Knowledge and attitudes towards cervical cancer prevention among women in Khartoum state, Sudan.

BACKGROUND: Cervical cancer is considered the third leading cause of death among women worldwide, and human papillomavirus was identified as a major causative agent for developing cervical cancer. OBJECTIVES: This study aimed to assess the knowledge and attitudes towards cervical cancer prevention among women in Khartoum state, Sudan. DESIGN: A community-based cross-sectional study implemented in Khartoum state, Sudan, from 1 August 2020 to 1 September 2020. METHODS: We conducted a descriptive cross-sectional community-based study using an electronic questionnaire for data collection. Descriptive statistics, frequency, mean, and percentage were computed. RESULTS: The study included 716 female participants with a mean age of 27.6 + 8.7 years. 580 (81.0%) and 229 (32.0%) had heard about cervical cancer and Pap test, respectively. cervical cancer was assumed related to alcohol consumption 109 (15.2%), giving birth to many children 51 (7.1%), ageing 118 (16.5%), and having many sexual partners 335 (46.8%). In addition, 300 (41.9%) attributed cervical cancer to having human papillomavirus infection, 256 (35.6%) to the prolonged use of contraceptives, and 162 (22.6%) to smoking. Knowledge about the best time to be vaccinated against human papillomavirus, 110 (15.4%) stated it is better after marriage. Regression models to predict the effectors on participants' knowledge and attitudes showed a low standard deviation of the estimates with higher values of the adjusted R2 [R: 0.041, 0.017, and 0.006; std: 1.527, 0.417, and 0.426]. This indicates the combined influence of occupation, educational level, family income, and marital status on the participant's knowledge and attitude levels. CONCLUSION: This study revealed that the participant's knowledge and attitudes levels are mainly driven by their occupation, educational level, family income, and marital status altogether. This underscores the need for a countrywide community engagement campaign through health education and raising awareness sessions, and massive social media to sensitize the community and healthcare providers about the risk of cervical cancer and the available prevention and control measures.

Pap smear recommendations in older women, does the data support stopping?

PURPOSE OF REVIEW: To review the recommendations for cervical cancer screening in older women and to determine the evidence upon which the current and emerging recommendations are based on. To evaluate the possible consequences of stopping cervical cancer screening in older women. RECENT FINDINGS: Recommendations are to space cervical cancer screening intervals for women aged 21-65 and stop in women older than 65. Cervical cancer incidence and mortality burden are significant in women over the age of 65. Human papillomavirus (HPV) vaccination rates are poor in older women. Advanced cervical cancer rates are increasing, including adenocarcinoma rates. Vulvar carcinoma rates are also increasing, and gynecological care and exams are less frequent when women are not getting routine pap testing. SUMMARY: The current review shows that there is limited evidence on which to base the recommendation to stop screening. There is confusion among patients and physicians, and other healthcare providers over who to screen and when, and this is exacerbating the already known difficulty accessing healthcare among racial and ethnic minorities, underinsured, and rural populations, but rates of cancer are also rising most rapidly in white women. Recommendations to space or stop screening are often based on the perceived psychological distress of women undergoing testing and the cost of population screening.

Psychosexual distress following routine primary human papillomavirus testing: a longitudinal evaluation within the English Cervical Screening Programme.

OBJECTIVE: To assess psychosexual distress over a 12-month period among women receiving different human papillomavirus (HPV) and cytology results in the context of the English HPV primary screening pilot. DESIGN: Longitudinal, between-group study. SETTING: Five sites in England where primary HPV testing was piloted. POPULATION: Women aged 24-65 years (n = 1133) who had taken part in the NHS Cervical Screening Programme. METHODS: Women were sent a postal questionnaire soon after receiving their screening results (baseline) and 6 and 12 months later. Data were analysed using linear regression models to compare psychosexual outcomes between groups receiving six possible combinations of HPV and cytology screening results, including a control group with normal cytology and no HPV test. MAIN OUTCOME MEASURES: Psychosexual distress, assessed using six items from the Psychosocial Effects of Abnormal Pap Smears Questionnaire (PEAPS-Q). RESULTS: At all time points, there was an association between screening result group and psychosexual distress (all P < 0.001). At baseline, mean psychosexual distress score (possible range: 1-5) was significantly higher among women with HPV and normal cytology (B = 1.15, 95% CI 0.96-1.34), HPV and abnormal cytology (B = 1.02, 95% CI: 0.78-1.27) and persistent HPV (B = 0.90, 95% CI 0.70-1.10) compared with the control group (all P < 0.001). At the 6 and 12 month follow ups the pattern of results were similar, but coefficients were smaller. CONCLUSIONS: Our findings suggest receiving an HPV-positive result can cause psychosexual distress, particularly in the short-term. Developing interventions to minimise the psychosexual burden of testing HPV-positive will be essential to avoid unnecessary harm to the millions of women taking part in cervical screening. TWEETABLE ABSTRACT: Receiving an HPV-positive result following primary HPV testing can cause psychosexual distress, particularly in the short-term.

Barriers to Cervical Cancer Screening Among Women Living With HIV in Low- and Middle-Income Countries: A Systematic Review.

Women living with HIV in low-and-middle-income countries (LMICs) are at high risk of developing cervical cancer due to their immunocompromised status. Screening is an imperative prevention measure for early detection and for ultimately reducing high rates of cervical cancer; however, cervical cancer screening uptake among this group remains low. This systematic review aimed to identify barriers to cervical cancer screening among women living with HIV in LMIC. A comprehensive literature search was undertaken, and an analysis of included studies was completed to abstract major themes related to cervical cancer screening barriers for women living with HIV in LMIC. Lack of cervical cancer and cervical cancer screening knowledge among patients was found to be the most prevalent barrier to cervical cancer screening. Our findings highlight a dire need for interventions to increase knowledge and awareness of cervical cancer screening among women living with HIV in LMIC, along with addressing barriers within health care systems.

The Korean guideline for cervical cancer screening.

The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D).

Perceptions of barriers and facilitators to cervical cancer screening among low-income, HIV-infected women from an integrated HIV clinic.

Significantly elevated rates of cervical cancer and low rates of Papanicolaou (Pap) smear screening have been documented among HIV-infected women. However, little is known about women's perceptions of cervical cancer screening utilization. Hence, this study describes barriers and facilitators related to cervical cancer screening in a sample of HIV-infected women seeking care at an integrated HIV clinic in Houston, Texas. Using an inductive qualitative methodological approach, data were obtained from five focus group discussions with a total of 33, HIV-infected women. The majority of the study sample consisted of women who self-identified as Black (69.7%), and reported heterosexual contact as the mode of HIV acquisition (75.8%). Barriers to cervical cancer screening were described as pain and discomfort associated with receiving Pap smears and subsequent procedures; lack of awareness of cervical cancer as a preventable disease; limited transportation access; and systemic issues as it relates to scheduling gynecological appointments. Facilitators were described as awareness of HIV-infected women's increased risk of cervical cancer and strong provider-patient relationships. To address disparities in cervical cancer screening among low-income HIV-infected women, programs should capitalize on the identified facilitators and alleviate modifiable barriers using multilevel strategies.

Benefits and harms of cervical screening from age 20 years compared with screening from age 25 years.

BACKGROUND: To quantify the benefits (cancer prevention and down-staging) and harms (recall and excess treatment) of cervical screening starting from age 20 years rather than from age 25 years. METHODS: We use routine screening and cancer incidence statistics from Wales (for screening from age 20 years) and England (screening from 25 years), and unpublished data from the National Audit of Invasive Cervical Cancer to estimate the number of: screening tests, women with abnormal results, referrals to colposcopy, women treated, and diagnoses of micro-invasive (stage 1A) and frank-invasive (stage IB+) cervical cancers (under three different scenarios) in women invited for screening from age 20 years and from 25 years. RESULTS: Inviting 100,000 women from age 20 years yields an additional: 119,000 screens, 20,000 non-negative results, 8000 colposcopy referrals, and an extra 3000 women treated when compared with inviting from age 25 years. Screening from age 20 years prevents between three and nine frank invasive cancers and between 0 and 23 cancers in total (depending on the scenario). A cumulative increase of nine stage IB+ cancers corresponds to an annual rate increase of 0.9 per 100,000 women aged 20-29 years. CONCLUSIONS: To prevent one frank invasive cancer, one would need to do between 12,500 and 40,000 additional screening tests in the age group 20-24 years and treat between 300 and 900 women.

The role of gel application in decreasing pain during speculum examination and its effects on papanicolaou smear results.

PURPOSE: This study aimed to investigate the effects of water-based gel application in reducing pain or discomfort associated with speculum examination, and compared the presence of unsatisfactory Papanicolaou smear results between gel-applied and control groups. METHODS: In this prospective randomized controlled study, a total of 1,580 patients were analyzed. The subjects were randomized to a gel group and a control group. For the collection of the smear sample, water-based gel was used in the gel group and dry speculum was used in the control group. All patients were asked to score their pain on a numeric pain scale at two time points during the procedure (insertion and opening phase of speculum). Cytopathologists who analyzed the smear cytology were blinded to the study. Pain intensity during speculum examination, as well as unsatisfactory smear results, were analyzed between the groups. RESULTS: The pain scores obtained at two different time points of speculum application were significantly lower in the gel group compared to the control group both in premenopausal and postmenopausal women (p < 0.001). The ratios of unsatisfactory cytopathologic examination results were 1.13 and 1.39% for the gel-applied and control groups, which were not significantly different. CONCLUSION: Lubrication of the outer superior and inferior blade of the plastic vaginal speculum with a small amount of a water-soluble lubricant gel decreases the pain associated with insertion and opening of the vaginal speculum in both premenopausal and postmenopausal women without affecting the quality of the cytology results during the collection of Papanicolaou test specimens.

Cervical cancer screening in pregnancy.

Cervical cancer is the most commonly diagnosed malignancy during pregnancy with an incidence of 1.5 to 12 per 100,000 pregnancies. In the United States between 2% and 7% of all pregnant women will have an abnormal Pap test. The management of these abnormal results during pregnancy can present a challenge to the practitioner. This article reviews recently published guidelines and current evidence for evaluation and management of abnormal cervical cytology and cervical cancer in pregnancy.

Optimal sampling devices for liquid-based procedure in screening for cervical cancer: comparison between cotton stick/Cytobrush and Cervex-Brush.

OBJECTIVE: To find an appropriate sampling device for a liquid-based procedure in the population screening for cervical cancer, focusing on bleeding at sampling and the amount of cells smeared. METHODS AND MATERIALS: 1,000 consecutive women who underwent primary screening were studied. The specimens were obtained with the cotton stick/Cytobrush® method in the first 500 cases or with the Cervex-Brush® in the following 500 subjects, and were processed using the Thinlayer Advanced Cytology Assay System (TACAS™) following the manufacturer's instructions. RESULTS: (1) Bleeding at cellular sampling using the cotton stick/Cytobrush and Cervex-Brush methods occurred in 1.2 and 8.8% of the cases, respectively (p < 0.0001). (2) The incidences of cells obtained with the two methods which covered the whole area, <1/2 and ≥1/4, and <1/4 of the observation fields were 55.4 versus 62.2% (p < 0.05), 14.6 versus 9.4% (p < 0.05), and 2.0 versus 4.0% (p < 0.05), respectively. (3) The incidences of endocervical or metaplastic cells obtained with ≥500 and <10 were 34.6 versus 20.0% (p < 0.01) and 9.4 versus 18.4% (p < 0.01), respectively. In cases of cells covering <1/4, incidences with <10 were 0 and 0.6% (n = 3), respectively. (4) Detection rates of abnormal cytology were 3.4 and 5.2% (n.s.), including atypical squamous cells of undetermined significance in 2.4 and 3.2%. CONCLUSIONS: The cotton stick/Cytobrush is superior to the Cervex-Brush as a cellular sampling device for the TACAS liquid-based procedure.

Association of speculum lubrication with pain and Papanicolaou test accuracy.

PURPOSE: To determine the effects of lubrication of the vaginal speculum before insertion during a Papanicolaou test on perceived pain and quality of the cytology specimen. METHODS: Four hundred eligible women participating in cervical cancer screening and an early detection program were randomized with respect to lubricant gel use before speculum insertion. Perceived pain during speculum insertion and cytology results were assessed in study groups. RESULTS: The mean age of the patients was 45.7 years (range, 23-77 years). Pain score of the NO GEL group was significantly higher than that of the GEL group (2.3 and 1.6, respectively; P < .05). For premenopausal women, lubricant gel use significantly reduced the pain scores of the participants (P < .05). Cytological interpretations of the Papanicolaou test specimens were comparable among all groups. CONCLUSIONS: During the collection of Papanicolaou test specimens, lubrication of the vaginal speculum with a small amount of K-Y Jelly (a water-soluble lubricant gel) decreases the pain associated with insertion of the vaginal speculum among postmenopausal women without obscuring the cytological interpretation of conventional or liquid-based cytology. In women of reproductive age, lubrication of the speculum with K-Y Jelly does not cause a meaningful effect with respect to perceived pain.

Resultados citopatológicos de mulheres que realizaram exame do colo do útero em um laboratório escola da Universidade Federal de Goiás, Goiânia-GO: estudo de prevalência / Cytopathological results from women that realized the examination of cervix in a laboratory-school from Federal University of Goiás, Goiânia-GO: prevalence study

Objetivo - Avaliar a prevalência de câncer de colo do útero e infecções genitais em mulheres atendidas no serviço de saúde pública de Goiânia-GO. O exame de Papanicolaou é o método utilizado para detecção das lesões intraepiteliais e neoplásicas da cérvice uterina, tendo importante papel na prevenção do câncer do colo do útero e no diagnóstico das infecções genitais. Métodos - Estudo retrospectivo dos laudos dos exames citopatológicos das mulheres atendidas nas Unidades de Atenção Básica em Saúde (UABS) de Goiânia-GO, entre 03/2006 a 05/2008. Os esfregaços citológicos foram analisados no Centro de Análises Clínicas Rômulo Rocha da Faculdade de Farmácia da Universidade Federal de Goiás (CACRR/FF/UFG). Resultados - Um total de 15.615 mulheres foi incluído no estudo. A mediana de idade foi de 33 anos (14-93 anos), a maioria (57,6%) tinha entre 20 e 39 anos e 6,6% (n=1.034) eram < 20 anos de idade. Mais de 50% dos casos de infecção entre adultas e adolescentes eram causados por Gardnerella vaginalis e 13,6% por Trichomonas vaginalis. Entre mulheres mais jovens (20-39 anos),16,9% das infecções foi causada por Candida sp. Aproximadamente 7,6% dos esfregaços avaliados apresentaram alterações celulares, sendo 4,9% células escamosas atípicas de significado indeterminado/lesão intraepitelial escamosa de baixo grau (ASC-US/LSIL) para as mulheres entre 20-29 anos e 2,6% células escamosas atípicas com possível lesão de alto grau/lesão intraepitelial escamosa de alto grau e células glandulares atípicas (ASC-H/+) para mulheres entre 20 e 49 anos. Conclusão - Lesões graves em mulheres jovens chamam atenção para a necessidade de políticas de saúde pública que reforcem a importância do Papanicolaou para a prevenção do colo de útero.

Objective - To correlate the prevalence of cervical cancer and genital infections with the age of women treated at public health service of Goiânia-GO. Papanicolaou test is the method used for detection of intraepithelial and neoplastic lesions in the uterine cervix, playing an important role in cervical cancer prevention and helping in female genital infections'diagnosis. Methods - Women's cytopathological tests were analyzed at Health Care Units from Goiânia-GO, between 03/2006 and 05/2008. Smears were analyzed at Clinical Analysis Laboratory Rômulo Rocha, at Pharmacy Faculty of the Federal University of Goiás. Results - The total of 15.615 women were included in this study. The median age was 33 years (14-93 years), 57.6% were between 20 and 39 years of age and 6.6% were adolescents <20 years of age. More than 50% of cases of infection among adults and adolescents were caused by Gardnerella vaginalis, followed by 13.6% by Trichomonas vaginalis and to 16.9% by Candida sp. Approximately, 7.6% of smears evaluated showed cellular alterations, and 4.9% atypical squamous cells of undetermined significance/squamous intraepithelial lesion of low grade (ASC-US/LSIL) for women aged 20-29 years and 2.6% atypical squamous cells can damage high-grade/squamous intraepithelial lesion high-grade and atypical glandular cells (ASC-H/+) for women aged 20-49 years. Conclusion - Serious injuries in young women draw attention to the need for public health policies that reinforce the importance of the Papanicolaou test for cervical cancer prevention.

Effect of liquid-based gel application during speculum examination on satisfactory level of smear examination.

PURPOSE: The aim was to evaluate the use of liquid-based gel during cytologic follow-up and the effect of liquid-based gel application during speculum examination on satisfactory level of smear. METHODS: A total of 1,999 patients were taken into the study. Patients were divided into two groups as gel-applied group and control group. Age and menopausal status of patients, and the physicians taking the smear (resident or specialist) were recorded. In control group, dry speculum was used for the collection of smear sample. All specimens were evaluated for correlation of the cytopathology, the number of "unsatisfactory" samples, and any secondary diagnoses. RESULTS: Assessment of smear satisfactoriness revealed that 2.2% (43) of them were unsatisfactory. Unsatisfactory smear ratio was significantly high in gel-applied group. Screening done by residents increased unsatisfactory result risk for about 5.5 times. Evaluation of effect of menopausal status on smear adequency revealed no difference between premenopausal and postmenopausal women. CONCLUSION: Cervical smear seems to be more accurate without gel application. Experience of the physician is also important. Water-based gel can be used in some women who experience overt pain during speculum examination, but these patients must be warned about unsatisfactory results and the need of repeat test.

After-effects reported by women having follow-up cervical cytology tests in primary care: a cohort study within the TOMBOLA trial.

BACKGROUND: Although it is recognised that some women experience pain or bleeding during a cervical cytology test, few studies have quantified physical after-effects of these tests. AIM: To investigate the frequency, severity, and duration of after-effects in women undergoing follow-up cervical cytology tests, and to identify subgroups with higher frequencies in Grampian, Tayside, and Nottingham. DESIGN: Cohort study nested with a multi-centre individually randomised controlled trial. METHOD: The cohort included 1120 women, aged 20-59 years, with low-grade abnormal cervical cytology who completed a baseline sociodemographic questionnaire and had a follow-up cervical cytology test in primary care 6 months later. Six weeks after this test, women completed a postal questionnaire on pain, bleeding, and discharge experienced after the test, including duration and severity. The adjusted prevalence of each after-effect was computed using logistic regression. RESULTS: A total of 884 women (79%) completed the after-effects questionnaire; 30% of women experienced one or more after-effect: 15% reported pain, 16% bleeding, and 7% discharge. The duration of discharge was ≤2 days for 66%, 3-6 days for 22%, and ≥7 days for 11% of women. Pain or bleeding lasted ≤2 days in more than 80% of women. Severe after-effects were reported by <1% of women. The prevalence of pain decreased with increasing age. Bleeding was more frequent among nulliparous women. Discharge was more common among oral contraceptive users. CONCLUSION: Pain, bleeding, and discharge are not uncommon in women having follow-up cervical cytology tests. Informing women about possible after-effects could better prepare them and provide reassurance, thereby minimising potential non-adherence with follow-up or non-participation with screening in the future.

Persistent inflammation on Pap smear: does it warrant evaluation?

OBJECTIVE: Due to the low sensitivity of Pap smear, premalignant lesions of the cervix can be missed in women with inflammatory Pap smears. However, it is not practically possible to subject all women with inflammatory Pap smear to colposcopy. This study was carried out with the aim to evaluate whether women with persistent inflammation on Pap smear need further evaluation with colposcopy. MATERIALS AND METHODS: Four hundred and twenty women were screened at a tertiary level hospital with Pap smear. Women with inflammation on Pap smear were given treatment as per WHO guidelines and Pap smear was repeated at an interval of 6-12 weeks. Women with persistent inflammation on Pap smear were then subjected to colposcopy and directed biopsy if required. RESULTS: Of the 420 women screened, 102 (24.3%) women had a Pap smear showing inflammation. Thirty six women (8.6%) had persistent inflammatory Pap smear. Thirty women were subjected to colposcopy and 16 (53.3%) had abnormal findings on colposcopy. Five out of these 30 women (16.67%) had Cervical intraepithelial neoplasia (CIN) on biopsy. CONCLUSIONS: Nearly 16.67% women with persistent inflammation on Pap smear had cervical intraepithelial neoplasia. Hence, a large number of women with CIN would be missed if persistent inflammation on Pap smear is not evaluated further.

Urinary symptoms after a routine pelvic exam.

PURPOSE: To determine if urinary symptoms are more common in women during the 4 weeks after a routine pelvic examination. METHODS: This was a 4-week, prospective, observational cohort study in a Family Medicine residency clinic at an urban university. Participants included women ages 18 to 40 years who identified themselves as sexually active and who presented for a routine pelvic examination. Controls were women presenting for other health maintenance with no pelvic examination. Independent variables included age, pelvic examination/no pelvic examination, intercourse frequency, and condom use. Dependent variables included dysuria and urinary frequency. Relative rates of dysuria and frequency were compared using χ(2) analysis. Mean rates of dysuria, frequency, intercourse, and condom use were compared using 2-tailed t tests. RESULTS: Sixty-three subjects and 87 controls completed the study. More subjects had days with dysuria (17% vs 7%; P < .01), days with frequency (27% vs 14%; P < .01), days with both dysuria and frequency (13% vs 3%; P < .01), and days with either dysuria or frequency (32% vs 17%; P < .01). Subjects had less intercourse than controls (1.6 times per week vs 2.2 times per week; P < .01) and used condoms less frequently (33% vs 41%; P < .01). CONCLUSIONS: Dysuria and urinary frequency are more common among sexually active women during the month after a routine pelvic examination.

Genitourinary infections after a routine pelvic exam.

PURPOSE: To determine if genitourinary problems are more common in women in the first 1 to 2 months after a routine pelvic examination. METHODS: This was a historical cohort study in 2 family medicine teaching clinics at an urban university. Participants included all women who received a Papanicolaou smear during calendar year 2006. Subjects included all participants for weeks 1 to 7 after their Papanicolaou smear. Controls were all participants in weeks 8 to 52 after their Papanicolaou smear. The independent variable was time after Papanicolaou smear, and dependent variables included frequency of visits for urinary complaints, diagnosed urinary tract infections (UTIs), vaginal complaints, diagnosed vaginitis, and sexually transmitted diseases. Relative frequencies compared using 2-tailed t tests. RESULTS: UTIs and urinary complaints were significantly more frequent during the first 7 weeks after a Papanicolaou smear compared with weeks 8 to 14, 8 to 48, and 8 to 52. The overall rate of UTIs was 7.33 per 100 person-years; the attributable risk during the first 7 weeks was 0.82 per 100 person-years, or 11% of observed UTIs. Combined Candidal and bacterial vaginitis was marginally more frequent during the first 7 weeks compared with weeks 8 to 48 and 8 to 52 only. The incidence of sexually transmitted diseases combined was 1.13 per 100 person-years, distributed evenly over the study period unrelated to time. CONCLUSIONS: The risk of UTI is increased in the 7 weeks after a Papanicolaou smear.