Uptake of Cervical Cancer Screening and Associated Factors Among Women Attending Outpatient Services in Rwamagana Hospital, Rwanda

BackgroundCervical cancer is a global public health threat for women. Rwanda Ministry of Health recommends screening as preventive strategy. However, the screening remains low in Rwanda.ObjectiveTo determine the uptake level of cervical cancer screening and associated factors among Rwandan women.MethodsA quantitative analytical cross-sectional study design was used. We recruited 178 participants using convenience sampling from an estimated 320 women who attended outpatient department in the previous month. The sample size was calculated using the Yamane’s formula. We used chi-square test, t-test and multiple logistic regression analysis to analyse data.ResultsA total of 178 (100%) participants completed the survey. Forty-one (23%) participants had undertaken cervical cancer screening. Knowledge (OR: 1.26,95% CI:1.069-1.485, p=.006) and income were predictors of cervical cancer screening uptake. Participants earning RWF ≥ 63,751 were more likely to uptake cervical cancer screening (OR:11.141, 95% CI:3.136-39.571, p< .001) compared to those earning less than RWF 25,500 monthly.ConclusionCervical cancer screening uptake among study population was low. Participants with more knowledge and high-income were more likely to uptake cervical cancer screening. Improving women’s knowledge and socioeconomic situation would improve the uptake of cervical cancer screening.Rwanda J Med Health Sci 2021;4(3):387-397

Knowledge of Breast Self-Examination, Breast and Cervical Cancer Screening among Indian Women

The burden of breast and cervical cancer in terms of incidence and mortality in low- and mid-income countries is increasing daily due to late diagnosis, unhealthy lifestyle choices, late presentation, and poor attitude to screening. Early detection increases the chances of survival. This present study assessed Assam women’s breast and cervical cancer screening (CCS) awareness, the practice of breast self-examination (BSE), and uptake of human papillomavirus vaccines. An internet-based cross-sectional questionnaire was utilized to obtain 251 consenting respondents. The mean age of respondents was 27.8 ± 6.91. Only 205 (81.7%) and 110 (43.8%) respondents have satisfactory levels of BCS, and CCS knowledge, respectively. While only 76 (30.3%) respondents had satisfactory BSE practice. Age range (26 – 32 years), tertiary education, and being single were demographic characteristics that influenced knowledge and practice. Though the respondents had a satisfactory knowledge level, screening uptake among respondents is very poor as only 32 (12.7 %) had ever been screened and only 19 (7.6 %) ever been vaccinated. The major reasons for poor screening uptake were “no symptoms” and “not aware of screening location”. Most respondents (227, 90.4 %) are willing to go for screening if well oriented. This presents an opportunity to enhance awareness about screening and vaccination among Assam women. The media/internet and health practitioners can be leveraged to promote the uptake and utilization of screening services and BSE practice. Doi: 10.28991/SciMedJ-2021-0304-5 Full Text: PDF

Does Direct-to-Consumer Personal Genetic Testing Improve Gynecological Cancer Screening Uptake among Never-Screened Attendees? A Randomized Controlled Study

The clinical impact of direct-to-consumer genetic testing (DTC-GT) on health behavior change has remained controversial. The aim of this study is to clarify the short-term effects of DTC-GT on gynecological cancer screening uptake among middle-aged never-screened Japanese women in a randomized controlled trial (RCT). A total of 144 women aged 45–50 who had never undergone gynecological cancer screening were randomly selected to receive health education (control group), or health education and DTC-GT (intervention group), at a 1:1 ratio. We compared the gynecological screening uptake during the follow-up period. Furthermore, to estimate the impact of learning of an elevated genetic cancer risk in the intervention group, we conducted an analysis dichotomized by genetic risk category. A total of 139 women completed the one-year follow-up survey (69 in the control group and 70 in the intervention group). The follow-up period did not differ between control and intervention groups (the median follow-up period was 276 days and 279 days, respectively, p = 0.746). There were 7 (9.7%) women in the control group and 10 (13.9%) in the intervention group who attended breast cancer screening (p = 0.606), and 9 (12.5%) women from both groups attended cervical cancer screening (p = 1.000). Likewise, there were no significant differences in cancer screening uptake in the analysis stratified by risk category within the intervention group. In conclusion, there was no significant effect of DTC-GT on gynecological cancer screening uptake in this RCT setting. Increasing cancer screening attendance may require a combination of well-established intervention strategies and DTC-GT. Clinical Trial Registration: UMIN-CTR Identifier, UMIN000031709.

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.

Perceived barriers and enablers to the provision of diabetic retinopathy screening for young adults: a cross-sectional survey of healthcare professionals working in the UK National Diabetic Eye Screening Programme

IntroductionDiabetic retinopathy screening (DRS) attendance in young adults is consistently below recommended levels. The aim of this study was to conduct a survey of screening providers in the UK Diabetic Eye Screening Programme (DESP) to identify perceived barriers and enablers to DRS attendance in young adults and elicit views on the effectiveness of strategies to improve screening uptake in this population.Research design and methodsMembers of the British Association of Retinal Screening (n=580) were invited to complete an anonymous online survey in July 2020 assessing agreement with 37 belief statements, informed by the Theoretical Domains Framework (TDF) of behavior change, describing potential barrier/enablers to delivering DRS for young adults and further survey items exploring effectiveness of strategies to improve uptake of DRS.ResultsIn total, 140 (24%) responses were received mostly from screener/graders (67.1%). There was a high level of agreement that the DESP had a role in improving attendance in young adults (96.4%) and that more could be done to improve attendance (90.0%). The most commonly reported barriers related to TDF domains Social influences and Environmental context and resources including lack of integration of DRS with other processes of diabetes care, which limited the ability to discuss diabetes self-management. Other barriers included access to screening services and difficulties with scheduling appointments. Less than half (46.4%) of respondents reported having a dedicated strategy to improve screening uptake in young adults. Strategies perceived to be effective included: screening within the community; prompts/reminders and integrating eye screening with other diabetes services.ConclusionsScreening providers were concerned about screening uptake in young adults, although many programs lacked a dedicated strategy to improve attendance. Problems associated with a lack of integration between DRS with other diabetes care processes were identified as a major barrier to providing holistic care to young adults and supporting diabetes self-management.

Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial

Background: Cervical cancer disproportionately affects women aged 65 years and older, especially those with inadequate previous screening. Speculum use is a key deterrent to screening attendance in older women. Aim: To assess whether offering non-speculum clinician-taken sampling and self-sampling increase uptake among lapsed attenders aged 50-64. Design and setting: Pragmatic randomised control trial conducted between August 2018 and November 2019 at 10 general practices in East London, UK. Method: Participants were 784 women aged 50-64 last screened 6-15years before randomisation. Intervention women received a letter offering the choice of a self-sampling kit or a clinician-taken non-speculum sample. Control women received usual care. Main outcome measure: uptake within 4 months. Results: Screening uptake 4 months after randomisation was significantly higher in the intervention arm: 20.4% (N=80/393) vs 4.9% (N=19/391, absolute difference=15.5%, 95%CI: 11.0%-20.0%, p<0.001). This was maintained at 12 months; 30.5% (N=120/393) vs 13.6% (N=53/391), respectively (absolute difference=17.0%, 95%CI: 11.3%-22.7%, p<0.001). Conventional screening attendance within 12 months was very similar for both arms (intervention: 12.7% (N=50/393) vs control: 13.6% (N=53/391)). Ethnic differences were observed in screening modality preference. More white women opted for self-sampling (50.7%, N=38/75) while most Asian and Black women opted for conventional screening. Conclusions: Offering non-speculum clinician-sampling and self-sampling substantially increases uptake in older women with lapsed screening attendance. Non-speculum clinician sampling appeals to women who dislike the speculum but prefer a clinician to take their sample and who lack confidence in self-sampling. Providing a choice of screening modality may be important for optimising cervical screening uptake.