Knowledge and Attitudes toward Colorectal Cancer among Healthcare Workers: A Pilot Cross-Sectional Survey in Thailand.

BACKGROUND: Colorectal cancer is an important public health problem in Thailand. The health workforce is one of the key strategies to reduce the burden of cancer. They are not only involved in patient care, but they can improve public knowledge of cancer within their community. This study aimed to explore the knowledge and attitudes toward colorectal cancer among Thai healthcare workers. METHODS: A cross-sectional pilot study was conducted from October 2021 to March 2022. Convenience sampling was used to recruit study participants who worked in selected primary healthcare units or hospitals located in different regions across the country. The data on demographics and health behavior, knowledge of using the Fecal Immunochemical Test (FIT), and knowledge and attitudes toward colorectal cancer were collected using self-administered questionnaires. Descriptive statistics were used for data analysis. RESULTS: A total of 300 healthcare workers were recruited in the study. The majority of participants presented a healthy lifestyle: 74% were in the healthy weight range, 68% had never consumed alcohol, and 99.3% were never smokers. More than 70% of participants provided correct answers to questions about the use of a FIT kit. The mean score for knowledge of colorectal cancer was 12.16 + 2.16 (out of 14) and 240 (80%) participants were considered to have adequate knowledge. Also, colorectal cancer knowledge was associated with age of participants (p<0.05). Most of the participants (76.2-92.3%) had positive attitudes toward colorectal cancer screening, however about half of them thought that a colonoscopy could be painful, uncomfortable, and embarrassing. CONCLUSIONS: Overall, the majority of participants had adequate knowledge of colorectal cancer and positive attitudes toward its screening. The present study provided overview information on practical guidance for undertaking a nationwide survey in the future.

Agreement between Self- and Physician­Sampling for Detection of High­Risk Human Papillomavirus Infections in Women Attending Cervical Screening at National Cancer Institute, Thailand.

BACKGROUND: We determined testing of self-sampling vagina swabs for Human Papilloma Virus (HPV) can be used to screen for cervical disease in outpatient clinics. METHODS: In this study, women attending cervical cancer screening clinic and gynecology clinic of the National Cancer Institute were invited to take a vaginal self-sampling and physician-collected cervical sampling. RESULTS: Of 268 participants, 20 (7.5%) were HPV-positive on the physician-collected samples. Among these screen-positive women, only two (0.7%) had HPV 18 and/or 45 and none had HPV 16 infections. For the self-collected samples, 4 participants had invalid HPV test results. Of the remaining 264 women with valid test results on self-collected samples, 29 (11.0 %) were HPV-positive, of whom, two (0.8%) were infected with HPV 16 and one (0.4%) with HPV 18 and/or 45 infections. The agreement between self-sampling and physician-sampling HPV test results (when two HPV results categories were considered) was 92. 8% with a moderate Kappa value of 0.57. CONCLUSION: Overall, self-sampling seems to be a reliable alternative to health-provider collection. However, instructions on proper procedures for sample collection to the women are important step before general roll out.

Acceptability and Preference for Human Papilloma Virus Self-Sampling among Thai Women Attending National Cancer Institute.

BACKGROUND: Cervical cancer screening is an important public health strategy to reduce cervical cancer incidence and mortality. Human papillomavirus (HPV) self-sampling is the alternative method that can potentially increase participation in cervical cancer screening. This study aimed to evaluate the acceptability of HPV self-sampling as a primary cervical cancer screening among Thai women. METHODS: A cross-sectional study was conducted at National Cancer Institute, Thailand, between March and September 2021. Eligible women were invited to collect their own samples with a vaginal cotton swab for cervical screening. The data on demographics, acceptability, and preference for HPV self-sampling were collected via a self-administered questionnaire. A Likert scale was used to assess the response of self-sampling acceptability. The multivariable logistic regression determined factors that influence preference for HPV self-sampling. RESULTS: A total of 265 participants were recruited. Over 70% agreed that self-sampling was easy, less embarrassing, and not painful. They also felt confident in their ability to self-sample correctly and would recommend this method to a friend or relative. For their next screening round, 66.4% preferred self-sampling whereas 33.6% preferred clinician-collected samples as routine screening. The factors that influence preference for self-sampling were age, marital status, feeling less embarrassed, and confidence in performing the tests. CONCLUSIONS: Most of the study participants accepted HPV self-sampling. This suggests that the self-sampling method will be an additional option to increase cervical cancer screening coverage which leads to improving the effectiveness of the national program.

National Cervical Cancer Screening in Thailand.

BACKGROUND: Cervical cancer is an important public health problem in Thailand. It was the most common cancer in Thai women with the incidence rate of 23.4 per 100,000 women in 1990. OBJECTIVE: The aim of this study was to share the experiences and summary the outcome of cervical cancer screening program in Thailand. METHODS: The Ministry of Public Health in cooperation with the National Health Security Office, launched the National Cervical Cancer Screening Program, covering 76 provinces nationwide under Universal Coverage Scheme in 2005. The screening method are Pap smear and Visual Inspection with Acetic acid (VIA) for women aged 30-60 and 35-45 respectively with a 5-year screening interval. Detecting cervical pre-cancerous lesions will follow by day care treatment such as cryotherapy, Loop Electrosurgical Excision Procedure, etc. Results: The first phase (2005-2009), was carried out on 3,124,855 women, the coverage reached 77.5%. For the second phase (2010-2014), 7,637,226 women were screened, reaching 53.9% coverage of target women. However, we have few data of follow up examination after abnormal screening. Therefore, we conducted new system to get more follow up data in 2019. Under the coordination of many related partners, 10,762,081 women have been screened during 2005-2014. The incidence rate declined to 11.7 per 100,000 women which is ranked as the third most common in women in 2014. CONCLUSION: This article briefly reviews the challenge of implementing an efficient cervical cancer screening in Thailand. In 2020, HPV testing has been introduced as a primary screening test for all Thai women attending public health sector instead of conventional Pap test.