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3.
Viruses ; 13(3)2021 03 16.
Article in English | MEDLINE | ID: covidwho-1457709

ABSTRACT

BACKGROUND: Efficacy for cervical cancer prevention of opportunistic HPV vaccination in post-pubertal girls is lower than in 11-year-olds. METHODS: Women born between 1986 and 1992 vaccinated at 15-25 years of age (at least one dose of 4-valent HPV vaccine) and screened at 24-27 years of age were included. Frequency of opportunistic vaccination, overall and by birth cohort, was calculated; screening outcomes were compared between vaccinated and unvaccinated women. RESULTS: Overall, 4718 (4.9%) HPV-vaccinated, and 91,512 unvaccinated, women were studied. The frequency of vaccination increased by birth cohort, ranging between 1.8% and 9.8%; age at vaccination decreased progressively by birth cohort (p < 0.0001). Participation in screening was 60.8% among vaccinated, and 56.6% among unvaccinated, women (p < 0.0001). Detection rates (DR) for high-grade lesions were lower in vaccinated women (2.11‰ vs. 3.85‰ in unvaccinated, for CIN3+, p = 0.24; 0.0‰ vs. 0.22‰ for cancer). The DR of CIN3+ increased with age at vaccination, scoring respectively 0.0‰, 0.83‰, and 4.68‰ for women vaccinated when they were 15-16, 17-20, and 21-25 years old (p = 0.17). CONCLUSIONS: In comparison to unvaccinated women, higher compliance with cervical cancer screening invitation and lower CIN3+ DR among vaccinated women was observed. Age at vaccination was inversely correlated to vaccination efficacy.


Subject(s)
Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/administration & dosage , Uterine Cervical Neoplasms/prevention & control , Adolescent , Adult , Early Detection of Cancer , Female , Humans , Italy/epidemiology , Mass Screening , Retrospective Studies , Young Adult
4.
Curr Oncol ; 28(5): 3705-3716, 2021 09 24.
Article in English | MEDLINE | ID: covidwho-1438539

ABSTRACT

Despite a global and nationwide decrease, Native Americans continue to experience high rates of cancer morbidity and mortality. Vaccination is one approach to decrease cancer incidence such as the case of cervical cancer. However, the availability of vaccines does not guarantee uptake, as evident in the Coronavirus 2019 pandemic. Therefore, as we consider current and future cancer vaccines, there are certain considerations to be mindful of to increase uptake among Native Americans such as the incidence of disease, social determinants of health, vaccine hesitancy, and historical exclusion in clinical trials. This paper primarily focuses on human papillomavirus (HPV) and potential vaccines for Native Americans. However, we also aim to inform researchers on factors that influence Native American choices surrounding vaccination and interventions including cancer therapies. We begin by providing an overview of the historical distrust and trauma Native Americans experience, both past and present. In addition, we offer guidance and considerations when engaging with sovereign Tribal Nations in vaccine development and clinical trials in order to increase trust and encourage vaccine uptake.


Subject(s)
Cancer Vaccines , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , American Natives , Female , Humans , Papillomavirus Infections/prevention & control , Uterine Cervical Neoplasms/prevention & control
6.
Pan Afr Med J ; 39: 149, 2021.
Article in English | MEDLINE | ID: covidwho-1359430

ABSTRACT

Cervical cancer is the leading gynaecological malignancy in Zimbabwe, constituting 33% of all female cancers in 2016. Primary prevention through vaccination and secondary prevention through screening are important public health interventions to reduce the cervical cancer burden. Unfortunately, the ongoing COVID-19 pandemic has brought unprecedented challenges to healthcare delivery, posing threats to prevention efforts at a time when the public health sector is extremely fragile. The fragility of the sector has complicated treatment for cervical cancer before and during the COVID-19 pandemic, and is expected to worsen beyond the pandemic. A multi-sectoral intersection between public health experts, clinicians and communities is urgently required to restore preventive and treatment services for cervical cancer and reduce the increased burden, morbidity and mortality stemming indirectly from the pandemic.


Subject(s)
COVID-19 , Mass Screening/statistics & numerical data , Public Health , Uterine Cervical Neoplasms/prevention & control , Delivery of Health Care/organization & administration , Early Detection of Cancer/statistics & numerical data , Female , Humans , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/therapy , Zimbabwe
8.
Int J Environ Res Public Health ; 18(14)2021 07 06.
Article in English | MEDLINE | ID: covidwho-1323222

ABSTRACT

Cervical cancer screening (CCS) has been proven to reducing mortality of cervical cancer; yet migrant women show a lower participation in screening compared to non-migrants. This study explores the perspectives of healthcare workers and community workers on the factors influencing the CCS participation of migrant women living in Portugal. A qualitative study with online focus groups was conducted. Healthcare workers experienced in CCS and community workers working with migrant communities were purposively sampled. A semi-structured guide was used covering the participation of migrant women in CCS, barriers, and strategies to overcome them. Data were analyzed using content analysis. Participants considered that migrant women have low participation in CCS related to insufficient knowledge, low risk perception, and lack of interest on preventive care. Other barriers such as difficulties in accessing the healthcare services, relationship with healthcare workers, language, and cultural differences were highlighted. Promoting continuity of care, disseminating culturally tailored information, and use of self-sampling methods were suggested to improve participation in CCS. Inequalities in access to CCS among migrant women are mostly caused by information gaps and healthcare system-related barriers. Building a migrant-friendly healthcare system that creates opportunities for healthcare workers to establish relationships with their patients and delivering culturally and linguistically adapted information may contribute to overcoming those barriers and increasing the participation of migrant women in screening.


Subject(s)
Transients and Migrants , Uterine Cervical Neoplasms , Early Detection of Cancer , Female , Health Services Accessibility , Humans , Mass Screening , Portugal , Qualitative Research , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control
9.
Prev Med ; 151: 106606, 2021 10.
Article in English | MEDLINE | ID: covidwho-1294328

ABSTRACT

Screening is an important component of cancer control internationally. In Scotland, the National Health Service Scotland provides screening programmes for cervical, bowel and breast cancers. The COVID-19 pandemic resulted in the suspension of these programmes in March 2020. We describe the integrated approach to managing the impact of the pandemic on cancer screening programmes in Scotland throughout 2020. We outline the policy context and decision-making process leading to suspension, and the criteria and framework informing the subsequent, staggered, restart in subsequent months. The decision to suspend screening services in order to protect screening invitees and staff, and manage NHS capacity, was made after review of numbers of screening participants likely to be affected, and the potential number of delayed cancer diagnoses. Restart principles and a detailed route map plan were developed for each programme, seeking to ensure broad consistency of approach across the programmes and nationally. Early data indicates bowel, breast and cervical screening participation has increased since restart. Primary care has had to adapt to new infection prevention control measures for delivery of cervical screening. Cancer charities provided cancer intelligence and policy briefs to national bodies and Scottish Government, as well as supporting the public, patients and screening invitees through information and awareness campaigns. Emerging from the pandemic, there is recognition of the need and the opportunity to transform and renew both cancer and screening services in Scotland, and in particular to address long-standing workforce capacity problems through innovation and investment, and to continue to prioritise addressing health inequalities.


Subject(s)
COVID-19 , Uterine Cervical Neoplasms , Early Detection of Cancer , Female , Humans , Pandemics , SARS-CoV-2 , Scotland , State Medicine , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control
12.
J Natl Cancer Inst ; 113(6): 662-664, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1249307

ABSTRACT

These past months of the coronavirus disease-2019 (COVID-2019) pandemic have given us ample opportunity to reflect on the US health-care system. Despite overwhelming tragedy, it is an opportunity for us to learn and to change. As we postpone routine visits because of the pandemic, we worry about risks for patients who delay cancer screening. We use cervical cancer screening and prevention as an example of how we can use some "lessons learned" from the pandemic to prevent "collateral losses," such as an increase in cancers. COVID-2019-related health-system changes, like the more rapid evaluation of diagnostic tests and vaccines, the transition to compensated virtual care for most counseling and education visits, and broadened access to home services, offer potential benefits to the delivery of cervical cancer screening and prevention. While we detail the case for cervical cancer prevention, many of the issues discussed are generalizable to other preventative measures. It would be a tragedy if the morbidity and mortality of COVID-2019 are multiplied because of additional suffering caused by delayed or deferred cancer screening and diagnostic evaluation-but maybe with creativity and reflection, we can use this pandemic to improve care.


Subject(s)
COVID-19 , Early Detection of Cancer/methods , Uterine Cervical Neoplasms/prevention & control , Female , Humans , SARS-CoV-2
13.
Womens Health (Lond) ; 17: 17455065211017070, 2021.
Article in English | MEDLINE | ID: covidwho-1242233

ABSTRACT

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented upheaval within global healthcare systems and resulted in the temporary pausing of the National Health Service (NHS) Scotland Cervical Screening Programme. With several months of backlogs in appointments, there has not only been a reduction in primary samples being taken for human papilloma virus (HPV) testing but there have also been fewer women referred to colposcopy for investigation and treatment of precancerous or cancerous changes as a result. Encouraging uptake for cervical screening was always a priority before the pandemic, but it is even more important now, considering that the fears and barriers to screening that women may have are now exacerbated by COVID-19. OBJECTIVES: This article explores the impact of the pandemic on the uptake of cervical screening within NHS Ayrshire & Arran and evaluates potential strategies to improve uptake now and in future such as self-sampling and telemedicine. METHODS: This article presents evidence-based literature and local health board data relating to cervical screening during the pandemic. RESULTS: Human papilloma virus self-sampling carried out by the woman in her home has been shown to improve uptake, especially in non-attenders, whilst maintaining a high sensitivity and, crucially, reducing the need for face-to-face contact. Increased education is key to overcoming barriers women have to screening and telemedicine can strengthen engagement with women during this time. CONCLUSION: There are lessons to be learned from the pandemic, and we must use this opportunity to improve cervical screening uptake for the future.


Subject(s)
Early Detection of Cancer/methods , Mass Screening/methods , Mass Screening/statistics & numerical data , Papillomaviridae , Self Care , Uterine Cervical Neoplasms/prevention & control , Adult , Appointments and Schedules , COVID-19/epidemiology , Cervical Intraepithelial Neoplasia/prevention & control , Colposcopy , Female , Humans , Middle Aged , Papanicolaou Test , Scotland/epidemiology , Vaginal Smears
14.
Prev Med ; 151: 106623, 2021 10.
Article in English | MEDLINE | ID: covidwho-1240652

ABSTRACT

COVID-19 has disrupted cervical screening in several countries, due to a range of policy-, health-service and participant-related factors. Using three well-established models of cervical cancer natural history adapted to simulate screening across four countries, we compared the impact of a range of standardised screening disruption scenarios in four countries that vary in their cervical cancer prevention programs. All scenarios assumed a 6- or 12-month disruption followed by a rapid catch-up of missed screens. Cervical screening disruptions could increase cervical cancer cases by up to 5-6%. In all settings, more than 60% of the excess cancer burden due to disruptions are likely to have occurred in women aged less than 50 years in 2020, including settings where women in their 30s have previously been offered HPV vaccination. Approximately 15-30% of cancers predicted to result from disruptions could be prevented by maintaining colposcopy and precancer treatment services during any disruption period. Disruptions to primary screening had greater adverse effects in situations where women due to attend for screening in 2020 had cytology (vs. HPV) as their previous primary test. Rapid catch-up would dramatically increase demand for HPV tests in 2021, which it may not be feasible to meet because of competing demands on the testing machines and reagents due to COVID tests. These findings can inform future prioritisation strategies for catch-up that balance potential constraints on resourcing with clinical need.


Subject(s)
COVID-19 , Papillomavirus Infections , Uterine Cervical Neoplasms , Early Detection of Cancer , Female , Humans , Mass Screening , Papillomavirus Infections/diagnosis , Papillomavirus Infections/prevention & control , SARS-CoV-2 , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control
15.
JCO Glob Oncol ; 7: 416-424, 2021 03.
Article in English | MEDLINE | ID: covidwho-1239918

ABSTRACT

PURPOSE: The coronavirus-induced pandemic has put great pressure on health systems worldwide. Nonemergency health services, such as cancer screening, have been scaled down or withheld as a result of travel restrictions and resources being redirected to manage the pandemic. The present article discusses the challenges to cancer screening implementation in the pandemic environment, suggesting ways to optimize services for breast, cervical, and colorectal cancer screening. METHODS: The manuscript was drafted by a team of public health specialists with expertise in implementation and monitoring of cancer screening. A scoping review of literature revealed the lack of comprehensive guidance on continuation of cancer screening in the midst of waxing and waning of infection. The recommendations in the present article were based on the advisories issued by different health agencies and professional bodies and the authors' understanding of the best practices to maintain quality-assured cancer screening. RESULTS: A well-coordinated approach is required to ensure that essential health services such as cancer management are maintained and elective services are not threatened, especially because of resource constraints. In the context of cancer screening, a few changes in invitation strategies, screening and management protocols and program governance need to be considered to fit into the new normal situation. Restoring public trust in providing efficient and safe services should be one of the key mandates for screening program reorganization. This may be a good opportunity to introduce innovations (eg, telehealth) and consider de-implementing non-evidence-based practices. It is necessary to consider increased spending on primary health care and incorporating screening services in basic health package. CONCLUSION: The article provides guidance on reorganization of screening policies, governance, implementation, and program monitoring.


Subject(s)
COVID-19 , Mass Screening/organization & administration , Neoplasms/prevention & control , Breast Neoplasms/diagnosis , Breast Neoplasms/prevention & control , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/prevention & control , Delivery of Health Care , Early Detection of Cancer , Female , Health Policy , Humans , Mass Screening/methods , Neoplasms/diagnosis , Neoplasms/therapy , Pandemics , Practice Guidelines as Topic , Telemedicine , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control
17.
Vaccine ; 39(20): 2731-2735, 2021 05 12.
Article in English | MEDLINE | ID: covidwho-1193499

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has significantly affected utilization of preventative health care, including vaccines. We aimed to assess HPV vaccination rates during the pandemic, and conduct a simulation model-based analysis to estimate the impact of current coverage and future pandemic recovery scenarios on disease outcomes. The model population included females and males of all ages in the US. The model compares pre-COVID vaccine uptake to 3 reduced coverage scenarios with varying recovery speed. Vaccine coverage was obtained from Truven Marketscan™. Substantially reduced coverage between March-August 2020 was observed compared to 2018-2019. The model predicted that 130,853 to 213,926 additional cases of genital warts; 22,503 to 48,157 cases of CIN1; 48,682 to 110,192 cases of CIN2/3; and 2,882 to 6,487 cases of cervical cancer will occur over the next 100 years, compared to status quo. Providers should plan efforts to recover HPV vaccination and minimize potential long-term consequences.


Subject(s)
Alphapapillomavirus , COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , COVID-19 Vaccines , Female , Humans , Male , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , SARS-CoV-2 , United States/epidemiology , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/prevention & control , Vaccination , Vaccination Coverage
19.
Prev Med ; 144: 106399, 2021 03.
Article in English | MEDLINE | ID: covidwho-1139631

ABSTRACT

WHO/UNICEF estimates for HPV vaccination coverage from 2010 to 2019 are analyzed against the backdrop of the 90% coverage target for HPV vaccination by 2030 set in the recently approved global strategy for cervical cancer elimination as a public health problem. As of June 2020, 107 (55%) of the 194 WHO Member States have introduced HPV vaccination. The Americas and Europe are by far the WHO regions with the most introductions, 85% and 77% of their countries having already introduced respectively. A record number of introductions was observed in 2019, most of which in low- and middle- income countries (LMIC) where access has been limited. Programs had an average performance coverage of around 67% for the first dose and 53% for the final dose of HPV. LMICs performed on average better than high- income countries for the first dose, but worse for the last dose due to higher dropout. Only 5 (6%) countries achieved coverages with the final dose of more than 90%, 22 countries (21%) achieved coverages of 75% or higher while 35 (40%) had a final dose coverage of 50% or less. When expressed as world population coverage (i.e., weighted by population size), global coverage of the final HPV dose for 2019 is estimated at 15%. There is a long way to go to meet the 2030 elimination target of 90%. In the post-COVID era attention should be paid to maintain the pace of introductions, specially ensuring the most populous countries introduce, and further improving program performance globally.


Subject(s)
COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Uterine Cervical Neoplasms , Europe , Female , Humans , Immunization Programs , Papillomavirus Infections/prevention & control , SARS-CoV-2 , United Nations , Uterine Cervical Neoplasms/prevention & control , Vaccination , Vaccination Coverage , World Health Organization
20.
MMWR Morb Mortal Wkly Rep ; 70(4): 109-113, 2021 Jan 29.
Article in English | MEDLINE | ID: covidwho-1112895

ABSTRACT

On March 19, 2020, the governor of California issued a statewide stay-at-home order to contain the spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19).* The order reduced accessibility to and patient attendance at outpatient medical visits,† including preventive services such as cervical cancer screening. In-person clinic visits increased when California reopened essential businesses on June 12, 2020.§ Electronic medical records of approximately 1.5 million women served by Kaiser Permanente Southern California (KPSC), a large integrated health care system, were examined to assess cervical cancer screening rates before, during, and after the stay-at-home order. KPSC policy is to screen women aged 21-29 years every 3 years with cervical cytology alone (Papanicolaou [Pap] test); those aged 30-65 years were screened every 5 years with human papillomavirus (HPV) testing and cytology (cotesting) through July 15, 2020, and after July 15, 2020, with HPV testing alone, consistent with the latest recommendations from U.S. Preventive Services Task Force.¶ Compared with the 2019 baseline, cervical cancer screening rates decreased substantially during the stay-at-home order. Among women aged 21-29 years, cervical cytology screening rates per 100 person-months declined 78%. Among women aged 30-65 years, HPV test screening rates per 100 person-months decreased 82%. After the stay-at-home order was lifted, screening rates returned to near baseline, which might have been aided by aspects of KPSC's integrated, organized screening program (e.g., reminder systems and tracking persons lost to follow-up). As the pandemic continues, groups at higher risk for developing cervical cancers and precancers should be evaluated first. Ensuring that women receive preventive services, including cancer screening and appropriate follow-up in a safe and timely manner, remains important.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care, Integrated , Early Detection of Cancer/statistics & numerical data , Quarantine/legislation & jurisprudence , Uterine Cervical Neoplasms/prevention & control , Adult , Aged , COVID-19/epidemiology , California/epidemiology , Female , Humans , Middle Aged , Young Adult
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