cytology were between the ages of 25 and 54 years. The 2nd cytology demonstrated 67.6% (250/370) of normality, 24.5% (91/370) of squamous atypia, and 6.2% (23/370) of AGC, 0.8% (3/370) adenocarcinoma in situ and 0.8% (3/370) adenocarcinoma invasor. On biopsy of the women with a second AGC cytology, 43.4% (10/23) had normal histology, 43.4% (10/23) had squamous lesions, 8.7% (2/23) had invasive adenocarcinoma, and 1.2% (1/23) had an inconclusive report. All of the women with high-grade squamous intraepithelial lesion (HSIL) or invasive adenocarcinoma (respectively 5 and 2 patients), after a 2nd AGC cytology were 25 years old or older. Conclusion The prevalence of the AGC cytology was low in the studied population. Most of the AGC cytology cases occurred in adult women between the ages of 25 and 54. Although most of the patients had normal histology after follow-up, several of them presented with squamous intraepithelial lesions or invasive adenocarcinoma.

Resumo Objetivo Determinar a prevalência de citologia com laudo de células glandulares atípicas (AGCs, na sigla em inglês) e analisar a significância clínica nas diferentes faixas etárias Métodos Estudo observacional retrospectivo, usando os dados arquivados no sistema do Instituto Nacional de Câncer no Brasil, que incluiu mulheres rastreadas entre janeiro de 2002 a dezembro de 2008. As mulheres incluídas tinham citologia com resultado de AGCs, que foram acompanhadas com colposcopia e nova citologia Resultados Um total de132,147 exames citopatológicos foram incluídos durante o período de estudo. Quinhentas e trinta e três mulheres com citologia de AGC foram identificadas e destas, 69.41% (370) foram encaminhadas para colposcopia e nova citologia. A prevalência de citologia de AGC na população estudada foi 0.4%. A maioria das mulheres (79.22%) com resultado citológico de AGC tinham idade entre 25 e 54 anos. A segunda citologia demonstrou 67.56% (250/370) de normalidade, 24.5% (91/370) de atipias escamosas, e 6.2% (23/370) de AGC. Na biopsia das mulheres com a 2ª citologia de AGC, 43.4% (10/23) tinham histologia normal, 43.4% (10/23) tinha lesões escamosas, 8.7% (2/23) tinha adenocarcinoma invasor e 1.2% (1/23) tinha laudo inconclusivo. Todas as mulheres com lesões intraepiteliais escamosas de alto grau (HSIL, na sigla em inglês) ou adenocarcinoma invasor (respectivamente 5 e 2pacientes), após a 2ª citologia com AGC, tinham 25 anos de idade ou mais. Conclusão A prevalência de citologia com AGC foi baixa na população estudada. Muitos casos de citologia com AGC apareceram em mulheres adultas, entre 25 e 54 anos de idade. Embora a maioria das pacientes tiveram histologia normal após seguimento, várias apresentaram lesões intraepiteliais escamosas ou glandulares invasoras.

Perception on cervical cancer and enhancing strategies to screening uptake among women in Bamenda, Cameroon: A qualitative method

The treatment of cervical cancer has a good prognosis if diagnosed early. Hence, screening is very vital. The aim of this study was to evaluate the perception of women on cervical cancer and strategies to enhance its screening uptake in the city of Bamenda, Cameroon. Qualitative study was carried out from July, 2019 to August, 2019. Eight focus group discussions were organized in five different quarters in the city of Bamenda. These quarters and participants were purposively selected and each group constituted 6 to 8 Participants. Ethical clearance and administrative authorization for the study were obtained prior to the study. Data was analyzed using thematic analysis with the help of QDA Miner. A total of 53 study participants took part in this study. Their ages ranged between 21 to 45 years. Most participants did not know about cervical cancer. Their perceived barriers to cervical cancer screening included: inadequate sensitization; financial challenges and embarrassing testing strategies; lack of awareness on the availability of screening centers; poor attitude of health personnel. Proposed strategies to enhance cervical cancer screening were: sensitization of the population, recruitment of more competent staff, testing centers should be located closed to the target population, less embarrassing screening methods should be used, health care workers should demonstrate positive attitudes during care, female staff should manage the screening units, screening cost should be subsidized. Due to the Small purposive sample size and qualitative nature of this study, the findings are not generalizable

Factors influencing cervical cancer screening among pregnant women in Nairobi, Kenya

To characterize cervical cancer screening knowledge, beliefs, behaviors, and sociodemographic factors among women aged 25-45 years who access and utilize prenatal care services in Nairobi, Kenya. A descriptive cross-sectional design using a convenience sample of pregnant women receiving prenatal health services at a public and a private hospital in Nairobi, Kenya. Constructs from the Health Belief Model (HBM) guided the design, interpretation of the results, and recommendations. Data were analyzed using SPSS version 24. Bivariate analyses were conducted to examine associations between variables. There was a significant association (p=0.001) between knowledge and screening behaviors. There was no association (p=0.066) between cervical cancer beliefs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy) and screening behaviors. Knowledge and beliefs influence cervical cancer screening behavior. Low cervical cancer screening uptake substantiates the need for tailoring culturally specific health behavior change communication to address misconceptions about cervical cancer screening in Kenya.

Barriers to cyotherapy treatment services for precancerous cervical lesions among women in Western Kenya

BACKGROUND Cervical cancer is the fourth most fatal and common disease globally among women of reproductive age in Kenya; it ranks the second most frequent type of cancer after breast cancer. Due to the high burden, cryotherapy treatment services, which are effective for the treatment of precancerous lesions are available in selected health facilities in Kenya, however, barriers to the treatment services are poorly understood. Nonetheless, understanding these barriers is critical for enhanced service delivery. MATERIALS AND METHODS :A descriptive facility-based cross-sectional study design was carried out to determine the barriers to cryotherapy treatment services among 60 women of reproductive age on a one-year therapy at Migosi Sub County Hospital in Western Kenya. The participants were selected purposively and interviewed via telephone calls using pre-coded semi-structured questionnaires. However, data from 5 nurses working in the cryotherapy section were collected through face-to-face interviews at the health facility. Data were entered in an excel sheet and then exported to SPSS version 23.0 for analysis. Both descriptive and inferential statistics (Chi-square) were used and data were presented in form of tables. RESULTS :Overall, 52 (85.4%) respondents adhered to post-care treatment instructions and reported no adverse reactions. However, 28 (46.7%) experienced unavailability of cryotherapy services at the time of the appointment and got the services later, 24 (40%) got the services at the time of the appointment but waited for a long time before being served, 37 (61.7%) did not know why they were being treated and 46 (76.7%) had misconceptions and myths about the therapy. In addition, there was a statistically significant association between knowing both the benefits of screening and cryotherapy [X 2 (1, N = 60) = 5.90, p = .02]. Also, the knowledge of the benefits of cryotherapy did not influence one's decision to wait for cryotherapy treatment services, [X 2(1, N = 60) = 3.98, p = .46]. CONCLUSION : The study shows very good adherence to post-treatment instruction but inadequate availability of cryotherapy treatment services. Also, the misconceptions and myths about cryotherapy are public health concerns. Therefore, the study recommends improved awareness campaigns and service delivery for the enhanced uptake of cryotherapy treatment services.

Application of the hub and spokes model in improving access to cervical cancer screening in Ghana

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. Main outcome measure: The detection of screen positives Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed

Knowledge, Attitude and Practice towards cervical cancer screening among healthcare providers in Luang Prabang and Salavan Provinces, Lao PDR / Lao Medical Journal

@#Objective: we aimed to assess the knowledge, attitude and practice (KAP) of healthcare providers (HCP) towards cervical cancer (CC) screening and to identify possible factors associated with its low utilization among women presenting at gynaeco-obstetrics units in the Lao PDR. Methods: A cross-sectional study was conducted between March - June 2018 on a sample of 85 (HCP) at gynaecology units in two provincial and eleven district hospitals in Luang Prabang (LPB) and Salavan (SLV) Provinces. Results: Of the 85 HCP, 63.4% were from SLV and 36.6% from LPB. 81% were females and mean ager was 32 years. Only 7% of them had good knowledge, 18.8% had good CC screening attitudes and only 1.2% had good CC screening practices. 36.2% of female HCP had been screened for CC and 48.3% had not been screened because they thought only those who had symptoms and risk factors should go for. The most common reasons for not conducting routine CC screening of patients were: lack of medical equipment (53.7%), and incompetent techniques (43.3%). HCP graduates and post graduates had a higher knowledge score (aOR = 4.09, 95% CI: 1.43-11.66, P = 0.008), and attitude score (aOR = 5.54, 95% CI: 1.55-19.75, p=0.008). Those, who had been working for more than 10 years, were more likely to have higher attitude scores (aOR = 6.07, 95% CI: 1.36-27.15, p =0.018). Conclusions: CC screening knowledge among HCP is generally fair. However, CC screening attitudes are still poor. Re-orientation courses on CC screening for HCP are urgently needed in order to move forward to the next steps in CC screening programs.

A Systematic Evaluation of Methods Used and the Effectiveness of Health Education Interventions to Improve Knowledge, Beliefs, and Practices of Cervical Cancer Screening

@#Introduction: Screening of cervical cancer had decreased its morbidity and mortality in developed countries. Health education interventions are expected to enhance knowledge, attitude and practice of screening. Their success rely on designs and methods. Thus, this systematic review aims to identify the methods used and the effectiveness of health education interventions in improving knowledge, beliefs, and practices of cervical cancer screening among women of reproductive age. Methods: A systematic review of all published eligible studies in (PubMed, Science Direct and MEDLINE) databases from 1st of January 2016 to 31st of October 2020 was run using different keywords. A total of 14 research articles were included. The quality and risk of bias of studies was assessed by using EPHPP and the average score was given accordingly. This study was registered in PROSPERO (record #CRD42020188462). Results: The review combined 14 studies. Five studies were conducted in the USA, two in Hong Kong, one in Korea, one in England, one in Denmark, one in Norway, one in Turkey, one in Malaysia and one in Tanzania. Almost all interventions boosted the knowledge, attitude or screening uptake. Conclusion: This review showed that the most popular methods of delivering health intervention were health talk, Group discussion and pamphlet. Health education interventions was effective in improving the knowledge, attitude and screening uptake. Although, this effect differs according to methods of delivery, study background and populations. Therefore, it is better to understand the existing situation to develop the best intervention and more studies are needed to recognise barriers to screening.

Citologia oncótica cervicovaginal na população lésbica e transgêneros / Cervicovaginal oncotic cytology in the lesbian and transgender population

O câncer de colo uterino causa a morte de milhares de mulheres no mundo. Entre essas mulheres, há grupos como o de lésbicas e transgêneros que têm dificuldade no rastreio devido à discriminação e ao desconhecimento. As lésbicas e transgêneros masculinos que não fizeram histerectomia total devem se manter no rastreio da mesma forma que as mulheres cisgêneros. Transgêneros femininos devem ser seguidas, porém ainda não há protocolos definidos.(AU)

Cervical cancer causes the death of thousands of women worldwide. Among these women, there are groups, like lesbians and transgenders that present difficulty in screening due to discrimination and lack of knowledge. The lesbians and transgenders men who didn´t have total hysterectomy, must keeping in screening the same way as cisgenders. Transgender woman must be followed, but there aren't definitive guidelines.(AU)

Knowledge, attitude and practice towards cervical cancer screening and human papilloma virus vaccine at a tertiary care facility in North India

Background: Cervical cancer continues to be a major health care problem and most common cause of cancer deaths. Many screening methods are available to detect the disease in precancerous stage. Cervical cancer is the only cancer that is preventable with HPV vaccine against the causative agent responsible for this condition. Knowledge and attitude of women determine the likelihood of women undergoing screening procedures and HPV vaccination which will have implications for the future generations. This study was conducted to determine the knowledge, attitude and practice of women towards cervical screening and HPV vaccine.Methods: This is a facility based observational cross-sectional study conducted at Dr. RMLIMS, Lucknow, over a period of 3 months - January 2019 to March 2019. Women attending gynecology OPD were enrolled after verbally consenting for the study and were required to fill a pre-structured questionnaire which was then analyzed and assessed.Results: A total of 368 participants answered the questionnaire. Overall, 154 subjects (41.8%) had adequate knowledge regarding cervical carcinoma risk factors, symptoms, screening for cancer and HPV vaccine. Favorable attitude was seen in 315 (85.5%) participants. Ninety-six participants (26.0%) had ever had a cervical cancer screening and 23 participants (6.2%) had ever received HPV vaccine which was very low. Lack of knowledge and cost factors were the main reasons cited for these low screening and vaccination rates among the participants.Conclusions: The study shows that knowledge was inadequate and screening and vaccination rates were very low in the study population. This highlights the need to educate the community regarding cervical cancer prevention and to make these services readily available at affordable costs to achieve the ultimate goal of elimination of cervical cancer.

The correlation between colposcopy, cervical cytology and histopathology in the diagnosis and management of cervical lesions: a cross sectional study

Background: The study was undertaken to see the correlation between cervical cytology, histopathology and colposcopy in the diagnosis and management of various cervical lesions.Methods: It is a cross sectional study conducted at a tertiary care hospital in Mumbai, in the department of obstetrics and gynecology from February 2007 to March 2008. A total 55 sexually active women were enrolled for the study who belonged to age group greater than 20 years with history of chronic leucorrhoea or post-coital bleeding/spotting, intermenstrual bleeding/spotting or examination findings of erosion, an unhealthy cervix, a lesion bleeding on touch or an abnormal or suspicious Papanicolaou smear. These women then underwent cytology, colposcopy and cervical biopsy.Results: The accuracy of cytology when compared to colposcopy was 81.82%. The accuracy of colpo-histopathology was 83.6%. The combined accuracy was 76.36%.Conclusions: The simultaneous use of cytological studies and screening colposcopy has been shown to increase the cervical cancer detection. Colposcopy offers an excellent tool in the hands of a gynaecologist to evaluate the uterine cervix and it is not possible to develop this kind of perspective by any other method.

Pap smear in antenatal women: a valuable opportunity for screening and awareness

Background: Pregnancy creates an important opportunity to screen the cervix for neoplastic and infectious diseases and to spread awareness. A pap smear is simple, cost effective and safe in pregnancy. In low resource countries, this may be the only opportunity when the woman visits a health centre.  It also helps identify and treat infections that could hamper the pregnancy outcome. Objective of the study is to determine the awareness of pap smear as a cervical cancer screening test in antenatal women; to determine the incidence of cervical neoplasia and premalignant lesions of the cervix in antenatal women.Methods: A cross-sectional study was carried out between November 2018 to April 2019. Inclusion criteria were pregnant women in the first trimester. Exclusion criteria were pregnancy greater than 12 weeks, symptoms of vaginal infection, history of sexual intercourse or vaginal medication or bleeding in the last 48 hours or a normal pap smear in the last 3 years. The reporting was done as per Bethesda 2014.Results: 308 women underwent a pap smear in their 1st trimester. 94% were satisfactory smears and 3(0.9%) an abnormal smear (2 LSIL and 1 ASCUS). 31.2% had inflammatory smears. Only 15 women were aware of pap smear as a test for cancer cervix screening and all these women were graduates and above. No women had ever had a pap smear test in the past. One fifth of women studied had 1 or more risk factor the commonest being early age at first intercourse.Conclusions: The antenatal period should be utilized as an opportunity to screen women for cancer cervix.

A study of evaluation of unhealthy cervix by various diagnostic modalities

Background: This study was carried out to evaluate cases of unhealthy cervix by using Pap (Papanicolaou) smear, colposcopy and cervical biopsy and to arrive at a definitive diagnosis. It correlated the findings of Pap smear, colposcopy and histopathology. It is important to strictly implement the screening program and spread awareness of the disease symptoms and its management to reduce the overall incidence of morbidity and mortality reported due to cervical cancer.Methods: A total 120 patients satisfying the inclusion/exclusion criteria were recruited for the study and informed consent was taken from all the participants. Pap smear was taken for all the cases. Then cases were subjected to colposcopy followed by biopsy. All the findings were correlated and analyzed. The findings of Pap smear and colposcopy were correlated with the gold standard of histopathology.Results: The sensitivity and specificity of Pap smear and colposcopy with respect to cervical biopsy were 53.1% and 98.7%, 87.87% and 72.72% respectively. Colposcopy had higher sensitivity and lower specificity than Pap smear for screening of cancer cervix.Conclusions: Cervical cancer is one of the preventable and highly curable conditions when diagnosed in the precancerous stage. The incidence of deaths resulting from cervical cancer can be brought down with adequate cervical cancer screening. Colposcopy and colposcopy directed biopsy should be done along with Pap smear in screening for early detection of cervical cancer since the accuracy of detection of cervical abnormalities is higher when these two methods are used complementarily.