Cervical pap smear study and its utility in cervical cancer detection and prevention

The objective of present study to find out women for precancerous lesions with the help of pap smear test as early identification marker. Determine the percentage of cervical cancer in relationship with demographic, education and occupation. To find out pap smear effectiveness in various infections. To find out correlation pap smear findings with symptoms.This is a cross-sectional study involving the screening of women from the rural population of Siddipet district for the assessment of health status using pap smear test who have attended the outpatient department of Obstetrics and Gynecology conducted during the period of August 2019 to May 2021. The present study included 1500 Pap smears, of which the most common abnormality was inflammatory smear, which is followed by atrophic smear. Among all the study respondent’s majority (64.5%) of the women were home makers and not working, remaining participants were either self employed or working women. Percentage of abnormal smear reports was reported in group 2 (31-40 years) subjects followed by group 3 (41-50 years) women. In 22 patients, Atypical Squamous Cell of Undetermined Significance (ASCUS) was observed. The present study reported very less cervical cancer prevalence in our study population.Pap smear testing is a sensitive and effective screening test which can be used for identification of precancerous epithelial lesions. Pap smear test should be recognized as a routine screening method to decrease Mortality and Morbidity due to the cervical cancer. This study also regard us as paps smear is a gold standard for cervical screening. This study also suggests that every woman above the age 30 years should undergo screening programs for cervical cancers. So Morbidity and Mortality due to cervical cancers can be prevented by early identification of cervical cancer by doing screening at regular intervals.

Determinants and levels of cervical Cancer screening uptake among women of reproductive age in South Africa: evidence from South Africa Demographic and health survey data, 2016

Background Cervical cancer (CC) is the cancer with the most incidents and the leading cause of cancer mortality among women in South Africa. CC screening is one of the most cost-effective control approaches for the disease burden. This study assessed the determinants and individual-level indicators of cervical cancer screening uptake among women of reproductive age in South Africa. Methods We analyzed data from the 2016 South Africa Demographic Health Survey. Our analysis focused on 5903 women (15–49 years). We conducted Chi-square test for bivariate analysis, and multivariate binary logistics regression was used to analyze independent association between individual-level factors and women who have had Pap smear testing. Statistical significance was set at p < 0.05. Results The mean age at cervical cancer screening uptake among women in South Africa was 40.8 years (SD 18.6, range 15–95 years). A majority of the women (39.3%) were aged 45 years and above and 54.6% of them resides in urban settlements. About 35.4% of women (n = 2098) have had a Pap smear test, with 66.5% of them who had a Pap smear test resides in Western Cape province. The proportion of women who had a Pap smear test was significantly higher among those with higher educational attainment (68.7%, p = 0.000), in the rich wealth index (50.1%, p = 0.000), and those with health insurance cover (60.3%, p = 0.000). Pap smear testing was found to be more prevalent among women aged 45+ years, were in the white population group, had higher education, were divorced, and had health insurance cover. The predominance of Pap smear test was 14% higher among women who are working in the professional/formal sector (AOR; 1.38, 95% CI; 1.14–1.69). The uptake of Pap smear test was also higher among women aged 35–44 years. Conclusions The prevalence of cervical cancer uptake is substantially low among women aged 15–24 years in South Africa and shows a degree of between-provinces differences. Therefore, heath educational interventions aimed at increasing the uptake of cervical cancer screening services in South Africa are critically needed.

Setting Up a Cytology Laboratory for Cervical Cancer Screening in a Developing Country: A One Year’s Early Experience at a Private Facility

IntroductionWidespread cytology-based method of screening such as Pap smear test has significantly led to a reduction in the incidence and mortality associated with cervical cancer in many developed countries. In these countries, facilities needed for early detection of cervical cancer such as cytology laboratories are existent and generally available to their population. In a developing countries like Somalia, access to cytology services for cervical cancer screening remains limited and as result majority of patients present with advanced stage disease (stage III & IV) that is too difficult to treat.InterventionTo address this challenge, the management of AL-Zahra Specialty Hospital contracted a cytologist based in Uganda to guide in setting-up of cytology laboratory in the heart of Mogadishu, Somalia so as to provide cervical cancer screening and diagnostics services to the population. Other interventions made by the visiting cytologist involved guiding the procurement officer in the purchase of basic equipment, reagents, consumables and training of health care staff. This resulted into conducting 1020 cervical cytological tests over a period of 12months (1st September, 2018 to 30th September 2019).Lesions learntIn order to increase access to cytology services, we learnt that the federal government of Somalia should consider making cervical cytology (pap smear test) as part of routine screening policy for all sexually active women as part of health care package. An increase in sample volume may be improved through awareness campaigns and conducting community screening activities. ConclusionSomalia, a developing country has made great strides towards addressing the limited facilities for cervical cancer screening by using very limited funding. We hope that our experiences shall provide technical guidance & direction to physicians, laboratory managers and investors who wish to establish similar cervical cytology laboratories in an economically constrained low-resource setting.

A study on the relationship of cervical cancer with vaginal microbiota and trichomoniasis infection; a single center study

Introduction: Cervical cancer is the most prevalent cancer associated with infection, which is provoked by the human papillomavirus (HPV). Natural vaginal microbes, known as vaginal microbiota, play an important role in regulating vaginal pH and are therefore important in the risk of cervical cancer. Trichomoniasis vaginalis is a genital infection that reports 250 million new infections worldwide each year and can increase the risk of developing cervical cancer in the general population. Objectives: The aim of this study was to investigate the relationship between cervical cancer and vaginal microbiota or trichomoniasis infection by examining several risk factors. Patients and Methods: This prospective case study was conducted from 2014 to 2018 from an educational pathology group in Isfahan, 200 samples are included in this study. The groups consist of women over 18 years old. The study group included patients with cervical cancer lesions. For participants, a questionnaire containing information about age, gender, abortion, age at first delivery, smoking or passive smoking and the result of Pap smear test (HPV, vaginal microbiota or Trichomonas) was completed. Results: Results suggested that cancerous and precancerous lesion development is not associated with parity, age at first child’s birth. However, it is statistically associated with lower vaginal microbiota, increased Trichomonas infection, old age, increased abortion rate, smoking, and the presence of HPV infection on Pap smear. Conclusion: Protection from harmful factors that affect a healthy vaginal microbiome, such as Trichomonas infections, can reduce the risk of cervical cancer.

The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women

Objective Cervical cancer is considered treatable as long as it is detected early and managed effectively. Pap smear test is a screening tool that plays an important role in the early detection, prevention and can prevent any early cervical cell changes from becoming cancer. This study aims to survey the effect of educational programs based on beliefs, subjective norms, and perceived behavior control on doing the pap-smear test in a sample of Iranian women. Materials and methods This experimental interventional study was performed on 300 women admitted to Fasa City, Fars Province, Iran health centers in 2018–2019. A questionnaire consisting of demographic information, knowledge, Health Belief Model, and Theory of Planned Behavior constructs were used to measure on doing of Pap smear test in women before and after 6 months’ educational intervention. Results The results revealed that 6 months after the intervention, 108 women (72%) in the experimental group and only 9 women (6%) in the control group received the Pap smear test. Conclusions The current research results revealed that education based on the combination of the health Belief model and theory of planned behavior might be promoting participation and an increasing rate of receiving Pap smear tests in women.

Exploring the barriers to Pap smear test in Iranian women: a qualitative study

Background Cervical cancer is one of the most frequent types of cancer in females. The Pap smear is one of the most essential ways of diagnosing and screening for this malignancy, and any failure can be caused by a number of causes. The current study sought to investigate barriers to Pap smear in Iranian women. Method This qualitative content analysis study was conducted in Iran in 2019. Data was gathered through focus groups and individual semi-structured interviews with 32 women and health professionals. The interviewees were chosen using a combination of purposive and theoretical sampling. The data was then analyzed using the content analysis approach developed by Graneheim and Lundman. Guba and Lincoln's criteria for establishing trustworthiness were explored. Results Data analysis resulted in the identification of four primary categories, seventeen subcategories, and 186 original concepts. The main categories include weakness of health system, difficult accessibility, low health literacy, and socio-cultural factors. Conclusion By informing women about the necessity and importance of Pap smear, providing the conditions, facilities, and equipment to facilitate the testing process, and paying more attention to cultural and social factors in cervical cancer and Pap smear planning, interventions, and policies, barriers to Pap testing can be eliminated.

Expectations about check-up examinations among Swiss residents: A nationwide population-based cross-sectional survey

Introduction General health check-up examinations in asymptomatic adults have not been shown to be beneficial. Instead, opportunistic prevention during regular primary care consultations is most cost-effective and recommended. The study aimed to elucidate the expectations about check-ups of the general Swiss population. Methods A nationwide cross-sectional telephone survey was conducted in a representative sample of the population, stratified by sex, age, and language in November 2019. Results Data of 1077 respondents were analysed. Mean age was 45 years (range 18 to 89), and 51% were female. Overall, 40% of respondents expected to have check-up examinations (yearly: 41.6%), and 42% expected opportunistic prevention. Most expected check-up interventions were sex-specific such as mammography (89% of women), Pap smear test (89% of women), and blood test of prostate-specific antigen (81% of men). The least favoured ones related to counselling (tobacco: 27%; alcohol abuse: 29%). Most significant predictors of positive check-up expectations were being male (OR = 1.45, CI: 1.02–2.05 P = 0.04)), age between 45 and 59 years old (OR = 2.03, CI: 1.27–3.23, P = 0.003 vs. 18 to 29 years), having a degree from professional (OR = 1.73, 95% CIs: 1.11–2.69, P 0.015) or, middle school (OR = 1.99, 95% CIs:1.04–3.78, P = 0.037) or university (OR = 1.66, 95% CIs: 1.06–2.61, P< 0.001, vs. secondary school) and the more importance attributed to regularly checking one’s health (OR = 2.12, 95% CIs: 1.70–2.36, P < 0.001) Conclusions Almost half of the population expected to have mostly yearly check-up examinations in addition to regular care, which is in contradiction to recommendations. This behaviour impacts the rational use of health care resources and must be considered by physicians and given the active role of patients in the health care system.

Effect of Theory-Based Educational Intervention and WhatsApp Follow Up on Pap Smear Uptake Among Post-Natal Women in Seremban, Negeri Sembilan, Malaysia: A Cluster Randomised Control Trial (Preprint)

BACKGROUND Despite the availability and accessibility of free Pap smear test as a screening tool for cervical cancer, the rate of Pap smear test uptake remains unchanged over the last 15 years in Malaysia. High coverage of Pap smear uptake is shown to improve mortality rate. Furthermore, factors that contributed to low Pap smear uptake in Malaysia were beyond individual factors and the use of mobile technology could help to improve Pap smear uptake. However, there is lack of intervention studies that go beyond the individual factors and evaluate the use of mobile technology particularly WhatsApp application. OBJECTIVE The study aims to determine the effect of theory-based educational intervention and WhatsApp follow up to improve Pap smear uptake among post-natal women in a district in Malaysia. METHODS This is a two-armed, parallel single-blind cluster randomized controlled study among post-natal women in Seremban District. Twelve health clinics were randomly allocated to be in the intervention and control groups with a ratio of 1:1. This two phase intervention module was developed using Social Cognitive Theory and was delivered via face-to-face in the first phase and WhatsApp follow up in the second phase. Participants were follow-up at immediate, 4 weeks-, 8 weeks- and 12 weeks post-intervention. Primary outcome was Pap smear uptake and secondary outcomes include scores of knowledge, attitude and self-efficacy for Pap smear screening and intention to adhere to Pap smear practice. The data was analysed using IBM Statistical Package for Social Science (SPSS) version 25 and generalized mixed model was used to determine the effectiveness the intervention. α value will be set at below 0.05. RESULTS A total of 401 post-natal women were recruited with total response rate of 82.5%. There was a significant difference between the intervention and control groups in the Pap smear uptake (F(4,1178) = 3.222, p = <0.001), knowledge scores (F(4, 1172) = 14.946, p = <0.001), attitude scores (F(4, 1172) = 24.417, p = <0.001) and self-efficacy scores (F(1, 1172) = 10.432, p = <0.001). However, no significant difference in the intention to adhere to Pap smear practice between the intervention and the control groups (F(4, 1180) = 0.878, p = 0.476). CONCLUSIONS This study shows that Social Cognitive Theory-based intervention and WhatsApp follow up is an effective intervention for improving the Pap smear uptake among post-natal women in Seremban District in Malaysia. This intervention module can be tested in other women’s population to evaluate the effect of this theory and WhatsApp follow up on the Pap smear uptake. CLINICALTRIAL Thaiclinicaltrials.org TCTR20200205001; https://www.thaiclinicaltrials.org/show/ TCTR20200205001

The Impact of Video-Based Educational Interventions on Cervical Cancer, Pap Smear and HPV Vaccines

Background: Video-based interventions have the potential to contribute to long-lasting improvements in health-seeking behaviours. Ghana's upsurge rate of information and communication technology usage presents an opportunity to improve the awareness of HPV vaccination and screening rates of cervical cancer among women in Ghana. This research aimed to assess the impact of video-based educational intervention centred on the Health Belief and Transtheoretical Models of behavioural changes in promoting HPV vaccination, cervical carcinoma awareness and willingness to have Pap smear test (PST) among women in Ghana.Methods: To achieve the intended sample size, convenient, purposive and stratified random sampling techniques were used. SPSS v. 23.0 was used in the data analysis. Percentages and frequencies were used to represent participants' demographic characteristics, knowledge of (1) cervical carcinoma, (2) human papillomavirus vaccine, and (3) Pap smear test. The chi-square test by McNemar was employed to evaluate variations in the post- and pre-intervention responses. A p-value &lt; 0.05 was considered statistically significant. The level of significance was adjusted owing to multiple comparisons by using the Bonferroni's correction.Results: Before the intervention, 84.2% of the participant had some knowledge or information about cervical cancer, but after the intervention, 100% of the participant became aware of cervical cancer which represents 15.8% increment at a P &lt; .001. The willingness to have a pap smear test increased from 35.8% to 94.2% (df = 58.4%, P &lt; .001) after the educational intervention. The willingness to be vaccinated increased from 47.5% to 81.7% (df = 34.2%, P &lt; .001) after the educational intervention. Six months after the intervention, participants were followed-up. 253 (42.2%) participants had gone for cervical cancer screening (Pap smear test) while 347 (57.8%) participants had not been screened. In terms of HPV vaccination, 192 participants (32.0%) had begun their HPV vaccination cycle.Conclusion: The study results show that health education, using videos, may be influential in perception changing, self-efficacy improvement and the understanding of cervical carcinoma screening and HPV vaccination.

Factors associated with the intention to undergo Pap smear testing in the rural areas of Indonesia: a health belief model

Purposes This study aimed to understand the influence of health beliefs, demographic factors, and health characteristics on the intention to undergo Pap smear testing among women in rural areas of Indonesia. Methods A descriptive cross-sectional study was conducted and 687 married women participated in the study. A convenience sampling was applied to recruit the participants from community health centres in a rural region in Indonesia. Self-reported data using the Health Beliefs Model Scale for Cervical Cancer and Pap Smear Test was collected to assess the health beliefs. Independent t-tests, simple logistic regressions, and a hierarchical logistic regression with 3 steps were run. Statistical significance for analysis was set at p < 0.05. Results The mean age of the participants was 42 years (SD = 8.4). Among the participants, 81% of the women had never undergone a Pap smear test, and 61% (n = 422) of the women reported a high intention of receiving a Pap smear test. Income and education Health beliefs regarding Pap smear testing were different between women who had low and high intentions to undergo Pap smear testing. Health beliefs, such as perceived benefits, severity, barriers to Pap smear testing, and health motivation for a Pap smear test were associated with the intention to undergo Pap smear testing among rural Indonesian women. Overall, the hierarchical multiple regression with 3 steps containing demographic, health characteristics, and health belief variables accounted for 31% variance of the intention to undergo Pap smear test among the Indonesian rural women. Conclusions Low screening rates of cervical cancer and high intentions to do the screening exist among rural Indonesian women. Health beliefs significantly affect the rural women’s intention of Pap smear testing in Indonesia.