The ESSAG-trial protocol: A randomized controlled trial evaluating the efficacy of offering a self-sampling kit by the GP to reach women underscreened in the routine cervical cancer screening program.

BACKGROUND: In Flanders (Belgium), women not screened for cervical cancer (CC) within the last three years receive an invitation letter from the regional screening organization, the Centre for Cancer Detection (CCD), encouraging them to have a cervical specimen taken by their general practitioner (GP) or gynecologist. However, the coverage for CC screening remains suboptimal (63%). The offer of a self-sampling kit (SSK, for HPV testing) by a GP may trigger participation among women who do not attend regular screening. METHODS: The ESSAG-trial is a cluster-randomized controlled trial with three arms, each including 1125 women aged 31-64 years, who were not screened for CC in the last 6 years. In arm A, GPs offer a SSK when eligible women consult for any reason. In arm B, women receive a personal GP signed invitation letter including an SSK at their home address. In the control arm, women receive the standard invitation letter from the CCD. The primary outcome is the response rate at three months after inclusion. Secondary outcomes are: screen test positivity; compliance with foreseen follow-up among screen-positives; costs per invited and per screened women; as well as contrasts between trial arms and between socio-demographic categories. CONCLUSION: The ESSAG-trial will assess the effect of GP-based interventions using SSKs on CC screening participation among hard-to-reach populations. Findings will inform policymakers about feasible strategies on increasing CC screening that may be rolled-out throughout the whole region. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05656976.

The edutainment program on knowledge, perception, and uptake of cervical cancer screening among Muslim women in Southern Thailand: a quasi experimental study.

INTRODUCTION: Cervical cancer is a significant global health concern and is the third most common cancer in women. Owing to their religious beliefs, Muslim women in Thailand are less likely to be screened for cervical cancer. OBJECTIVE: This study aimed to explore how a Health Belief Model (HBM) (HBM = Health Belief Model)-Based Edutainment Program affects the knowledge, perception, and uptake of cervical cancer screening among Muslim women in Thailand. METHODS: A quasi-experimental study was conducted in two rural districts of Southern Thailand with 83 Muslim women (intervention = 42, control = 41). The assessment was conducted through face-to-face interviews at baseline, post-intervention, and at 3-month follow-up. The intervention included four sessions involving video clips, folk songs, and short films. Data analysis was performed using repeated-measures ANOVA (ANOVA = Analysis of Variance) at a significance level of 0.05. RESULTS: There were significant differences in the mean score of knowledge and perception between the intervention and control groups post-intervention and at 3-month follow-up (p < 0.001). The mean scores of knowledge and perception in the intervention group significantly increased post-intervention and at 3-month follow-up (p < 0.001). The uptake of cervical cancer screening tests in the intervention group was approximately twice as high as that in the control group (90.47% vs. 51.21%). CONCLUSION: The findings revealed that the Edutainment Program could improve the knowledge, perception, and uptake of cervical cancer screening among Muslim women in Thailand. In future studies, the intervention suggests testing different population groups to improve access to primary care for everyone.

Knowledge, attitudes and practices toward cervical cancer screening among ethnic minorities in inner Mongolia, China.

AIMS: This study aimed to assess the knowledge, attitudes and practices (KAP) towards cervical cancer screening among ethnic minorities in Inner Mongolia, China. METHODS: A cross-sectional study was conducted in Inner Mongolia between May and September, 2023, and recruiting participants undergoing dual-cancer screening. Demographic characteristics and KAP status were assessed using a self-administered questionnaire. RESULTS: A total of 533 valid questionnaires were collected, with 53.66% aged 40 years or younger. Mean scores for knowledge, attitude, and practice were 13.58 ± 5.41, 41.06 ± 4.53, and 13.35 ± 1.53, respectively. Positive associations were found between knowledge and attitude (r = 0.348, p < 0.001), knowledge and practice (r = 0.288, p < 0.001), and attitude and practice (r = 0.817, p < 0.001). Structural equation modelling confirmed direct positive associations between knowledge and attitude (path coefficient = 0.307, p < 0.001) and attitude and practice (path coefficient = 0.270, p < 0.001). Additionally, knowledge demonstrated an indirectly positive association with practice (path coefficient = 0.083, p = 0.007). CONCLUSION: Ethnic minorities in Inner Mongolia exhibit insufficient knowledge, positive attitudes, and proactive practices toward cervical cancer screening. Implementing targeted educational initiatives is crucial to enhance their KAP.

Knowledge About Cervical Cancer and Awareness About Human Papillomavirus Vaccination Among Medical Students at the Northern Border University, Arar, Kingdom of Saudi Arabia.

Objectives To evaluate the knowledge and awareness about cervical cancer and human papillomavirus (HPV) vaccination among medical undergraduates at Northern Border University. Methods It was a cross-sectional study done on students selected conveniently from the College of Medicine, Northern Border University, Arar. The data were collected regarding knowledge about HPV infection and vaccine awareness using a validated questionnaire. Results A total of 200 students responded to the questionnaires, with 104 (52%) being male students and 120 (60%) being clinical years of MBBS. The mean knowledge score was 17.12 ± 2.73 out of 24, which was labeled as moderate knowledge about cervical cancer and HPV. Almost two-thirds of the students responded correctly to the etiology and risk factors of cervical cancer, while only half of the students knew the correct screening intervals for cervical cancer. The awareness of students about the HPV vaccine was deficient, and the mean score was estimated to be 4.20 ± 0.79 out of nine. Female students and students in clinical years showed significantly better understanding and awareness about cervical cancer and its vaccine and showed greater vaccine acceptability as compared to male students and students in preclinical years. Conclusion The present study shows moderate knowledge about cervical cancer but deficient awareness of medical students about the HPV vaccine. However, the students were willing to get educated about cervical cancer and its vaccine and showed a favorable opinion towards vaccinating the schoolgirls and educating their patients as future physicians. The information can be considered a benchmark on knowledge and awareness levels and can be utilized to modify medical curricula and develop efficient awareness programs.

Providers and women's perspectives on opportunities, challenges and recommendations to improve cervical cancer screening in women living with HIV at Mbarara Regional Referral Hospital: a qualitative study.

BACKGROUND: Cervical cancer screening uptake remains low despite being a critical prevention method for adult women living with HIV(WLHIV). These women experience greater incidence and persistence of high-risk human papillomavirus (HPV) and severe outcomes, including cervical cancer comorbidity and death. OBJECTIVE: We explored the opportunities, challenges, and recommendations of clinical care providers and WLHIV to improve cervical cancer screening uptake among WLHIV in Southwestern Uganda. METHODS: In a cross-sectional qualitative study from January to June 2021 at Mbarara Regional Referral Hospital, we interviewed six key informant clinical care providers and held four focus group discussions with women living with HIV. Data was coded using Atlas ti software and analysed using thematic inductive analysis. RESULTS: The participants identified several prevailing opportunities for cervical cancer screening, including skilled clinical care workers, public awareness for demand creation, optimized clinic flow, provider-led referrals, and peer-led information sharing that ease clinic navigation and shorten participant throughput. However, challenges occurred due to standalone services resulting in double queuing, longer clinic visit hours, missed chances for screening alongside unsupported lower health facilities leading to crowding at the referral hospital, and inadequate patient privacy measures leading to shame and stigma and the misconception that cervical cancer is incurable. Integrating HPV-DNA testing in HIV services was perceived with ambivalence; some participants worried about the quality of sample collection, while others valued the privacy it offered. Optimising self-collected DNA testing and sufficient counselling were recommended to improve cervical cancer screening uptake. CONCLUSION: Opportunities for cervical cancer screening included trained clinical care professionals, increased public awareness, improved clinic flow, provider referrals, and peer education. Challenges, such as unsupported lower-level health facilities, misconceptions, inadequate patient privacy, and uncertainty about integrating HPV-DNA screening into HIV services, were cited. Adequate counselling and self-sample collection were recommended to foster screening. Our findings may guide healthcare programs integrating cervical cancer screening into HIV clinics to reach the 70% World Health Organisation targets by 2030.

Uptake of cervical cancer screening and associated factors among HIV positive women attending adult art clinic at public hospitals in Addis Ababa, Ethiopia, 2022.

BACKGROUND: Cervical cancer is the second most common malignancy in Ethiopia and first in some African countries. It is six times more likely to occur in positive cases of the human immunodeficiency virus than in the general population. If diagnosed and treated early enough, cervical cancer is both treatable and preventable. However, among Ethiopian women who test positive for HIV, the uptake of cervical cancer screening is low. Its determinant factors were not well studied in the study area. Hence, this study was aimed at filling this information gap. OBJECTIVE: To assess uptake of cervical cancer screening services and associated factors among HIV-positive women attending an adult antiretroviral treatment clinic at public hospitals in Addis Ababa, Ethiopia, June 1-30, 2022. METHODS: A cross-sectional investigation was carried out in a hospital. 407 participants in all were chosen using the systematic sampling technique. A pretested interviewer-administered questionnaire was used to collect the data from respondents. The data were entered into Epi data version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analysis was employed. Adjusted odds ratio with its 95% confidence interval and p value < 0.05 were used to estimate the strength and significance of the association. RESULT: Among a total of 407 respondents, 238 (58.5%), 95% CI (53.5-63.3), HIV-positive women were screened at least once in the last five years. In multivariable analysis, age > 45 years old (AOR = 0.18, 95% CI: 0.053-0.644), number of children (3 children) (AOR = 0.19, 95% CI:0.036-0.979), perception of being susceptible to cervical cancer (AOR = 6.39, 95% CI: 1.79-22.74), knowledge of cervical cancer and its screening (AOR = 19.34, 95% CI: 7.87-47.75), and positive attitude towards cervical cancer screening (AOR = 8.06, 95% CI:3.62-17.91) were significantly associated factors with the uptake of cervical cancer screening. CONCLUSION AND RECOMMENDATION: in this study, Age > 45 years, having less than three children, feeling susceptible, knowing about cervical cancer and screening, and having a positive attitude toward cervical cancer screening were significant factor of uptake of cervical cancer screening service. There is a need to strengthen the policy and health education on safe sexual practices and healthy lifestyles through information dissemination and communication to scale up screening service utilization.

Stakeholder perceptions of cervical screening accessibility and attendance in Ireland: a qualitative study.

Organized cervical screening programmes are commonplace in high-income countries. To provide an equitable cervical screening service, it is important to understand who is and is not attending screening and why. Promotion of screening and service improvement is not possible without recognition and identification of the barriers and needs of communities that are less engaged with screening. This study explored stakeholder perceptions of cervical screening attendance and accessibility in Ireland. Semi-structured interviews were conducted with 12 healthcare professionals, policymakers and academics. Interviews were conducted online in 2022. Reflexive thematic analysis was used inductively to generate themes, supported by NVivo. Three themes were developed: (i) getting the right information out the right way, (ii) acceptability and accessibility of screening and (iii) trying to identify and reach the non-attenders. Participants felt public knowledge of cervical screening and human papilloma virus was low and communication strategies were not adequate. Individual, cultural, structural and service-level factors influenced the accessibility and acceptability of screening. Identifying and reaching non-attenders was considered challenging and community outreach could support those less likely to attend screening. Stakeholder perspectives were valuable in understanding the complexities of screening accessibility and attendance from individual to service-level factors. Cultural competency training, inclusive language and visual cues in waiting rooms would support engagement with some populations who may be hesitant to attend screening. Collaboration with community organizations has opportunities to promote screening and understand the needs of those less likely to attend screening.

Clinical evaluation of an artificial intelligence-assisted cytological system among screening strategies for a cervical cancer high-risk population.

BACKGROUND: Primary cervical cancer screening and treating precancerous lesions are effective ways to prevent cervical cancer. However, the coverage rates of human papillomavirus (HPV) vaccines and routine screening are low in most developing countries and even some developed countries. This study aimed to explore the benefit of an artificial intelligence-assisted cytology (AI) system in a screening program for a cervical cancer high-risk population in China. METHODS: A total of 1231 liquid-based cytology (LBC) slides from women who underwent colposcopy at the Chinese PLA General Hospital from 2018 to 2020 were collected. All women had received a histological diagnosis based on the results of colposcopy and biopsy. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), false-positive rate (FPR), false-negative rate (FNR), overall accuracy (OA), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and Youden index (YI) of the AI, LBC, HPV, LBC + HPV, AI + LBC, AI + HPV and HPV Seq LBC screening strategies at low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) thresholds were calculated to assess their effectiveness. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic values of the different screening strategies. RESULTS: The Se and Sp of the primary AI-alone strategy at the LSIL and HSIL thresholds were superior to those of the LBC + HPV cotesting strategy. Among the screening strategies, the YIs of the AI strategy at the LSIL + threshold and HSIL + threshold were the highest. At the HSIL + threshold, the AI strategy achieved the best result, with an AUC value of 0.621 (95% CI, 0.587-0.654), whereas HPV testing achieved the worst result, with an AUC value of 0.521 (95% CI, 0.484-0.559). Similarly, at the LSIL + threshold, the LBC-based strategy achieved the best result, with an AUC of 0.637 (95% CI, 0.606-0.668), whereas HPV testing achieved the worst result, with an AUC of 0.524 (95% CI, 0.491-0.557). Moreover, the AUCs of the AI and LBC strategies at this threshold were similar (0.631 and 0.637, respectively). CONCLUSIONS: These results confirmed that AI-only screening was the most authoritative method for diagnosing HSILs and LSILs, improving the accuracy of colposcopy diagnosis, and was more beneficial for patients than traditional LBC + HPV cotesting.

Findings and Challenges in Replacing Traditional Uterine Cervical Cancer Diagnosis with Molecular Tools in Private Gynecological Practice in Mexico.

We have been encouraging practicing gynecologists to adopt molecular diagnostics tests, PCR, and cancer biomarkers, as alternatives enabled by these platforms, to traditional Papanicolaou and colposcopy tests, respectively. An aliquot of liquid-based cytology was used for the molecular test [high-risk HPV types, (HR HPV)], another for the PAP test, and one more for p16/Ki67 dual-stain cytology. A total of 4499 laboratory samples were evaluated, and we found that 25.1% of low-grade samples and 47.9% of high-grade samples after PAP testing had a negative HR HPV-PCR result. In those cases, reported as Pap-negative, 22.1% had a positive HR HPV-PCR result. Dual staining with p16/Ki67 biomarkers in samples was positive for HR HPV, and 31.7% were also positive for these markers. Out of the PCR results that were positive for any of these HR HPV subtypes, n 68.3%, we did not find evidence for the presence of cancerous cells, highlighting the importance of performing dual staining with p16/Ki67 after PCR to avoid unnecessary colposcopies. The encountered challenges are a deep-rooted social reluctance in Mexico to abandon traditional Pap smears and the opinion of many specialists. Therefore, we still believe that colposcopy continues to be a preferred procedure over the dual-staining protocol.

Toward Interpretable Cell Image Representation and Abnormality Scoring for Cervical Cancer Screening Using Pap Smears.

Screening is critical for prevention and early detection of cervical cancer but it is time-consuming and laborious. Supervised deep convolutional neural networks have been developed to automate pap smear screening and the results are promising. However, the interest in using only normal samples to train deep neural networks has increased owing to the class imbalance problems and high-labeling costs that are both prevalent in healthcare. In this study, we introduce a method to learn explainable deep cervical cell representations for pap smear cytology images based on one-class classification using variational autoencoders. Findings demonstrate that a score can be calculated for cell abnormality without training models with abnormal samples, and we localize abnormality to interpret our results with a novel metric based on absolute difference in cross-entropy in agglomerative clustering. The best model that discriminates squamous cell carcinoma (SCC) from normals gives 0.908±0.003 area under operating characteristic curve (AUC) and one that discriminates high-grade epithelial lesion (HSIL) 0.920±0.002 AUC. Compared to other clustering methods, our method enhances the V-measure and yields higher homogeneity scores, which more effectively isolate different abnormality regions, aiding in the interpretation of our results. Evaluation using an external dataset shows that our model can discriminate abnormality without the need for additional training of deep models.

Building Capacity for Cervical Cancer Prevention in U.S.-Affiliated Pacific Islands: The Pacific Against Cervical Cancer Project.

The U.S.-affiliated Pacific Islands (USAPI) have higher cervical cancer incidence and mortality rates and lower screening coverage compared with the United States. This is likely because of economic, geographical, health care delivery, and cultural barriers for women living in these resource-constrained, isolated regions. The most recent U.S. and World Health Organization cervical cancer screening guidelines recommended primary human papillomavirus (HPV) testing as one screening option or the preferred screening modality. Primary HPV screening-based strategies offer several advantages over current screening methods in the USAPI. However, adoption of this newer screening modality has been slow in the United States and not yet incorporated into USAPI screening programs. The U.S. Centers for Disease Control and Prevention and partners initiated the Pacific Against Cervical Cancer (PACe) project in 2019 to evaluate the feasibility, acceptability, and cost-effectiveness of primary HPV testing-based strategies in Guam and in Yap, Federated States of Micronesia. This report provides an overview of the PACe project and outlines the approaches we took in implementing primary HPV testing as a new cervical cancer screening strategy (including the option of self-sampling in Yap), encompassing four core components: (1) community engagement and education, (2) medical and laboratory capacity building, (3) health information and system improvement, and (4) modeling and cost-effectiveness analysis. The PACe project provides examples of systematic implementation and resource appropriate technologies to the USAPI, with broader implications for never screened and under-screened populations in the United States and Pacific as they face similar barriers to accessing cervical cancer screening services.

Barriers and Facilitators to Breast and Cervical Cancer Screenings for Hispanic Women in a Rural State.

INTRODUCTION: The Centers for Disease Control and Prevention (CDC) and the Division of Cancer Prevention of Control administer the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), designed to increase early detection of cancers among low-income uninsured and underinsured women. However, rates of cancer diagnosis and survivorship differ among women of different ethnicities. We investigated two questions: 1) what are the potential barriers and facilitators for women to complete recommended breast and cervical cancer screenings, and 2) are the barriers and facilitators different for Hispanic women when compared to non-Hispanic White women? METHODS: We used a community-based participatory research approach and mixed methods: qualitative interviews with women enrolled in the program and a systematic process improvement approach to identify root causes of completing or not completing screenings. We conducted semi-structured interviews in English (n = 11) and Spanish (n = 9) and analyzed responses using fishbone diagrams. RESULTS: We recruited 20 participants in four categories: (a) non-Hispanic White women who completed screenings (n = 9), (b) non-Hispanic White women who did not complete screenings (n = 2), (c) Hispanic women who completed screenings (n = 7), and (d) Hispanic women who did not complete screenings (n = 2). Among all women, facilitators included assistance from program staff with appointments and reminders. Hispanic women reported barriers including language difficulties and confusion about the program. Non-Hispanic White women identified barriers as confusion about the role of insurance. CONCLUSIONS: We found that there are differences in barriers and facilitators for non-Hispanic White women and Hispanic women due to language, the role of insurance, and the level of trust in the program. Reasons for not completing screenings for Hispanic women were structural and systemic in nature; reasons for non-Hispanic White women were based on personal choices.

Association between multiple dimensions of access to care and cervical cancer screening among Kenyan women: a cross-sectional analysis of the Demographic Health Survey.

BACKGROUND: Cervical cancer remains the second most common cause of death in women and poses a growing public health challenge. It is urgent to increase cervical cancer screening rates in Kenya as per the 2018 Kenya National Cancer Screening Guidelines. Addressing access to care may serve as a target to achieve this goal; however, how individual dimensions of access to care are associated with the utilization of cervical cancer screening services in low- and middle-income countries, including Kenya, remains unclear. This study aimed to examine how different aspects of access to care (affordability, availability, geographical access, and social influence) were associated with cervical cancer screening among Kenyan women of reproductive age. METHODS: This cross-sectional study used data from the 2014 Kenya Demographic and Health Survey and the 2010 Kenya Service Provision Assessment. The final sample included 5,563 women aged 25-49 years. Logistic regression models were used to examine the association between different aspects of access to care and the uptake of cervical cancer screening. RESULTS: Factors such as being in the poorest wealth quintile, lacking health insurance, having difficulty obtaining funds for treatment (affordability), limited availability of screening services at nearby facilities (availability), living in rural areas (geographical access), and having healthcare decisions made solely by husbands/partners or others (social influence) were associated with a decreased likelihood of the uptake of cervical cancer screening. CONCLUSIONS: Increasing health insurance coverage, enhancing the availability of screening services at health facilities, expanding mobile screening health facilities in rural areas, and empowering women to make their own healthcare decisions are crucial steps for increasing cervical cancer screening uptake in Kenya.

Adherence and Correlates of Cervical Cancer Screening Among East African Immigrant Women in Washington State.

INTRODUCTION: Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI. METHODS: We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women. RESULTS: CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14-1.90, 1.38:95%CI:1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04-1.44, 1.46:95%CI:1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03-1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02-1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27-2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24-2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26-0.96, comparing < 18.5 kg/m2 vs 18.5-24.9 kg/m2). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio:2.44:95%CI:1.15-5.18). CONCLUSION: CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.

Cervical cancer screening and vaccination acceptability and attitudes among Arab American women in Southeastern Michigan: a qualitative study.

Among Arab-American women in Michigan, rates of cervical cancer screening are lower than those in non-Hispanic White and Black women in the state. A deep understanding of the Arab community's perspective on cervical cancer screening is needed to address the disparity in rates across populations in Michigan. Arab and Chaldean women across Michigan were invited to participate in Zoom-based focus groups to understand the attitudes, acceptability, and barriers of cervical cancer screening among this population. Four focus groups with a total of 19 women aged 30 to 61 were conducted. The focus groups were conducted in English, Arabic, or both languages. The guided discussion was focused on knowledge of cervical cancer and Human papillomavirus (HPV) and its transmission, attitudes towards HPV vaccination, and attitudes towards cervical cancer screening. HPV self-sampling as an alternative to traditional provider-based screening was specifically discussed as this has been proposed as a way to increase screening in hard-to-reach populations. The conversations revealed insights related to barriers at the individual and community levels for screening and vaccination, attitudes towards preventive health care including screening, a need for accessible women's health literature, and health education. The women also discussed vaccine hesitancy related to HPV and COVID-19, suggesting a need for targeted community interventions.

Evolution of Pathological Techniques for the Screening of Cervical Cancer: A Comprehensive Review.

The evolutionary journey of cervical cancer screening has been a major medical success story, considering the substantial role it has played in dwindling the disease burden. Through sustained collaborative efforts within the medical community, significant advances have been made from the humble yet path-breaking conventional Pap smear to the current automated screening systems and human papillomavirus (HPV) molecular testing. With the integration of artificial intelligence into screening techniques, we are currently at the precipice of circumventing the pitfalls of manual cytology readings and improving the efficiency of the screening systems by a significant margin. Despite the technological milestones traversed, the high logistics and operational cost, besides the technical know-how of operating the automated systems, can pose a major practical challenge in the widespread adoption of these advanced techniques in cervical cancer screening programs. This would suggest the need to adopt strategies that are tailored to the demands and needs of the different settings keeping their limitations in mind. This review aims to take the reader through the entire evolutionary journey of cervical cancer screening programs, highlight the individual merits and demerits of each technique, and discuss the recommendations from the major global guidelines.

Lower incidence of vaginal cancer after cervical human papillomavirus screening - long-term follow-up of Finnish randomized screening trial.

OBJECTIVE: Around 70% of vaginal cancers and 40-50% of vulvar cancers are attributable to human papillomavirus (HPV). Globally the burden of these diseases is estimated to grow due to the increasing HPV prevalence and rapidly aging global population. We aimed to examine if HPV screening for cervical cancer has an additional beneficial effect in preventing vaginal and vulvar cancers. To assess this, we used long-term follow-up data from the Finnish randomized HPV screening trial. METHODS: Between 2003 and 2008, over 236,000 women were individually randomized (1:1) to primary HPV or cytology screening in Southern Finland. We followed this cohort up to the year 2020. To compare the study arms, we calculated site-specific and pooled incidence rate ratios (IRRs) and mortality rate ratios (MRRs) for vaginal and vulvar cancers using Poisson regression. RESULTS: During 3,5 million person-years of follow-up, the IRR for vaginal cancer in the HPV arm compared to the cytology arm was 0.40 (95% CI 0.17-0.88) and the corresponding MRR was 0.74 (95% 0.21-2.24). The corresponding IRR for vulvar cancer was 0.73 (95% 0.50-1.08) and the MRR was 0.64 (95% 0.23-1.62). The pooled IRR was 0.67 (95% 0.47 ̶ 0.95) and MRR 0.67 (95% 0.31 ̶ 1.37). CONCLUSION: We found lower incidence of vaginal cancers with HPV screening compared to cytology screening. To validate our results, we recommend analyzing data on vaginal and vulvar cancers also from other HPV screening studies.

Sociodemographic characteristics associated with cervical cancer screening participation by send-to-all and opt-in HPV self-sampling: Who benefits? Results from a randomized controlled trial among long-term non-attending women in Norway.

With the objective to investigate associations between sociodemographic characteristics and participation in interventions designed to increase participation in cervical cancer screening among under-screened women, we randomized a random sample of 6000 women in Norway aged 35-69 years who had not attended cervical screening for ≥10 years to receive either (i) a reminder to attend regular screening (control), (ii) an offer to order a self-sampling kit (opt-in), or (iii) a self-sampling kit unsolicited (send-to-all). We analyzed how sociodemographic characteristics were associated with screening participation within and between screening arms. In the send-to-all arm, increased screening participation ranged from 17.1% (95% confidence interval [95% CI] = 10.3% to 23.8%) to 30.0% (95% CI = 21.5% to 38.6%) between sociodemographic groups. In the opt-in arm, we observed smaller, and at times, non-significant increases within the range 0.7% (95% CI = -5.8% to 7.3%) to 19.1% (95% CI = 11.6% to 26.7%). In send-to-all versus control comparisons, there was greater increase in participation for women in the workforce versus not (6.1%, 95% CI = 1.6% to 10.6%), with higher versus lower income (7.6%, 95% CI = 2.2% to 13.1%), and with university versus primary education (8.5%, 95% CI = 2.4% to 14.6%). In opt-in versus control comparisons, there was greater increase in participation for women in the workforce versus not (4.6%, 95% CI = 0.7% to 8.5%), with higher versus lower income (6.3%, 95% CI = 1.5% to 11.1%), but lower increase for Eastern European versus Norwegian background (-12.7%, 95% CI = -19.7% to -5.7%). Self-sampling increased cervical screening participation across all sociodemographic levels, but inequalities in participation should be considered when introducing self-sampling, especially with the goal to reach long-term non-attending women.

Cervical cancer screening practices in HIV positive females - a missing link in health care delivery in Pakistan.

Objectives: To probe cervical cancer screening practices in local women positive for human immunodeficiency virus, and to determine the cervical cytological changes in them. METHODS: The serial cross-sectional study was conducted at the Jinnah Hospital and Services Hospital, Lahore, Pakistan, from April 2019 to October 2020, and comprised female patients aged 18-45 years who were positive for human immunodeficiency virus or acquired immunodeficiency syndrome and were registered with the relevant programme being run by the provincial government in Punjab. Blood samples of all the patients were collected for the determination of human immunodeficiency virus viral load and cluster of differentiation 4+ count. Cervical smears were taken for cytopathological analysis, while the swabs were analysed for culture sensitivity. The same individuals were subjected to the same testing one year later, and the status of the disease and clinical stability or disease progression was explored. Data was analysed using SPSS 25. RESULTS: There were 150 women with mean age 32.08±7.13 years (range: 21-45 years). Age at marriage/sexual activity was 17.33±4.73 years in 15(10%) subjects. Cytological examination showed atypical squamous cells of undetermined significance in 6(4%) of the cases whereas 3(2%) cases showed atypical squamous cells, which cannot rule out high grade squamous intraepithelial lesion on cytology, while the rest were classified as negative for intraepithelial lesion or malignancy. Cervical microbial changes revealed methicillin-resistant staphylococcus aureus infection in 9(6%) cases, extended-spectrum beta-lactamase in 15(10%) cases, whereas fungal infection and trichomonas vaginalis infection were found in 30(20%) smears. There was a significant association between cluster of differentiation 4+ cell count and stability of high-risk patients (p<0.001). After one year, 84(56%) patients remained clinically stable, while 51(34%) developed some chronic illness. There was a significant association between cluster of differentiation 4+ cell count <200/mm3 and the risk of developing a chronic illness (p<0.001). CONCLUSIONS: There was a dire need to educate healthcare workers to offer regular cervical screening to patients with high-risk sexually-transmitted infections to prevent them from the morbidity and mortality related to cervical cancer.

Mobile health-delivered narrative intervention to increase cervical cancer screening among Malawian women living with HIV: A pilot randomized controlled trial.

Objective: This study aimed to develop and evaluate a mobile health (mHealth)-delivered, theory-guided, culturally tailored storytelling narrative (STN) intervention to increase cervical cancer screening among Malawian women living with human immunodeficiency virus (HIV). Methods: This study involved two phases: Phase 1: development of a theory-guided and culturally adapted STN intervention and Phase 2: a pilot randomized controlled trial was conducted. Participants were randomly assigned to one of three arms: Arm 1: tablet-based video (mHealth) with STN (n = 60); Arm 2: mHealth with a video of nonnarrative educational materials (n = 59); and Arm 3: control group with only reading nonnarrative educational materials in person (n = 60). Cervical cancer screening was measured using visual inspection with acetic acid (VIA) uptakes by self-report and health passport record review at 2 and 6 months after intervention. Results: Both arms 1 and 2 had nearly twice the rate of VIA uptakes than those in Arm 3 (51.0% and 50.0%, respectively, vs. 35.0%, P = 0.01) at 2 months follow-up, but there were no differences among groups from 2- to 6-month follow-ups. All groups demonstrated significant improvement of knowledge about risk factors, intention, and VIA uptakes. Conclusions: The findings demonstrate the preliminary effectiveness of the intervention on cervical cancer screening behavior and the feasibility of the study regarding recruitment, retention, treatment fidelity, and acceptability of the single 30-min session. The feasibility and the preliminary results of the effectiveness of the proposed study indicate scaling up the STN intervention to a larger population of women to increase cervical cancer screening uptake to prevent deaths due to cervical cancer in Malawi.