Results from a cervical cancer screening program in Samsun, Turkey.

BACKGROUND: Cervical cancer is a preventable disease. This study aimed to share the results of the national cervical cancer screening program performed in primary health care institutions in Samsun between 2015 and 2019. METHODS: Women aged 30-65 years who were screened for cervical cancer in screening centers of Samsun between January 01, 2015, and December 31, 2019, were included in this descriptive study. The data were obtained from the automation program of the "National Human Papilloma Virus (HPV) Laboratory Application" used by the Provincial Directorate of Health Cancer Unit through filtering the completion time of the tests, and all results were evaluated without sampling. Thus, data were presented using descriptive statistics. RESULTS: The mean age of 89,302 women included in the cervical cancer screening program was 45.9 ± 9.0 years. Of the samples obtained from the participants, 1.0% were determined as insufficient material, 94.1% as HPV-negative, and 4.9% as HPV-positive. The most common HPV genotypes were 16, 51, 31, and 52. Of the 4337 HPV-positive women, 74.7% of the pap smear results were negative (including infection, 36.5%), and the most common premalignant lesions were atypical squamous cells of undetermined significance in 7.1% and low-grade squamous intraepithelial lesions in 6.9%. HPV 16/18 was also observed in 31.7% of HPV-positive women. Seven hundred ninety-five women were referred to a specialist physician for further examination and treatment within the scope of the screening algorithm. CONCLUSION: Detecting HPV-positivity by reaching more women within the national cervical cancer screening program's scope is vital in fighting against this disease. The effectiveness of cancer screening programs should be increased by ensuring community participation through awareness activities.

Efficacy of Oral Zinc Sulfate Supplementation on Clearance of Cervical Human Papillomavirus (HPV); A Randomized Controlled Clinical Trial.

AIM: Human Papillomavirus is one of the most crucial infectious disease in gynecology disease. To assess the efficacy of supplemental zinc treatment in clearance of HPV infection. METHODS: Eighty zinc-sufficient women between 21-55 years, with positive HPV DNA testing, and abnormal cervical cytology in Pap test (ASCUS or LISL) were randomly divided to case (n=40) and control group (n=40). Case group received oral tablets of zinc sulfate twice a day for 3 months while control group received no placebo. During follow-up patients underwent repeat HPV DNA test and PAP test and were evaluated for clearance/persistence of HPV infection and regression/progression in the lesion grading. RESULTS: As far as demographics, serum zinc levels and the relevant risk factors for persistence of HPV were concerned, there was no significant difference between two groups, except for the frequency distribution of HR-HPV which was significantly higher in case  group. Zinc treatment for 3 months reduced the risk of persistence of HPV infection and progression from baseline cytology (OR = 0.130) (CI 95% 0.04-0.381; p <0.001) and 0.301 (95% CI 0.777-0.116; p = 0.012), respectively. Age, initial cytology, HPV type, and contraceptive method were not related to persistence of HPV. Serum zinc levels increased in the casr group as a result of oral zinc consumption for 3-month period, though without any statistical significance (p = 0.407). CONCLUSION: The results of the following study suggested that oral intake of zinc sulfate supplement for 3 months increases the rates of HPV clearance and resolution of pre-existing cervical lesion.

Pap Smear and Mammogram Screening Rates in a Refugee and General OB/GYN Clinic: A Retrospective Review.

Although multiple studies have shown that resettled refugee women are less likely to receive preventative cancer screenings like pap smears and mammograms, a small number have demonstrated the opposite. This retrospective chart review, conducted between January 2017 and October 2018, compares pap smear and mammogram rates of patients seen in a refugee-specific OB/GYN clinic with patients from the general OB/GYN clinic at the same institution. Data from 298 patients (149 refugee and 149 general clinic patients matched by age and date-of-visit) were analyzed. Pap smear screening rates were 90.60% in the refugee group and 73.83% in the general group [p < 0.009, aOR 3.46 (1.36-8.81)], while mammogram screening rates were 36.84% and 38.60%, respectively (p = 0.46). The provision of holistic services meeting refugee women's unique needs can effectively increase pap smear screening rates.

Sentidos e Percepções das Mulheres acerca das Práticas Preventivas do Câncer do Colo do Útero: Revisão Integrativa da Literatura / Women's Feelings and Perceptions about Cervical Cancer Preventive Practices: Integrative Literature Review / Sentidos y Percepciones de las Mujeres sobre las Prácticas Preventivas del Cáncer del Cuello Uterino: Revisión Integradora de la Literatura

Introdução: O exame do Papanicolaou, caso seja realizado periodicamente, permite identificar alterações celulares que podem evoluir para o câncer. A baixa adesão ao preventivo é uma das causas que transforma o câncer do colo do útero na quarta causa mais frequente de morte de mulheres por câncer no Brasil. As percepções que elas têm sobre preventivo são variadas e podem ter relação direta com a adesão ao exame. Objetivo: Identificar estudos sobre sentidos e percepções das mulheres acerca do exame preventivo do câncer do colo do útero. Método: Revisão integrativa da literatura nas bases de dados do MEDLINE e LILACS, sem delimitação de tempo. Resultados: Os estudos mostraram que as mulheres, em sua maioria, desconhecem o objetivo principal do preventivo, referem medo em relação a um possível diagnóstico de câncer e ao desconforto físico decorrente do exame, além de apresentarem sentimentos como vergonha em expor o próprio corpo, associando à sexualidade. Barreiras institucionais, sociais e a falta de acolhimento por parte do profissional comprometem a adesão da mulher ao exame. Conclusão: As mulheres atribuem sentimentos considerados negativos como vergonha e medo do preventivo, bem como desconhecimento da importância e do objetivo principal do exame, contribuindo para a baixa adesão ao rastreamento. Portanto, torna-se necessário que os profissionais saibam quais são as dúvidas e os receios das mulheres, considerando seus aspectos socioculturais e econômicos, para potencializar o vínculo terapêutico e possibilitar melhor compreensão do significado e da importância do exame

Introduction: The Pap smear, if performed periodically, allows the identification of cellular changes that can progress to cancer. Low adherence to preventive care is one of the causes that makes cervical cancer the fourth most frequent cause of death in women by cancer in Brazil. They have multiple perceptions about the preventive exam and may be directly related to the adherence to the exam. Objective: To identify studies about women's feelings and perceptions about cervical cancer preventive exam. Method: Integrative literature review in MEDLINE and LILACS databases, without time limit. Results: The studies showed that most women are unaware of the main purpose of the preventive exam, they report fear in relation to a possible diagnosis of cancer and the physical discomfort from the exam, in addition to feelings such as embarrassment in exposing their own body, associating with sexuality. Institutional and social barriers and unacceptance by the professional compromise women's adherence to the exam. Conclusion: Women attribute negative feelings as embarrassment and fear of the preventive, and ignorance of the importance and main objective of the test, contributing to the low adherence to screening. Therefore, it is necessary for professionals to know women's fears and doubts, considering their sociocultural and economic aspects, to enhance the therapeutic bond and favor a better understanding of the meaning and importance of the exam

Introducción: La prueba de Papanicolaou, si se realiza periódicamente, permite la identificación de cambios celulares que pueden progresar a cáncer. La baja adherencia a los cuidados preventivos es una de las causas que convierte al cáncer de cuello uterino en la cuarta causa más frecuente de muerte en mujeres por cáncer en Brasil. Las percepciones que le dan al preventivo son variadas y pueden estar directamente relacionadas con la adherencia al examen. Objetivo: Identificar estudios sobre los sentidos y las percepciones de las mujeres sobre el examen preventivo del cáncer de cuello uterino. Método: Revisión integrativa de la literatura en las bases de datos MEDLINE y LILACS, sin límite de tiempo. Resultados: Los estudios mostraron que la mayoría de las mujeres desconocen el propósito principal del preventivo, reportan miedo en relación a un posible diagnóstico de cáncer y el malestar físico derivado del examen, además de presentar sentimientos como vergüenza al exponer los propios. cuerpo, asociándose con la sexualidad. Las barreras institucionales y sociales y la falta de aceptación por parte del profesional comprometen la adherencia de las mujeres al examen. Conclusión: Las mujeres atribuyen sentimientos negativos como la vergüenza y el miedo al preventivo, así como el desconocimiento de la importancia y objetivo principal de la prueba, contribuyendo a la baja adherencia al cribado. Por tanto, es necesario que los profesionales aprendan a recoger las dudas y miedos de las mujeres, considerando sus aspectos socioculturales y económicos, para potenciar el vínculo terapéutico y así posibilitar una mejor comprensión del significado e importancia del examen

Out of reach? Correlates of cervical cancer underscreening in women with varying levels of healthcare interactions in a United States integrated delivery system.

One in five U.S. women with health insurance are underscreened for cervical cancer. We sought to identify whether underscreening correlates differed among women with different levels of health care interaction. Among women age 30-64 years who were members of an integrated U.S. health system, we used 2014-2015 electronic health record data to identify underscreened cases (≥3.4 years since last Papanicolaou (Pap) test, n=3352) and screening-adherent controls (<3.4 years since last Pap test, n=45,359) and extracted data on potential underscreening correlates (demographics, health history, and healthcare utilization). We calculated the odds of underscreening in the total population and by subgroups defined by healthcare visits and online health portal usage in the prior 12 months. Underscreening was associated with older age (50-64 vs. 30-39; odds ratio (OR)=1.6; 95%CI=1.4-1.8), current tobacco use (vs. never use; OR=2.1; 95%CI=1.8-2.2), higher BMI (≥35 kg/m2 vs <25 kg/m2, OR=2.0; 95%CI=1.8-2.3), screening non-adherence for colorectal cancer (OR=5.1; 95%CI=4.6-5.7) and breast cancer (OR=8.1, 95%CI=7.2-9.0), and having no recent visit with their primary care provider (PCP) nor recent health portal use (vs. recent PCP visit and portal use; OR=8.4, 95%CI=7.6-9.4). Underscreening correlates were similar between the total study population and within all healthcare interaction groups. Interaction with the healthcare system is associated with lower odds of underscreening, but sociodemographic and health status correlates are similar regardless of primary care visits or online portal use. These data support the need for additional interventions to reach insured women who remain underscreened for cervical cancer.

Perceptions of Midwives on Pap Smear Tests during Pregnancy.

PURPOSE: The aim of the study was to explore and describe perceptions of midwives on Papanicolaou (Pap smear) test during pregnancy. METHODS: The study used qualitative, exploratory type of design. A probability purposive sampling was used to sample 12 registered midwives based in gynaecological units in a public hospital in Tshwane District, South Africa. Open-ended questionnaires, field notes, and audio tape were used to collect data. Data analysis process involved grouping and categorization into themes and sub-themes. RESULTS: This study showed that majority of midwives lacked scientific knowledge behind Pap smear test during pregnancy. Some of the participants could relate with the test and verbalized that there may be complications such as bleeding, which may lead to miscarriage. CONCLUSIONS: Findings showed that midwives were not performing Pap smear tests among pregnant women due lack of knowledge. This points out that Pap smear test is not prioritised as a secondary preventive tool at facility level. It is therefore recommended that refresher workshops be conducted at hospital level.

Complementary Medicine Use and Uptake of Cancer Screening Among US Adults: A Nationally Representative Cross-Sectional Survey.

Background: Cancer screenings can considerably reduce cancer mortality. There is limited information on the association between complementary medicine use and adherence to recommended cancer screenings. In this study, the potential associations between uptake of cancer screening and consultations with complementary medicine practitioners or mind-body medicine use are examined. Methods: This is a cross-sectional analysis of the 2017 National Health Interview Survey of a population-based sample (n = 26 742; response rate = 80.7%). Age- and sex-related risk groups for breast cancer (women 45 years and older), cervical cancer (women 21 years and older), and colorectal cancer (45 to 85 years) were analyzed in 2018. Prevalence of complementary medicine use in the past 12 months as well as prevalence of cancer screening uptake in the past 12 months were calculated. Results: At least one complementary medicine approach was used by 32.4% of participants. Controlling for sociodemographic and clinical variables, individuals who consulted a chiropractor or naturopath or who used mind-body medicine approaches were more likely to take up Pap smear test (odds ratio = 1.20-1.35), mammography (odds ratio = 1.22-1.38), and/or colorectal cancer screening (odds ratio = 1.18-1.37). Those consulting a homeopath were more likely to take up Pap smear test (odds ratio = 1.33). No association was found between consultations of practitioners of chelation therapy or traditional medicine and cancer screening uptake. Conclusion: Complementary medicine use seems to be associated with a better adherence to cancer screening. Individuals who consulted a chiropractor or naturopath or who used mind-body medicine approaches were more likely to take up the recommended screening.

Midwives' practices related to cervical cancer screening during pregnancy: A vignette-based study.

OBJECTIVE: To describe midwives' practices related to cervical cancer screening and women's eligibility for screening during pregnancy. STUDY DESIGN: Cross-sectional vignette-based study of French midwives during February-May 2018. MAIN OUTCOME MEASURES: Participants were asked to complete an internet-based questionnaire: a clinical case-vignette about a woman eligible for cervical cancer screening during pregnancy and a short self-administered questionnaire. RESULTS: We obtained 273 complete questionnaires from eligible midwives. Of those responding, 15% reported that they never screened for cervical cancer during pregnancy, 63.7% did so for women 25 years or older, and 51% adhered to the recommended intervals between tests. Overall, 110 (40%) midwives adhered to the complete screening protocol (age at initiation and interval). In this clinical case vignette of a woman meeting the criteria for screening, only 29% of midwives reported they would perform a Pap test at 25 weeks of gestation, while 91% would at 10 weeks. CONCLUSION: Midwives' practices of cervical cancer screening and their determination of women's eligibility during pregnancy vary, especially according to gestational age; Nevertheless, pregnancy is an appropriate time to screen women who meet the criteria for cervical cancer screening, especially if they are not receiving regular gynaecological care.

An Alternative Treatment for Vaginal Cuff Wart: a Case Report.

Human papillomavirus (HPV) has been directly related to acuminate warts and cervical cancer, the second most common neoplasia among women. Given the lack of treatment against the virus itself, many medications have been utilised, mainly aiming in modifying the host's immunological response. We present the case of a 54 years old postmenopausal patient with a history of vaginal cuff wart and HPV persistence that we managed in our clinic for 6 months with a mix of curcumin, aloe vera, amla and other natural ingredients. As the patient was found to be intolerant to imiquimod (one of the most common conservative methods of treatment) we attempted the use of curcumin, which was applied to the area of the wart three times per week for 6 months. Both clinical and colposcopical improvement was noted in regular clinic visits with regression of the lesion. The outcome of this case encourages our view that curcumin should be considered as a significant treatment modality against HPV infection and acuminate warts.

Risk factors and relationship between screening periodicity and risk of cervical cancer among nurses and midwives. A cross-sectional study.

BACKGROUND: If nurses and midwives undergo cervical cancer screening regularly, they can become role models for other women regarding this screening. OBJECTIVES: The aims here were (i) to determine factors associated with undergoing cervical cancer screening; and (ii) to examine the association of cervical cancer screening periodicity with cervical cancer risk levels among nurses and midwives. DESIGN AND SETTING: Cross-sectional study in a public hospital. METHODS: 466 nurses and midwives participated in this study. The relationships between undergoing Pap smear screening and sociodemographic characteristics, cervical cancer risk factors, perception of cervical cancer risk and calculated cervical cancer risk levels were examined. Cervical cancer risk levels were determined using the "Your Disease Risk" assessment tool (Washington University). RESULTS: 35% of the nurses and midwives had undergone Pap smear testing at least once in their lifetimes. The odds of having undergone Pap smear testing were higher among smokers (odds ratio, OR: 2.08; 95% confidence interval, CI: 1.24-3.48) and among those who perceived their risk of cervical cancer to be high (OR: 3.60; 95% CI: 1.36-9.51). The frequency of undergoing Pap smear testing at least once in a lifetime was higher among primiparae (OR: 17.99; 95% CI: 6.36-50.84) and secundiparae (OR: 41.53; 95% CI: 15.01-114.91) than among nulliparae. No relationship was found between Pap smear test periodicity and calculated risk level. CONCLUSION: There is a need to assess motivational barriers that might lead to low levels of Pap smear screening among nurses and midwives who are role models for women regarding cervical cancer prevention.

Risk factors and relationship between screening periodicity and risk of cervical cancer among nurses and midwives. A cross-sectional study

ABSTRACT BACKGROUND: If nurses and midwives undergo cervical cancer screening regularly, they can become role models for other women regarding this screening. OBJECTIVES: The aims here were (i) to determine factors associated with undergoing cervical cancer screening; and (ii) to examine the association of cervical cancer screening periodicity with cervical cancer risk levels among nurses and midwives. DESIGN AND SETTING: Cross-sectional study in a public hospital. METHODS: 466 nurses and midwives participated in this study. The relationships between undergoing Pap smear screening and sociodemographic characteristics, cervical cancer risk factors, perception of cervical cancer risk and calculated cervical cancer risk levels were examined. Cervical cancer risk levels were determined using the "Your Disease Risk" assessment tool (Washington University). RESULTS: 35% of the nurses and midwives had undergone Pap smear testing at least once in their lifetimes. The odds of having undergone Pap smear testing were higher among smokers (odds ratio, OR: 2.08; 95% confidence interval, CI: 1.24-3.48) and among those who perceived their risk of cervical cancer to be high (OR: 3.60; 95% CI: 1.36-9.51). The frequency of undergoing Pap smear testing at least once in a lifetime was higher among primiparae (OR: 17.99; 95% CI: 6.36-50.84) and secundiparae (OR: 41.53; 95% CI: 15.01-114.91) than among nulliparae. No relationship was found between Pap smear test periodicity and calculated risk level. CONCLUSION: There is a need to assess motivational barriers that might lead to low levels of Pap smear screening among nurses and midwives who are role models for women regarding cervical cancer prevention.

Understanding Patients' Perspectives and Information Needs Following a Positive Home Human Papillomavirus Self-Sampling Kit Result.

OBJECTIVE: We explored patient perspectives after a positive human papillomavirus (HPV) self-sampling result to describe experiences and information needs for this home-based screening modality. MATERIALS AND METHODS: We recruited women who tested high-risk (hr) HPV positive during a pragmatic trial evaluating mailed hrHPV self-sampling kits as an outreach strategy for women overdue for Pap screening in a U.S. integrated health care system. Telephone interviews were conducted from 2014 to 2017. Five independent coders analyzed transcripts using iterative content analysis. RESULTS: Forty-six women (61% of invited; median age 55.5 years) completed a semistructured interview. Six themes emerged: (1) convenience of home-based screening, (2) intense feelings and emotions after receiving positive kit results, (3) importance of seeing provider and discussing kit results, (4) information seeking from various sources, (5) confusion about purpose and meaning of HPV versus Pap tests, and (6) concern that HPV self-sampling is inaccurate when the subsequent Pap test is normal. CONCLUSIONS: Although women liked the kit's convenience, discussion about discordant home HPV and in-clinic Pap results led them to question the accuracy of HPV self-sampling. Patient-provider communication around home HPV kits is more complex than for reflex or cotesting because clinician-collected Pap results are unknown at the time of the positive kit result. Patients need education about differences between HPV and Pap tests and how they are used for screening and follow-up. To reassure patients and keep them interested in self-sampling, education should be provided at multiple time points during the screening process.

Nuevas estrategias de prevención y control de cáncer de cuello uterino en Chile / New strategies for the prevention and control of cervical cancer in Chile

Resumen: Objetivos: Discutir el cáncer cervicouterino (CC), el virus del papiloma humano (VPH), el programa de control del CC y proponer alternativas para Chile. Material y métodos: Se analiza el programa nacional del CC 1966-2015 y la guía clínica 2015-2020, la prevalencia de VPH en mujeres y en casos de CC; la infección y serología de VPH; la autotoma; la precisión y rentabilidad del tamizaje con VPH contra el Papanicolaou y las opciones de triaje en VPH AR positivas. Resultados: En Chile mueren 600 mujeres (principalmente de bajos recursos) al año por CC. La cobertura del Papanicolaou es < 70%, sensibilidad muy inferior al test de VPH, por lo que el cambio es rentable. Desde 2015 se vacuna contra VPH a niñas menores de 13 años. Conclusiones: Las condiciones técnicas y económicas existen en Chile para lograr una mejoría sustancial del CC: se sugiere el reemplazo del Papanicolaou por el examen de VPH; tamizaje cada cinco años con opción de autotoma; triaje con base en la tipificación de VPH 16/18 o Papanicolaou.

Abstract: Objective: To discuss cervical cancer (CC), Human Papilloma Virus (HPV), CC control program and propose alternatives for Chile. Materials and methods: We analyzed the national program of CC 1966-2015 and the clinical CC guideline 2015-2020; HPV prevalence in women and in cases of CC; HPV infection and serology; the self-vaginal sample; the accuracy and cost-effectiveness of screening with HPV versus Papanicolaou, and triage options among HPV-AR positives. Results: 600 women die of CC each year in Chile, mainly from low resources. Papanicolaou coverage is <70%; Papanicolaou sensitivity is much lower than HPV test. Change from Papanicolaou to HPV test is cost-effective. Since 2015, girls under 13 have been vaccinated against HPV. Conclusions: There are the technical and economic conditions for a substantial improvement of CC in Chile: replacement of the Papanicolaou by HPV; screening every five years, with the option of self-sampling, and triage based on HPV 16/18 or Papanicolaou typing.

CervixCheck: A Spiritually-Based Text Messaging Intervention to Promote Cervical Cancer Awareness and Pap Test Screening Intention among African-American Women.

BACKGROUND/PURPOSE: On a national level, African-American women have a 34% higher incidence of cervical cancer and are twice as likely to die of the disease when compared to White women. In response to the need to improve cervical cancer prevention and Pap test screening knowledge and utilization, we developed and pilot tested a 16-day SMS text message-based intervention. The CervixCheck study was designed to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention aimed at increasing cervical cancer awareness and Pap test screening intention in church-attending African-American women ages 21-65. Methods/Approach: The Theory of Planned Behavior guided the development of the CervixCheck intervention. This intervention utilized a non-experimental one-group pretest-posttest design. In this article, we present findings from the pilot testing phase. Of the 52 participants at baseline, 46 completed the post-program survey. RESULTS/FINDINGS: The current study provides evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There was a significant pre-post increase observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Findings post-intervention also revealed that 83% of participants reported being either "satisfied" or "very satisfied" with the CervixCheck intervention and 85% found the SMS text messages either "useful" or "very useful". CONCLUSIONS/SIGNIFICANCE: A spiritually-based SMS text messaging intervention could be a culturally-appropriate and cost-effective method of promoting cervical cancer early detection information to church-attending African-American women.

The evaluation of Oryza sativa L (Black rice) extracts for detection of spermatozoa on the clothing and vaginal swab samples.

Investigation of sexual assault cases from the evidence involving vaginal swab, clothing and others is examined by a forensic scientist. The explanation of trace findings on spermatozoa on clothing is often problematic due to the use of different staining methods. Conventional staining method used either Papanicolaou (PAP) or Dip quick® stain as synthetic dyes which are expensive imported material and harmful to human health. Therefore, the present study aims to determine the ability of Oryza sativa L (black rice) extract as a natural dye to detect spermatozoa on the clothing and vaginal swab casework samples for routine forensic examination. Results revealed that black rice extract has a highly effective for detecting spermatozoa on cloth and vaginal swab casework samples. There was no significantly different in the detection of spermatozoa compared with rapid PAP stain and Dip quick® stain. Results also showed that the staining of vaginal swab casework with black rice extracted can be used for PCR amplification of centromeric alphoid repeat gene on chromosome Y for 60 days. Moreover, the DNA extracted from stained semen slide generates a full profile of 16 alleles of STR typing. The results indicate that a new natural staining dye which extracted from black rice can be used to detect spermatozoa and identify a person from the trace evidence. The application of natural dyes for routine staining of spermatozoa from forensic specimens will decrease the expense to be spent in purchasing the synthetic dye and reduce their side effects on human and environment.

Cervical cancer prevention in Senegal: an International Cooperation Project Report.

BACKGROUND: Cervical cancer is the second most common women's cancer in less developed regions and it is the leading cause of cancer mortality among women in Senegal. Because of the high costs, cervical cancer prevention is very rare in developing countries and it is often based on visual inspection methods. The University of Parma (CUCI)  and the MANI association have developed a cervical cancer screening project addressed to rural Senegal communities. The aim of the project was to disseminate the cytocervical sampling technique among Senegalese nurses and midwives, as a completion to the local visual inspection method. Other objectives were to verify the prevalence of precancerous lesions and to evaluate cervical cancer knowledge and attitudes among women who participated at the screening campaign. INTERVENTIONS: A theoretical and practical training plan on cervical cancer screening was provided to the local health workers at various levels. The screening was performed through a first step visual inspection exam to 203 women, followed by a Pap smear in case of positive outcome. 20 women participated also to a structured interview. RESULTS: The Pap smear material was adequate in all the samples collected where this indicates that the objective to disseminate cervical cancer screening techniques has been achieved.  Of the 203 women involved in the screening project, 68 were tested positive at the first step and 38 of them were submitted to Pap tests. CONCLUSION: The difficulties encountered confirm how Pap tests have overall proved inordinately complex and expensive for developing countries. It seems more sensible to deal first with global health in terms of basic hygienic sanitation, including an educational component in screening programs in order to sensitize women to the risk factors of cervical cancer.

Cervical cancer prevention among quilombola women in the light of Leininger's theory. / Prevenção do câncer do colo uterino de quilombolas à luz da teoria de Leininger.

OBJECTIVE Our purpose was to discuss practices of cervical cancer prevention among Quilombola Women. METHOD This study used, in 2014, a qualitative research approach aiming twenty women from a quilombola community (people who live in quilombos, descendants of Afro-Brazilian slaves), which is located in Bahia. A semi-structured interview was developed by researchers in order to collect data. The Ethno-nursing Research method was used to analyze the data. RESULTS The use of cultural care through medicinal plants, and the nursing professional care (Pap Smear exam procedure) were stated by Quilombola women as serving as prevention practices against cervical cancer. However, most women stated that they did not use any prevention practices. CONCLUSION Social, cultural and health access issues are practices that are linked to the cervical cancer prevention among Quilombola Women. Therefore, it is indispensable to create an appropriate care plan for Quilombola women's reality.

Mixed Blessings? Religion/Spirituality Predicts Better and Worse Screening Behaviours.

Some health research suggests that religious and spiritual variables positively predict health-screening behaviours. However, much of the literature on this topic has utilized exclusively religious samples, or has sampled from populations without uniform access to health care. Either of these issues may have artificially inflated the relationship between religion/spirituality and health-screening behaviours. The current study used data from the 2012 Canadian Community Health Survey to examine a general sample of women from New Brunswick and Manitoba (N > 1200). Results indicated that lower levels of church attendance were positive predictors of papanicolaou tests and mammograms, while higher levels of attendance were generally associated with poorer screening behaviours. Religiosity was a uniformly non-significant predictor of screening behaviours. Finally, religious affiliation was inconsistently related to screening behaviours, but tended to favour religious non-affiliation when it was. Religion/spirituality does not appear to have a uniformly positive nor linear effect in predicting health-screening behaviours in women.

Patterns and correlates of cervical cancer screening initiation in a large integrated health care system.

BACKGROUND: The latest 2012 US Preventive Services Task Force cervical cancer screening guidelines recommended screening initiation at age 21 years. Little is known about the cervical cancer screening initiation practices in the community and whether there are critical gaps with respect to adherence to current clinical guidelines. Despite an overall decline in cervical cancer incidence across women of all ages, the incidence rate has not declined among 24-25 year olds between 2000 (2.79 per 100,000) and 2013 (2.93 per 100,000). Thus, it is important to understand cervical cancer screening initiation in young women and how woman- and provider-level factors affect the timing of screening initiation to identify areas for improving cervical cancer prevention. OBJECTIVE: We examined patterns and correlates of cervical cancer screening initiation among women turning age 21 years in a large community-based practice. STUDY DESIGN: Female members of Kaiser Permanente Southern California who turned age 21 years (baseline) during 2013-2015 and had not previously received a Papanicolaou test were included. Cervical cancer screening initiation through October 2016 was captured using electronic health records. Incidence rate and cumulative incidence of screening initiation was calculated. Associations between patient and provider characteristics and screening initiation were evaluated using multivariable Cox models. RESULTS: A total of 38,257 women were included and the Papanicolaou screening initiation rate was 44 per 100 person-years during the study period. Approximately 40% initiated screening within 1 year after turning age 21 years. In multivariable analyses, Asian/Pacific Islanders (hazard ratio, 0.91; confidence interval, 0.86-0.96 compared with non-Hispanic whites); Medicaid enrollees (hazard ratio, 0.90; confidence interval, 0.83, 0.97); those whose primary language is not English (hazard ratio, 0.71; confidence interval, 0.67, 0.75); those who have a historical inpatient visit, primary care physician in pediatrics, internal medicine, or another specialty compared with family practice; and have a male rather than female primary care physician (hazard ratio, 0.46; confidence interval, 0.36, 0.57) less often initiated screening. On the other hand, those who used other preventive services such as getting a human papilloma virus and influenza vaccination and those with a history of pregnancy, contraception use, and sexually transmitted infections more often had timely screening initiation. CONCLUSION: Less than half of the women insured for preventative services initiated screening at age 21 years. Strategies to improve adherence to screening initiation guidelines should consider a tailored approach for at-risk subgroups and addressing initiation challenges associated with male physicians.

Organized Cervical Cancer Screening Program in Barretos, Brazil: Experience in 18 Municipalities of São Paulo State.

OBJECTIVES: The aim of this report is to demonstrate the Barretos Cancer Hospital initiative of organizational, laboratorial, and human resources training in the implementation of an organized cervical screening program in low-resource settings. METHODS: We developed a computational program to report all epidemiological, clinical, and laboratorial findings, and to trace all necessary information to recruit women for regular screening or for referral for complementary exams after liquid-based Pap test analyses. RESULTS: All Pap tests were collected in liquid medium and in 2014 more than 160,000 tests were analyzed and 2,900 colposcopy examinations were performed. From 2012 to 2015, the percentage of exams collected increased from 54.6% in 2012 to 62.4% in 2013, 68.4% in 2014, and 71% in 2015. Per 1,000 Pap tests, 0.4 cases of invasive cancer were diagnosed; for in situ carcinoma, 1.9 cases were identified. More importantly, between 2011 and 2015, 89.4% of all carcinomas were detected at clinical stage 0 or I (in situ carcinoma), and only 5% at stages III and IV. CONCLUSIONS: Since the organized system was implemented, 98% of women have attended their recall for colposcopy. So far, we have not reached the target of 70% of women for this proposal, as recommended by the international standards.