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.

Rationale and design of the HOME trial: A pragmatic randomized controlled trial of home-based human papillomavirus (HPV) self-sampling for increasing cervical cancer screening uptake and effectiveness in a U.S. healthcare system.

Women who delay or do not attend Papanicolaou (Pap) screening are at increased risk for cervical cancer. Trials in countries with organized screening programs have demonstrated that mailing high-risk (hr) human papillomavirus (HPV) self-sampling kits to under-screened women increases participation, but U.S. data are lacking. HOME is a pragmatic randomized controlled trial set within a U.S. integrated healthcare delivery system to compare two programmatic approaches for increasing cervical cancer screening uptake and effectiveness in under-screened women (>3.4years since last Pap) aged 30-64years: 1) usual care (annual patient reminders and ad hoc outreach by clinics) and 2) usual care plus mailed hrHPV self-screening kits. Over 2.5years, eligible women were identified through electronic medical record (EMR) data and randomized 1:1 to the intervention or control arm. Women in the intervention arm were mailed kits with pre-paid envelopes to return samples to the central clinical laboratory for hrHPV testing. Results were documented in the EMR to notify women's primary care providers of appropriate follow-up. Primary outcomes are detection and treatment of cervical neoplasia. Secondary outcomes are cervical cancer screening uptake, abnormal screening results, and women's experiences and attitudes towards hrHPV self-sampling and follow-up of hrHPV-positive results (measured through surveys and interviews). The trial was designed to evaluate whether a programmatic strategy incorporating hrHPV self-sampling is effective in promoting adherence to the complete screening process (including follow-up of abnormal screening results and treatment). The objective of this report is to describe the rationale and design of this pragmatic trial.

Abordagem fenomenológica do câncer do colo do útero em gestantes: aspectos da prevenção / Enfoque fenomenológico para el cáncer del cuello uterino en embarazadas: aspectos de la prevención / Phenomenological approach for cervical cancer in pregnant women: prevention aspects

Introdução: O rastreamento do câncer do colo do útero no Brasil é realizado pelo exame de papanicolaou. Na gestação, faz parte da rotina do pré-natal, porém, muitas gestantes não se sentem informadas quanto a importância da realização desse exame. Objetivo: compreender o sentido da prevenção do câncer do colo do útero na ótica de gestantes. Métodos: fenomenológico, construído com base nas etapas metódicas heideggerianas. Resultados: o sentido da prevenção do câncer do colo do útero para as gestantes desvelou as possibilidades de vivenciar a ambiguidade na convivência conjugal e a inautenticidade nas relações entre profissional de saúde e cliente. Conclusão: Necessário se faz, enfrentar o desafio de reconhecer a fragilidade da cultura do desenho biomédico para cuidar da saúde das mulheres, na perspectiva de desenvolver um cuidado compreensivo(AU)

Introducción: la detección de cáncer de cuello uterino en Brasil se realiza mediante examen de Papanicolaou. Durante el embarazo, una parte de la rutina del prenatal. Sin embargo, muchas mujeres embarazadas no se sienten informadas sobre la importancia de este examen. Objetivo: comprender el significado de la prevención del cáncer de cuello uterino en el punto de vista de las mujeres embarazadas. Métodos: fenomenológico hermenéutico, construidos sobre la base de pasos metódicos heideggerianos. Resultados: el sentido de la prevención del cáncer del cuello uterino para las mujeres embarazadas dio a conocer las posibilidades de experimentar la ambigüedad en la vida conyugal y la falta de autenticidad en las relaciones entre profesionales de la salud y el cliente. Conclusión: Hay que encarar el desafío de reconocer la fragilidad de la cultura del diseño biomédico para cuidar de la salud de las mujeres con el fin de desarrollar una atención integral(AU)

Introduction: Early screening of cervical cancer in Brazil is performed by Pap smear. During pregnancy, it is part of the prenatal routine. However, many pregnant women do not feel informed about the importance of this test. Objective: To understand the meaning of cervical cancer prevention from the point of view of pregnant women. Methods: Hermeneutic phenomenology, built on the basis of Heideggerian methodical steps. Results: The purpose of cervical cancer prevention for pregnant women revealed the possibilities of experiencing the ambiguity in conjugal life and the lack of authenticity in the relationships between health professionals and the client. Conclusion: The challenge of recognizing the fragility of biomedical design culture to take care of women's health to deliver comprehensive care must be addressed(AU)

Clearance of cervical human papillomavirus infection by topical application of curcumin and curcumin containing polyherbal cream: a phase II randomized controlled study.

Curcumin and curcumin containing polyherbal preparations have demonstrated anti-microbial and anti- viral properties in pre-clinical studies. Till date no therapeutic intervention has been proved to be effective and safe in clearing established cervical human papillomavirus (HPV) infection. The present study evaluated the efficacy of Basant polyherbal vaginal cream (containing extracts of curcumin, reetha, amla and aloe vera) and of curcumin vaginal capsules to eliminate HPV infection from cervix. Women were screened by Pap smear and HPV DNA test by PCR. HPV positive women without high grade cervical neoplasias (N=287) were randomized to four intervention arms to be treated with vaginal Basant cream, vaginal placebo cream, curcumin vaginal capsules and placebo vaginal capsules respectively. All subjects were instructed to use one application of the assigned formulation daily for 30 consecutive days except during menstruation and recalled within seven days of the last application for repeat HPV test, cytology and colposcopy. HPV clearance rate in Basant arm (87.7%) was significantly higher than the combined placebo arms (73.3%). Curcumin caused higher rate of clearance (81.3%) than placebo though the difference was not statistically significant. Vaginal irritation and itching, mostly mild to moderate, was significantly higher after Basant application. No serious adverse events were noted.

Citología vaginal o papanicolau / Vaginal cytology or pap

Según el Instituto Nacional de Estadística y Geografía, durante 2010 uno de los principales tumores malignos que afectó a la población femenina adulta (de 20 años y más) en México fue el cervicouterino (9.7%). El método diagnóstico para cualquier alteración histopatológica es la citología vaginal, que es reconocido porprogramas de control y prevención del cáncer como una de las pruebas que ha reducido la incidencia y mortalidad provocadas por este padecimiento, gracias a su pronta detección. Es por ello la relevancia de este estudio y la reiteración en la exploración continua de tejidos sensibles.

According to the National Institute of Statistics and Geography in Mexico during 2010, one of the major malignancies affecting the adult female population (20 years and over) is the cervical (9.7%). The method for any alteration histopathological diagnosis is the vaginal cytology, as it is recognized by control programs and cancer prevention as one of the tests has reduced the incidence and mortality caused by this disease, thanks to early detection. That is why the importance of this study and repeated in continuousexploration of sensitive tissues.

Citología vaginal o Papanicolau / Vaginal cytology or Pap

Según el Instituto Nacional de Estadística y Geografía, durante 2010 uno de los principales tumores malignos que afectó a la población femenina adulta (de 20 años y más) en México fue el cervicouterino (9.7%). El método diagnóstico para cualquier alteración histopatológica es la citología vaginal, que es reconocido porprogramas de control y prevención del cáncer como una de las pruebas que ha reducido la incidencia y mortalidad provocadas por este padecimiento, gracias a su pronta detección. Es por ello la relevancia de este estudio y la reiteración en la exploración continua de tejidos sensibles. (AU)

According to the National Institute of Statistics and Geography in Mexico during 2010, one of the major malignancies affecting the adult female population (20 years and over) is the cervical (9.7%). The method for any alteration histopathological diagnosis is the vaginal cytology, as it is recognized by control programs and cancer prevention as one of the tests has reduced the incidence and mortality caused by this disease, thanks to early detection. That is why the importance of this study and repeated in continuousexploration of sensitive tissues. (AU)

Efficacy of screening in preventing cervical cancer among older women.

BACKGROUND: Although the effectiveness of cervical cancer screening has been firmly established in reproductive-age women, its usefulness in older women is unclear. We sought to evaluate the efficacy of cervical cancer screening in older women. METHODS: We conducted a case-control study within two integrated health care systems in the northwestern United States. Cases (n = 69) were women aged 55-79 years who were diagnosed with invasive cervical cancer during 1980-1999. Controls (n = 208) were women with an intact uterus and no diagnosis of cervical cancer, but otherwise similar to cases in terms of age and length of enrollment in the health plan. We reviewed medical records to ascertain screening history during the 7 years prior to reference date. RESULTS: Compared to cases, controls were more likely to have received a Pap test. After adjustment for age and current smoking status, screening prior to an estimated 1-year duration of the occult invasive phase of cervical cancer was associated with a substantial reduction in risk [odds ratio (OR) 0.23; 95% CI 0.11-0.44]. Similar results were obtained using different estimates of the duration of the occult invasive phase. Analysis of the relative incidence of invasive cervical cancer in relation to the time following a negative screening test suggested a large reduction during the first year (OR 0.09; 95% CI 0.03-0.24). The incidence remained low for several years thereafter, returning to the incidence among unscreened women after 5-7 years. CONCLUSIONS: Cervical cancer screening by means of cytology is highly efficacious in older women. Our findings also suggest that five-yearly screening is approximately as efficacious as more frequent screening.