National Cervical Screening Program renewal in Australia: survey of clinician views and attitudes

2020 ◽  
Vol 26 (5) ◽  
pp. 410
Author(s):  
Sally Sweeney ◽  
Yan Cheng ◽  
Jessica R. Botfield ◽  
Deborah Bateson
Keyword(s):  
Human Papillomavirus ◽  
Online Survey ◽  
Screening Program ◽  
New South ◽  
Cervical Screening ◽  
Missed Opportunities ◽  
Screening Guidelines ◽  
Health Checks ◽  
South Wales ◽  
Additional Education

From 1 December 2017, the National Cervical Screening Program was renewed in Australia, with updated national cervical screening guidelines released. This study was performed to determine clinicians’ familiarity with the updated guidelines and explore their views and attitudes towards the renewed program. Clinicians providing cervical screening in New South Wales, Australia, were invited to complete an online survey in 2018. Of the 241 clinicians who responded, 91.5% supported the change to 5-yearly human papillomavirus screening from the age of 25 years. However, nearly 13% indicated they did not know where to access the renewed guidelines and 37% had never or rarely accessed them. Open-ended responses highlighted clinicians’ concerns about missed cancers and missed opportunities for health checks. Those raising these concerns accessed the guidelines less frequently. The findings highlight important areas for additional education and support for clinicians in translating guidelines into practice to ensure successful delivery of the renewed program.

Levels of anxiety and distress following receipt of positive screening tests in Australia’s HPV-based cervical screening programme: a cross-sectional survey

2020 ◽  
Vol 96 (3) ◽  
pp. 166-172 ◽  
Author(s):  
Rachael Helen Dodd ◽  
Olivia Mac ◽  
Julia M L Brotherton ◽  
Erin Cvejic ◽  
Kirsten J McCaffery
Keyword(s):  
Online Survey ◽  
Screening Program ◽  
Cervical Screening ◽  
Screening Tests ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
General Distress ◽  
Hpv Test ◽  
Hpv Screening ◽  
Test Result

ObjectiveFrom December 2017, the Australian National Cervical Screening Program commenced 5 yearly primary human papillomavirus (HPV) screening; one of the first high-income countries to implement primary HPV screening. This study aimed to examine the psychosocial impact of self-reporting testing HPV positive in a sample of women screened since the renewal of the programme.MethodsWomen in Australia aged 25–74 years who reported participating in cervical screening since December 2017 were recruited through an online market research company to complete a cross-sectional survey. The primary outcomes were anxiety and general distress.Results1004 women completed the online survey; 80.9% reported testing HPV negative (HPV−), 6.5% reported testing HPV positive (HPV+) and 12.9% did not know/remember their test result. Women who reported testing HPV+ had significantly poorer psychological outcomes on a range of measures. Those who reported testing HPV+ had higher anxiety scores (53.03 vs 43.58 out of 80, p<0.001), showed more general distress (3.94 vs 2.52 out of 12, p=0.004), concern about their test result (5.02 vs 2.37, p<0.001), expressed greater distress about their test result (7.06 vs 4.74, p<0.001) and cancer worry (quite or very worried 35.4% vs 11.6%, p<0.001) than women who reported testing HPV−. Concern regarding test results was also significantly higher in women who did not know/remember their test result (3.20 vs 2.37, p<0.001) compared with women who reported testing HPV−. Women who reported testing HPV+ had greater knowledge of HPV (9.25 vs 6.62, p<0.001) and HPV testing (2.44 vs 1.30, p<0.001) than women who reported testing HPV−.ConclusionsReceipt of an HPV+ test result was associated with high levels of anxiety and distress, which reached clinical significance. Further work is needed to understand whether distress and concern could be reduced by ensuring all women receive high-quality standardised information with their results or by other interventions.

scholarly journals Drought, Wellbeing and Adaptive Capacity: Why Do Some People Stay Well?

2020 ◽  
Vol 17 (19) ◽  
pp. 7214
Author(s):  
Emma K. Austin ◽  
Tonelle Handley ◽  
Anthony S. Kiem ◽  
Jane L. Rich ◽  
David Perkins ◽  
...  
Keyword(s):  
Public Health ◽  
Adaptive Capacity ◽  
Online Survey ◽  
New South ◽  
Sociodemographic Factors ◽  
Strongly Correlated ◽  
Drought Condition ◽  
South Wales ◽  
Related Stress ◽  
The Relationship

Drought is a threat to public health. Individual and community adaptive capacity is crucial when responding to the impacts of drought. Gaps remain in the understandings of the relationship between wellbeing and adaptive capacity, and whether increased wellbeing can lead to improved adaptive capacity (or vice versa). This paper explores the relationship between drought, wellbeing and adaptive capacity to provide insights that will inform actions to enhance adaptive capacity, and hence increase opportunities for effective drought adaptation. The theory of salutogenesis and the associated sense of coherence (SOC) are used to measure adaptive capacity and to explain why some individuals remain well and adapt to adversity while others do not. An online survey of rural residents (n = 163) in drought-affected New South Wales (NSW), Australia, was conducted from November 2018 to January 2019. Linear regression was used to model the relationships between SOC, sociodemographic factors, drought and wellbeing. Findings demonstrate that SOC is strongly correlated with wellbeing. Drought condition did not influence adaptive capacity, although adaptive capacity and drought-related stress were only weakly correlated. Increased wellbeing was found to be associated with stronger adaptive capacity and therefore, an individuals’ capacity to cope with adversity, such as drought.

scholarly journals Human papillomavirus prevalence in women attending routine cervical screening in South Wales, UK: a cross-sectional study

2008 ◽  
Vol 99 (11) ◽  
pp. 1929-1933 ◽  
Author(s):  
S Hibbitts ◽  
J Jones ◽  
N Powell ◽  
N Dallimore ◽  
J McRea ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Cervical Screening ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
South Wales

High-grade cervical abnormalities and screening intervals in New South Wales, Australia

2008 ◽  
Vol 15 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Suzanne Schindeler ◽  
Stephen Morrell ◽  
Yeqin Zuo ◽  
Deborah Baker
Keyword(s):  
Cervical Cancer ◽  
New South ◽  
Cervical Screening ◽  
New South Wales ◽  
Pap Test ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Screening Interval ◽  
South Wales ◽  
Screening Intervals

Objectives This study aims to determine the association of two versus three year screening intervals with the likelihood of detection of a high-grade cervical abnormality and cervical cancer. Methods Data were obtained from the New South Wales (NSW) Papanicolaou (Pap) Test Register (PTR) and NSW Central Cancer Registry (CCR). Subjects were human papillomavirus (HPV) unvaccinated women aged 20-69 years who had a minimum of two Pap tests with a negative result at their first recorded Pap test (n = 1,213,295). Logistic regression was used to determine the association between screening interval and the likelihood of: (1) a cytological prediction of high-grade abnormality, defined as cervical intraepithelial neoplasia (CIN) 2 or greater; (2) a histologically confirmed high-grade abnormality; (3) a cytological prediction of cervical cancer and (4) a confirmed diagnosis of cervical cancer, controlling for potential confounders of age and socioeconomic status (SES) of area of residence. Results For each year increase in the screening interval, the odds of a histologically confirmed high-grade abnormality increased significantly in women aged 20-29 years (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.20-1.28) and in women aged 30-49 years (OR 1.11, 95% CI 1.06-1.16), but not in women aged 50-69 years (OR 1.08, 95% CI 0.89-1.32). Similar results were observed for cytologically detected high-grade abnormalities. The screening interval was significantly and positively associated with a cytological prediction of cervical cancer (OR 1.40, 95% CI 1.28-1.54) and a confirmed cervical cancer diagnosis (OR 1.66, 95% CI 1.33-2.07) in women aged 20-69 years. We estimate that if the screening interval were increased from two to three years, and the number of women participating in triennial screening participation was the same as for biennial participation in NSW, then 267 (95% CI 186-347) extra cases of high-grade abnormalities would be detected annually by cytology and 225 extra cases (95% CI 160-291) confirmed by histology, mostly confined to women aged 20-49 years. Equivalently, 2.3 (95% CI 1.8-2.8) and 1.9 (95% CI 1.5-2.4) extra cases of high-grade cytology and histology, respectively, would be expected per 1000 women with initially negative cytology if the screening interval were extended from two to three years. Conclusion Increasing the cervical screening interval from two to three years would be expected to significantly increase the odds of detection of a high-grade abnormality for NSW women aged 20-49 years and cervical cancer for NSW women aged 20-69 years. Accordingly, our study provides evidence in support of retaining the recommended cervical screening interval at two years for HPV unvaccinated, well women.

scholarly journals Validation of the cobas 6800 human papillomavirus test in primary cervical screening

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247291
Author(s):  
Karin Sundström ◽  
Helena Lamin ◽  
Joakim Dillner
Keyword(s):  
Human Papillomavirus ◽  
Screening Program ◽  
Cervical Screening ◽  
Relative Sensitivity ◽  
Test System ◽  
P Value ◽  
Histopathological Diagnosis ◽  
Hpv Test ◽  
Relative Specificity ◽  
Hpv Screening

Evaluation of Human Papillomavirus (HPV) testing systems suitable for large-scale organized cervical screening programs is required. We evaluated the cobas 6800 HPV test system for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) when nested in an organized primary HPV screening program, using the cobas 4800 test as comparator. The Karolinska University Hospital Cervical Cytology Biobank, containing frozen cervical samples from >700,000 women participating in organized cervical screening, was linked to the Swedish national cervical screening registry to identify 470 stored cervical samples taken <180 days before histopathological diagnosis of CIN3+. Two controls per case, with no abnormal results for 2 screening rounds, matched for age and sampling time were also retrieved. Aliquots from 1406 women were retrieved and re-tested on the cobas 4800 system and tested on the cobas 6800 system. There was high reproducibility between the original cobas 4800 HPV test results, and the cobas 4800 HPV re-testing performed on the samples retrieved from biobank storage. 462/464 biobanked samples from women with CIN3+ tested HPV-positive on the cobas 6800 system, corresponding to a relative sensitivity of 99.6%. 925/932 biobanked samples from control women tested HPV-negative on the cobas 6800 platform, corresponding to a relative specificity of 99.2%. By conventional criteria, the cobas 6800 was non-inferior both regarding relative sensitivity of >90% (non-inferiority p-value <0.0001) and relative specificity of >98% (non-inferiority p-value 0.006). We conclude that the cobas 6800 HPV test system had similar, high performance as the cobas 4800 such, when evaluated using cervical samples taken before CIN3+ in a real-life primary HPV screening program.

scholarly journals Organized primary human papillomavirus–based cervical screening: A randomized healthcare policy trial

PLoS Medicine ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. e1003748
Author(s):  
K. Miriam Elfström ◽  
Carina Eklund ◽  
Helena Lamin ◽  
Daniel Öhman ◽  
Maria Hortlund ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Detection Rate ◽  
Screening Program ◽  
Cervical Screening ◽  
Real Life ◽  
Intraepithelial Neoplasia ◽  
Population Based ◽  
Healthcare Policy ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Detection Rates

Background Clinical trials in the research setting have demonstrated that primary human papillomavirus (HPV)-based screening results in greater protection against cervical cancer compared with cytology, but evidence from real-life implementation was missing. To evaluate the effectiveness of HPV-based cervical screening within a real-life screening program, the organized, population-based cervical screening program in the capital region of Sweden offered either HPV- or cytology-based screening in a randomized manner through a randomized healthcare policy (RHP). Methods and findings A total of 395,725 women aged 30 to 64 years that were invited for their routine cervical screening visit were randomized without blinding to either cytology-based screening with HPV triage (n = 183,309) or HPV-based screening, with cytology triage (n = 212,416 women) between September 1, 2014 and September 30, 2016 and follow-up through June 30, 2017. The main outcome was non-inferior detection rate of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Secondary outcomes included superiority in CIN2+ detection, screening attendance, and referral to histology. In total, 120,240 had a cervical screening sample on record in the study period in the HPV arm and 99,340 in the cytology arm and were followed for the outcomes of interest. In per-protocol (PP) analyses, the detection rate of CIN2+ was 1.03% (95% confidence interval (CI) 0.98 to 1.10) in the HPV arm and 0.93% (0.87 to 0.99) in the cytology arm (p for non-inferiority <0.0001; odds ratio (OR) 1.11 (95% CI 1.02 to 1.22)). There were 46 cervical cancers detected in the HPV arm (0.04% (0.03 to 0.06)) and 48 cancers detected in the cytology arm (0.05% (0.04 to 0.07)) (p for non-inferiority <0.0001; OR 0.79 (0.53 to 1.18)). Intention-to-screen (ITS) analyses found few differences. In the HPV arm, there was a modestly increased attendance after new invitations (68.56% (68.31 to 68.80) vs. 67.71% (67.43 to 67.98); OR 1.02 (1.00 to 1.03)) and increased rate of referral with completed biopsy (3.89% (3.79 to 4.00) vs. 3.53% (3.42 to 3.65); OR 1.10 (1.05 to 1.15)). The main limitations of this analysis are that only the baseline results are presented, and there was an imbalance in invitations between the study arms. Conclusions In this study, we observed that a real-life RHP of primary HPV-based screening was acceptable and effective when evaluated against cytology-based screening, as indicated by comparable participation, referral, and detection rates. Trial registration ClinicalTrials.gov NCT01511328

scholarly journals Experience with high-risk human papillomavirus testing on vaginal brush-based self-samples of non-attendees of the cervical screening program

2011 ◽  
Vol 130 (5) ◽  
pp. 1128-1135 ◽  
Author(s):  
Murat Gök ◽  
Folkert J. van Kemenade ◽  
Daniëlle A.M. Heideman ◽  
Johannes Berkhof ◽  
Lawrence Rozendaal ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
High Risk ◽  
Screening Program ◽  
Cervical Screening ◽  
Human Papillomavirus Testing

Models of cervical screening in the era of human papillomavirus vaccination

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 359 ◽  
Author(s):  
Karen Canfell
Keyword(s):  
Human Papillomavirus ◽  
Screening Program ◽  
Cervical Screening ◽  
Age Groups ◽  
Simulation Modelling ◽  
Term Effect ◽  
Short Term ◽  
Human Papillomavirus Vaccination ◽  
Long Term Effect

Epidemiologic and economic evaluation using simulation modelling can support complex policy decisions, and is an important tool in predicting the future interaction between human papillomavirus vaccination and cervical screening. Several categories of screening program evaluation are of interest, including: (1) changes to screening considered over the short term, over which the effects of vaccination should be confined to the youngest age groups (<30 years old); (2) the medium and long-term effect of vaccination on the screening program; and (3) changes to screening in context of vaccination. This review considers some of the policy questions in each category and discusses the modelling implications, with particular focus on the Australian context.

scholarly journals Audit Of Laboratory Sensitivity Of Human Papillomavirus And Cytology Testing In A Cervical Screening Program

2021 ◽  
Author(s):  
Maria Hortlund ◽  
Laila Sara Arroyo Mühr ◽  
Camilla Lagheden ◽  
Anders Hjerpe ◽  
Joakim Dillner
Keyword(s):  
Human Papillomavirus ◽  
Screening Program ◽  
Cervical Screening
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