Anxiety in women referred for colposcopy: a prospective observational study

Purpose To evaluate the occurrence of anxiety in women attending a colposcopic examination within the new cervical cancer screening in Germany. Methods One hundred and fifty-six patients were asked to fill out Spielbergers STAI inventory form prior to their colposcopic examination. For the statistical analysis, a two by two between-group design was applied including the following group factors: the repeat factors included patients, who presented to our centre of dysplasia for the first time (new) and patients who have had an examination in our centre before (repeat). Further, the factor diagnosis included two groups: first, patients with cervical dysplasia and second, patients with vulva diseases. Results The analysis of the STAI results showed that patients presenting with cervical dysplasia for the first time had the highest levels of anxiety, directly followed by new patients in the vulva group. The ANOVA revealed a main effect of the repeat factor, F(1,140) = 7.53, p = 0.007. There was no significant effect of diagnosis. Conclusion Regardless of the diagnosis, patients being transferred for a colposcopy within the cervical cancer screening program for the first time have very high anxiety levels. The prospect of a potentially painful examination seems to be a key factor. Only a scientific evaluation of the new cervical cancer screening will be able to show if the rising numbers of colposcopic examinations is really worth the risk of exposing so many more women to the emotional distress of a colposcopy.

Knowledge, Barriers, and Motivators to Cervical Cancer Screening in Rwanda: a Qualitative Study

Background: Cervical cancer is a global public health problem with marked geographical disparity. There are high morbidity and mortality rates in low- and middle-income countries (LMICs) associated with low screening rates. In 2020, in Rwanda, 3.7 million women aged 15–59 years were at risk of developing cervical cancer. It is the most commonly diagnosed female cancer in Rwanda with an incidence rate of 42 cases per 100,000 women per year. Despite Rwanda being the first African country to vaccinate against human papillomavirus (HPV) with a three-dose regimen, vaccination coverage of nearly 93 % in the target population of girls aged < 15 years, and having an established cervical cancer screening program, recent studies have found low screening rates. Our study sought to determine knowledge, motivators, and barriers to cervical cancer screening.Methods: This was a qualitative phenomenological study conducted in an urban health facility (Muhima district hospital) and a rural health center (Nyagasambu health center) offering cervical screening services in Rwanda. Focus group discussion (FGD) participants were women seeking these services and other women attending the health facility for any reason, as well as female staff working in these health centers. We also interviewed a key informant (KI) from the national organization. FGD and KI interviews were recorded and transcribed, and the data were analyzed using thematic analysis.Results: Thirty women were enrolled in the FGDs, with an average age of 39 years. Many FGD women showed knowledge about cervical cancer existence and prevention methods. However, fear for pain, lack of knowledge about screening, how and where the screening was done, and privacy concerns were recurring subthemes. Key-informant and some FGDs participants have also mentioned a lack of health insurance as a possible barrier for cervical cancer screening.Conclusions: Barriers to the utilization of cervical cancer screening program in Rwanda are related to poor information about cervical cancer and the importance of screening among women, as well non-adherence to medical insurance schemes. Population sensitization through campaign and community outreach activities could have a positive impact on increasing the uptake of cervical cancer screening in Rwanda.

Effect of a community-based intervention to increase participation in cervical cancer screening among Pakistani and Somali women in Norway

Background Norway implemented a regular cervical cancer screening program based on triennial screening in 1995, recommending participation of all women between 25 and 69 years of age. Somali and Pakistani women have the lowest participation in cervical cancer screening in Norway. This study evaluates the effect of a community-based intervention aimed at increasing participation in the screening program among women from these two groups. Methods The intervention consisted of an oral 20–25 min presentation in Urdu and Somali on cervical cancer and screening and practical information on how to make an appointment and payment for the test. The participants were invited to pose questions related to the topic after the presentation. This study was carried out in four geographical areas surrounding the capital Oslo between February and October 2017, among women aged 25–69 years from Pakistan and Somalia. We recruited women in the intervention group directly from different community institutions, households, and religious sites. Women from Pakistan and Somalia residing in Oslo were the controls. The absolute intervention effect was measured as difference in absolute proportion of women screened and estimated as the interaction between time and group allocation in a generalized estimation equation model with binomial distribution and identity link function. Results The percentage of women screened in the intervention group increased, from 46 to 51%. The corresponding increase in proportion in the control group was from 44 to 45.5%. After adjustment for potential confounders the intervention group showed a significant larger increase in participation in the screening program as compared to the control group with an absolute difference in change in proportion screened of 0.03 (95% CI; 0.02- 0.06). Conclusions Our findings suggest that theory-based, culturally and linguistically sensitive educational interventions can raise awareness and motivate immigrant women to participate in cervical cancer screening program. In addition, approaching health professionals as well as immigrant women, might improve participation even more. Trial registration NCT03155581. Retrospectively registered, on 16 May 2017.

Genetic and Epigenetic Variations of HPV52 in Cervical Precancer

The goal of this study was to identify human papillomavirus (HPV) type 52 genetic and epigenetic changes associated with high-grade cervical precancer and cancer. Patients were selected from the HPV Persistence and Progression (PaP) cohort, a cervical cancer screening program at Kaiser Permanente Northern California (KPNC). We performed a nested case-control study of 89 HPV52-positive women, including 50 cases with predominantly cervical intraepithelial neoplasia grade 3 (CIN3) and 39 controls without evidence of abnormalities. We conducted methylation analyses using Illumina sequencing and viral whole genome Sanger sequencing. Of the 24 CpG sites examined, increased methylation at CpG site 5615 in HPV52 L1 region was the most significantly associated with CIN3, with a difference in median methylation of 17.9% (odds ratio (OR) = 4.8, 95% confidence interval (CI) = 1.9–11.8) and an area under the curve of 0.73 (AUC; 95% CI = 0.62–0.83). Complete genomic sequencing of HPV52 isolates revealed associations between SNPs present in sublineage C2 and a higher risk of CIN3, with ORs ranging from 2.8 to 3.3. This study identified genetic and epigenetic HPV52 variants associated with high risk for cervical precancer, improving the potential for early diagnosis of cervical neoplasia caused by HPV52.

Distribution of HPV genotypes among women with abnormal cytology results in Alberta, Canada

Background: Persistent infection with a subset of human papillomavirus (HPV) genotypes can cause abnormal cytology and invasive cervical cancer. This study examines the circulating HPV genotype strains in a local population of the province of Alberta (a largely unvaccinated population) to establish baseline frequency of vaccine and non-vaccine genotypes causing abnormal cervical cytology. Method: Remnant liquid-based cytology specimens from the Alberta Cervical Cancer Screening Program (March 2014–January 2016) were examined. Only specimens from women who had a cytology grading of atypical squamous cells of undetermined significance or higher were included. HPV genotype was determined for all samples, and results were stratified by demographics and cytology results. Results: Forty-four unique HPV genotypes were identified from 4,794 samples. Of the 4,241 samples with a genotype identified, the most common genotypes were HPV 16, 18, 31, and 51, with 1,599 (37.7%), 441 (12.2%), 329 (7.8%), and 354 (8.4%), respectively. HPV9 vaccine genotypes made up 73.2% of these genotyped samples. Compared with specimens in which HPV9 vaccine genotypes were not detected, those with a genotype covered by the HPV9 vaccine were from younger women (33 y [interquartile range {IQR] 28 to 42] versus 40 y [IQR 32 to 51]; p < 0.00001). Conclusions: The baseline distribution of HPV genotypes in this largely unvaccinated population indicates that the HPV 9 vaccine provides good protection from high-risk HPV infections. Determining the frequency of genotypes causing abnormal cytology in this population post–vaccine implementation will be important to assess efficacy of vaccination and monitor for any potential genotype replacement.