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1.
Artigo em Inglês | MEDLINE | ID: mdl-32867315

RESUMO

Background: Cervical cancer is one of the most common cancers in women and about 90% of cervical cancer can be reduced by regular screening. The Pap smear has been well in place as a primary cervical screening method since 1950s; however, coverage is still not optimal. This study explored the feasibility of HPV self-sampling in two under-screened population groups in Hong Kong (HK): never screened and not regularly screened females, to estimate the uptake rate and preference rate in the future. Materials and Methods: This was a cross-sectional study to explore the acceptability and feasibility of HPV self-sampling in two age groups: aged 25-35 and aged ≥45, which were reported as the highest proportion of the under-screened population in HK between 2017 and 2018. The study invited eligible women from an HPV study cohort to perform HPV self-sampling at home by themselves. The number of specimens returned from participants was recorded and used to determine the feasibility of HPV self-sampling in the community. The participants were asked to fill in the questionnaires before and after HPV self-sampling to indicate their attitudes, acceptability, and future preference for HPV self-sampling as an acceptable alternative primary cervical cancer screening method. Results: A total of 177 subjects participated in the present study and have achieved a good overall uptake rate of 73% (129/177) who returned the self-collected cervicovaginal sample for HPV testing. Among the under-screened population, there was a higher response rate in aged ≥45 than those aged 25-35. The findings also revealed that women who were under-screened, including those who have never been screened, were more likely to prefer HPV self-sampling than those who had regular screening. This study found that the acceptability of HPV self-sampling was fairly positive among the respondents. The findings also indicated that HPV self-sampling was not only beneficial to enhance their health awareness but also to promote the cervical cancer screening uptake rate, especially among the under-screened or never screened populations. Conclusions: HPV self-sampling would be a solution to overcome the perceived barriers in clinician-based screening. The findings also indicated that it could be feasible to use as an alternative primary cervical cancer screening.


Assuntos
Programas de Rastreamento/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Grupos Populacionais/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Estudos Transversais , Detecção Precoce de Câncer , Estudos de Viabilidade , Feminino , Hong Kong/epidemiologia , Humanos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Infecções por Papillomavirus/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Preferência do Paciente , Autocuidado , Manejo de Espécimes , Neoplasias do Colo do Útero/etnologia , Esfregaço Vaginal , Saúde da Mulher
2.
Cancer Causes Control ; 31(10): 931-941, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32803402

RESUMO

PURPOSE: Practice-based guidelines recommend HIV testing during initial invasive cervical cancer (ICC) workup. Determinants of HIV testing during diagnosis of AIDS-defining cancers in vulnerable populations, where risk for HIV infection is higher, are under-explored. METHODS: We examine factors associated with patterns of HIV testing among Medicaid enrollees diagnosed with ICC. Using linked data from the New Jersey State Cancer Registry and New Jersey Medicaid claims and enrollment files, we evaluated HIV testing among 242 ICC cases diagnosed from 2012 to 2014 in ages 21-64 at (a) any point during Medicaid enrollment (2011-2014) and (b) during cancer workup 6 months pre ICC diagnosis to 6 months post ICC diagnosis. Logistic regression models identified factors associated with HIV testing. RESULTS: Overall, 13% of women had a claim for HIV testing during ICC workup. Two-thirds (68%) of women did not have a claim for HIV testing (non-receipt of HIV testing) while enrolled in Medicaid. Hispanic/NH-API/Other women had lower odds of non-receipt of HIV testing compared with NH-Whites (OR: 0.40; 95% CI: 0.17-0.94). Higher odds of non-receipt of HIV testing were observed among cases with no STI testing (OR: 4.92; 95% CI 2.27-10.67) and < 1 year of Medicaid enrollment (OR: 3.07; 95% CI 1.14- 8.26) after adjusting for other factors. CONCLUSIONS: Few women had HIV testing claims during ICC workup. Opportunities for optimal ICC care are informed by knowledge of HIV status. Further research should explore if lack of HIV testing claims during ICC workup is an accurate indicator of ICC care, and if so, to assess testing barriers during workup.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Grupo com Ancestrais do Continente Europeu , Feminino , Infecções por HIV/complicações , Infecções por HIV/etnologia , Hispano-Americanos , Humanos , Modelos Logísticos , Medicaid , Pessoa de Meia-Idade , Sistema de Registros , Estados Unidos , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/etiologia , Adulto Jovem
3.
BMC Womens Health ; 20(1): 141, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631299

RESUMO

BACKGROUND: Male spouses and partners play an important role in determining a woman's willingness to participate in cervical cancer screening. However, the attitudes and behaviors by which they influence a woman's decision to undergo Pap testing remain poorly understood. METHODS: A series of semi-structured, qualitative interviews were conducted in Spanish with 19 recent Latino immigrants in Houston, Texas. The interview format was designed to establish each individual's pattern of engagement with the United States healthcare system, assess baseline knowledge of cervical cancer screening and evaluate attitudes and patterns of communication with their female partners regarding health care. Interview questions were constructed using principles of the Theory of Reasoned Action. All interviews were conducted in Spanish. After translation, responses were coded and scored with the goal of identifying themes and key observations. RESULTS: Most subjects reported few, if any, interactions with the healthcare system since their arrival in the United States. Although most participants reported being aware that women should be seen by their doctors regularly, fewer than half could clearly indicate the purpose of a Pap test or could state with certainty the last time their female partner had undergone screening. Multiple subjects expressed a general distrust of the health care system and concern for its costs. Approximately half of subjects reported that they accompanied their female partner to the health care provider's office and none of the participants reported that they were present in examination rooms at the time their partner underwent screening. Multiple participants endorsed that there may be some concerns within their community regarding women receiving frequent gynecologic care and distrust of the healthcare system. Almost all interviewed subjects stated that while they would allow their female partners to see male physicians, they also expressed the opinion that other men might be uncomfortable with this and that women would likely be more comfortable with female physicians. CONCLUSIONS: Strategies to enhance knowledge of HPV and cancer screening and improve trust in the health care system among male spouses or partners should be explored with the goal of promoting cervical cancer screening among immigrant Latinx populations.


Assuntos
Emigrantes e Imigrantes , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Programas de Rastreamento/psicologia , Neoplasias do Colo do Útero/diagnóstico , Detecção Precoce de Câncer , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Teste de Papanicolaou , Pesquisa Qualitativa , Texas/epidemiologia , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/psicologia , Esfregaço Vaginal/psicologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-32369999

RESUMO

Adequate health literacy is a necessity to enable effective decision making to seek, access and utilise appropriate health care service. Evidence exists indicating a low level of general health literacy among Black African women, especially those with a refugee background. Breast and cervical are the most common cancers, with Black African women or women with African ethnicity being disproportionately overrepresented. The level of health literacy specific to breast and cervical cancer among Black African women, especially those with a refugee background, has not been reviewed systematically. The present study describes a protocol for a systematic review of the available evidence on the level of health literacy specific to breast and cervical cancer among Black African women globally. We will perform a systematic review of the available quantitative and qualitative studies. The search will include studies that describe the level of health literacy specific to breast and cervical cancer among Black African women. We will conduct a preliminary search on Google scholar to build the concepts for search terms, and a full search strategy using the identified concepts and keywords across four databases namely PubMed, SCOPUS, CINAHL and Web of Sciences. We will use Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to schematically present the search strategy. We will use the standardized Joanna Briggs Institute quality appraisal and selection tool to recruit studies, and the data extraction tool to synthesise the information extracted from the recruited studies. We will be guided by socioecological theory and Indigenous epistemology to synthesise the non-quantifiable information thematically, and pool the quantitative information using meta-analysis, based on the availability of information.


Assuntos
Afro-Americanos , Neoplasias da Mama , Letramento em Saúde , Neoplasias do Colo do Útero , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etnologia , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia
5.
BMC Womens Health ; 20(1): 70, 2020 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-32252733

RESUMO

BACKGROUND: In Ethiopia, cervical cancer is the second most frequent cancer among women aged 15 to 44 years old. Cervical cancer screening is an effective measure to enhance the early detection of cervical cancer for prevention. However, the magnitude of cervical cancer screening is less than 1%. This study aimed to determine the influence of sociodemographic characteristics and related factors on screening. METHOD: A hospital-based cross-sectional study has been conducted from July to September 2017. Data have been collected using interviewer-administered questioner among 425 women (18-49 years age) who visited the family health department at St. Paul's Hospital. Descriptive statistics, chi-square, univariate and multivariate logistic regression were used for data analysis. RESULT: Of the 425 study participants, only 12.2% of women have been screened within the past 3 years. Women in the age range of 40-49 years old were more likely to be screened (36.1%) than women age 18-29 years (8%). Women living in urban were more likely to be screened (15.9%) than women living in rural (3.9%). Other factors including low monthly income, unlikely chance of having cancer, lack of knowledge, and fear test outcome were significantly associated with the low uptake of screening. CONCLUSION: This study revealed that the uptake of cervical cancer screening was low. Women in the potential target population of cervical cancer screening were just a proportion of all studied age groups and screening in them was more common than in younger women. Besides, rural residence, low monthly income, and lack of knowledge were important predictors for low utilization of cervical cancer screening practice.


Assuntos
Detecção Precoce de Câncer , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Gravidez , Encaminhamento e Consulta , Fatores Socioeconômicos , Inquéritos e Questionários , Neoplasias do Colo do Útero/etnologia , Adulto Jovem
6.
Medicine (Baltimore) ; 99(11): e19433, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176070

RESUMO

BACKGROUND: Number of studies have been performed to evaluate the relationship between the cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) gene variant rs5742909 polymorphism and cervical cancer risk, but the sample size was small and the results were conflicting. This meta-analysis was conducted to comprehensively evaluate the overall association. METHODS: PubMed, Web of Science, Embase, China Biology Medical Literature database, China National Knowledge Infrastructure, WanFang, and Weipu databases were searched before July 31, 2018. The strength of associations was assessed using odds ratios (ORs) and 95% confidence intervals (CIs). All of the statistical analyses were conducted using Review Manager 5.3 and Stata 14.0. RESULTS: Eleven studies involved 3899 cases and 4608 controls. Overall, significant association was observed between the CTLA-4 gene variant rs5742909 polymorphism and cervical cancer (T vs C: OR = 1.40, 95% CI = 1.12-1.76; TT vs CC: OR = 2.22, 95% CI = 1.13-4.37; TT vs CT+CC: OR = 1.96, 95% CI = 1.03-3.74; TT+CT vs CC: OR = 1.47, 95% CI = 1.14-1.90). In subgroup analysis by ethnic group, a statistically significant association was observed in Asians (T vs C: OR = 1.56, 95% CI = 1.22-1.99), but not in Caucasians (T vs C: OR = 1.19, 95% CI = 0.87-1.62). The sensitivity analysis confirmed the reliability and stability of the meta-analysis. CONCLUSION: our meta-analysis supports that the CTLA-4 gene variant rs5742909 polymorphism might contribute to individual susceptibility to cervical cancer in Asians.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Antígeno CTLA-4/genética , Predisposição Genética para Doença/etnologia , Polimorfismo de Nucleotídeo Único , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/genética , Feminino , Humanos
7.
BMC Womens Health ; 20(1): 55, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-32192493

RESUMO

BACKGROUND: Self-sampling for HPV testing may be a method to increase overall cervical cancer screening rates among Black women, who are underscreened for cervical cancer in parts of the US. The purpose of this study was to assess preferred characteristics for delivery of HPV self-sampling kits, return of HPV self-sampling kits, and communication of HPV test results and explore sociodemographic factors (income, education, and marital status) associated with acceptability of self-sampling for HPV testing. METHODS: Survey data were gathered at an Indiana minority health fair. Participants evaluated 9 scenarios that varied along 3 dimensions: HPV self-sampling kit delivery (mail, pharmacy pick-up, or clinic pick-up), HPV self-sampling kit return (mail, pharmacy drop-off, or clinic drop-off), and HPV test results (mail, phone call, or text message). The 9 scenarios were produced from a fractional factorial design and rated on a 0 to 100 scale. Ratings-based conjoint analysis (RBCA) determined how each dimension influenced ratings. A measure for acceptability of self-sampling was obtained from the ratings of all 9 scenarios. The acceptability measure was regressed on sociodemographics. RESULTS: The 98 participants ranged in age from 21 to 65 (M = 45). Across the 9 scenarios, overall acceptability to self-sample had a mean of 60.9 (SD = 31.3). RBCA indicated that HPV self-sampling kit return had the most influence on ratings, followed by HPV self-sampling kit delivery, and finally, HPV test result communication. Thirty-six percent of participants rated all self-sampling scenarios the same. Sociodemographic characteristics were not associated with acceptability of self-sampling. CONCLUSIONS: Self-sampling for HPV testing was found to be generally acceptable to Black women in this pilot survey study. This information could be used by researchers developing self-sampling interventions and the implementation of self-sampling among providers.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Autocuidado , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Feminino , Humanos , Indiana/epidemiologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/etnologia , Infecções por Papillomavirus/prevenção & controle , Manejo de Espécimes , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal
8.
Int J Equity Health ; 19(1): 42, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32216799

RESUMO

INTRODUCTION: Resource-constrained countries (RCCs) have the highest burden of cervical cancer (CC) in the world. Nonetheless, although CC can be prevented through screening for precancerous lesions, only a small proportion of women utilise screening services in RCCs. The objective of this study was to examine the magnitude of inequalities of women's knowledge and utilisation of cervical cancer screening (CCS) services in RCCs. METHODS: A total of 1,802,413 sample observations from 18 RCC's latest national-level Demographic and Health Surveys (2008 to 2017-18) were analysed to assess wealth-related inequalities in terms of women's knowledge and utilisation of CCS services. Regression-based decomposition analyses were applied in order to compute the contribution to the inequality disparities of the explanatory variables for women's knowledge and utilisation of CCS services. RESULTS: Overall, approximately 37% of women had knowledge regarding CCS services, of which, 25% belonged to the poorest quintile and approximately 49% from the richest. Twenty-nine percent of women utilised CCS services, ranging from 11% in Tajikistan, 15% in Cote d'Ivoire, 17% in Tanzania, 19% in Zimbabwe and 20% in Kenya to 96% in Colombia. Decomposition analyses determined that factors that reduced inequalities in women's knowledge of CCS services were male-headed households (- 2.24%; 95% CI: - 3.10%, - 1.59%; P < 0.01), currently experiencing amenorrhea (- 1.37%; 95% CI: - 2.37%, - 1.05%; P < 0.05), having no problems accessing medical assistance (- 10.00%; 95% CI: - 12.65%, - 4.89%; P < 0.05), being insured (- 6.94%; 95% CI: - 9.58%, - 4.29%; P < 0.01) and having an urban place of residence (- 9.76%; 95% CI: - 12.59%, - 5.69%; P < 0.01). Similarly, factors that diminished inequality in the utilisation of CCS services were being married (- 8.23%;95% CI: - 12.46%, - 5.80%; P < 0.01), being unemployed (- 14.16%; 95% CI: - 19.23%, - 8.47%; P < 0.01) and living in urban communities (- 9.76%; 95% CI: - 15.62%, - 5.80%; P < 0.01). CONCLUSIONS: Women's knowledge and utilisation of CCS services in RCCs are unequally distributed. Significant inequalities were identified among socioeconomically deprived women in the majority of countries. There is an urgent need for culturally appropriate community-based awareness and access programs to improve the uptake of CCS services in RCCs.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Renda/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia , Adulto , Países em Desenvolvimento , Feminino , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários
9.
Gynecol Oncol ; 157(1): 167-172, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31983517

RESUMO

OBJECTIVE: The Moore Criteria is a prognostic index for recurrent or metastatic cervical cancer based on five factors. The criteria were developed retrospectively and validated prospectively in clinical trial populations receiving systemic chemotherapy (C). Our objective was to evaluate the prognostic value of the Moore Criteria in a largely minority, non-trial population at first recurrence. METHODS: Patients treated for recurrent cervical cancer diagnosed between 2012 and 2017 were analyzed retrospectively. Progression free survival (PFS) was defined from the date of recurrence to date of second recurrence. Overall survival (OS) was defined from the date of recurrence to date of death. RESULTS: Of 274 patients identified, 78 were treated in the second line. 48 (61.5%) were Hispanic, 22 (28.2%) were black, and 7 (9%) were white non-Hispanic. By Moore criteria, 9 patients (11.5%) were classified as low-risk, 48 (61.5%) as moderate risk, and 21 (26.9%) as high-risk. 53 patients (67.9%) received C, and 25 (32.1%) received other treatment modalities without C. The high-risk category carried a significantly higher hazard ratio for both PFS (5.24, p < .001) and OS (3.15, p = .002) compared with the low- and intermediate-risk combined group. The low- and intermediate-risk groups demonstrated 78.9% response rate, compared with 33.3% in the high-risk category (p = .001). Black race did not affect survival or response rate. CONCLUSION: The Moore Criteria carries prognostic value across a diverse recurrent cervical cancer population outside of the clinical trial setting. Our data suggest that in a non-trial population, black race is not predictive of worse OS or PFS.


Assuntos
Modelos Estatísticos , Recidiva Local de Neoplasia/mortalidade , Neoplasias do Colo do Útero/mortalidade , Adulto , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etnologia , Recidiva Local de Neoplasia/terapia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/terapia , Adulto Jovem
10.
J Womens Health (Larchmt) ; 29(7): 996-1006, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31928405

RESUMO

Purpose: Health-related behaviors among underweight women have received less attention than overweight and obese women in the United States. Our purposes were to estimate the rate and modifiers of breast, cervical, and colorectal cancer screening adherence among underweight women and compare it to other body mass index (BMI) categories. Materials and Methods: We used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System (BRFSS) of age-eligible women (breast cancer screening, n = 163,164; cervical, n = 113,883 and colorectal, n = 128,287). We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force (USPSTF) guidelines. We calculated the prevalence of screening among four BMI categories (underweight <18.5, normal weight ≥18.5 to <25, overweight ≥25 to <30, and obese ≥30). Logistic regression models assessed the independent effect of BMI on screening adherence. Results: Underweight women had significantly lower breast (62.9%), cervical (67.5%), and colorectal (62.6%) cancer screening rates compared to other BMI categories. In logistic regression models, being underweight was associated with decreased odds of breast (odds ratio [OR] = 0.66; 95% confidence interval [CI] = 0.49-0.88) and cervical (OR = 0.54, 95% CI = 0.34-0.84), but not colorectal (OR = 0.88; 95% CI = 0.66-1.18) cancer screening adherence. We did not demonstrate a significant association between obesity and screening rates for any of the three cancers. Underweight women reported higher rates of smoking and lower levels of educational attainment, income, and insurance coverage compared to all other groups. Higher rates of chronic illness and health access hardship were observed among underweight women. Conclusion: BMI variably affects cancer screening. Compared to normal-weight women, being underweight is associated with breast and cervical cancer screening nonadherence. Promoting breast and cervical cancer screening among this currently underserved population may reduce future disparities.


Assuntos
Índice de Massa Corporal , Neoplasias da Mama/prevenção & controle , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/estatística & dados numéricos , Comportamentos Relacionados com a Saúde/etnologia , Programas de Rastreamento/estatística & dados numéricos , Cooperação do Paciente/psicologia , Participação do Paciente/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etnologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/etnologia , Feminino , Humanos , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Exame Físico/estatística & dados numéricos , Fatores de Risco , Magreza/epidemiologia , Estados Unidos/etnologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia , Esfregaço Vaginal/estatística & dados numéricos , Saúde da Mulher
11.
Gynecol Obstet Invest ; 85(2): 153-158, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31825934

RESUMO

BACKGROUND: Some previous studies already explored associations between tumor necrosis factor-α (TNF-α) polymorphisms and cervical cancer, with conflicting findings. OBJECTIVES: Here, we aimed to better analyze the relationship between TNF-α polymorphisms and cervical cancer in a larger combined population by performing a meta-analysis. METHODS: We searched PubMed, Embase, Web of Science, and CNKI for related articles. We calculated OR and 95% CI to estimate whether there are genetic associations between TNF-α polymorphisms and cervical cancer. RESULTS: Twenty-seven studies were included for this meta-analysis. TNF-α -308 G/A (dominant comparison: p = 0.0004, OR 0.71, 95% CI 0.58-0.86; recessive comparison: p = 0.0002, OR 1.46, 95% CI 1.19-1.79; overdominant comparison: p = 0.002, OR 1.37, 95% CI 1.12-1.68; allele comparison: p < 0.0001, OR 0.72, 95% CI 0.62-0.83) polymorphism was found to be significantly associated with cervical cancer in general population. Subgroup analyses showed similar positive findings for -308 G/A polymorphism in both Asians and Caucasians. Moreover, we found that -238 G/A polymorphism was also significantly associated with cervical cancer in Asians. CONCLUSIONS: This meta-analysis proved that TNF-α -238 and -308 G/A polymorphisms could be used to identity individual with elevated susceptibility to cervical cancer in certain populations.


Assuntos
Predisposição Genética para Doença/genética , Polimorfismo de Nucleotídeo Único , Fator de Necrose Tumoral alfa/genética , Neoplasias do Colo do Útero/genética , Alelos , Grupo com Ancestrais do Continente Asiático/genética , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Predisposição Genética para Doença/etnologia , Humanos , Neoplasias do Colo do Útero/etnologia
13.
Public Health ; 178: 1-4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31593783

RESUMO

OBJECTIVES: The objectives of this study were to reveal the screening uptake of South Asian women who had participated in the community-based multimedia intervention and to identify the reasons among those women who remained unscreened after receiving the intervention. STUDY DESIGN: This was a cross-sectional study. METHODS: South Asian women (Indian, Pakistani and Nepalese) who had attended a community-based multimedia intervention and who agreed to participate in a follow-up telephone survey were contacted. A structured telephone survey was conducted to collect data on their screening uptake status. RESULTS: There were altogether 371 women who completed the survey. Before attending the intervention, 220 of them had never had a Pap test. After the intervention, 75 of those 220 women (34.1%) decided to attend screening, of which 43 underwent their first Pap test, while 32 made their first Pap test appointment. Among those 151 women who previously underwent screening, 76 of them completed the screening or had scheduled a repeated test. Perceived barriers to screening such as lack of time, language barriers and perception that it was unnecessary to attend screening remained the major reasons for women who were not screened. CONCLUSION: Some South Asian women started to have their first Pap test, while some continued to attend screening after the intervention. As barriers that affect women's screening participation still exist, continuous and sustainable efforts should be made to improve the overall screening uptake.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Serviços de Saúde Comunitária/métodos , Detecção Precoce de Câncer/psicologia , Multimídia , Teste de Papanicolaou/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Neoplasias do Colo do Útero/etnologia , Adulto , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Estudos Transversais , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde , Humanos , Teste de Papanicolaou/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Neoplasias do Colo do Útero/prevenção & controle
14.
Am J Health Promot ; 34(1): 15-24, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31455085

RESUMO

PURPOSE: To determine whether group education is as effective as individual education in improving cervical cancer screening uptake along the US-Mexico border. DESIGN: Cluster randomized controlled study. SETTING: El Paso and Hudspeth Counties, Texas. PARTICIPANTS: Three hundred women aged 21 to 65 years, uninsured, due for a Pap test, no prior history of cervical cancer or hysterectomy. INTERVENTION: Theory-based, culturally appropriate program comprised of outreach, educational session, navigation services, and no-cost cervical cancer testing. MEASURES: Baseline, immediate postintervention, and 4-month follow-up surveys measured knowledge and theoretical constructs from the Health Belief Model, Theory of Reasoned Action, and the Social Cognitive Theory. ANALYSIS: Relative risk regression analyses to assess the effects of educational delivery mode on the uptake of screening. Mixed effect models to analyze changes in psychosocial variables. RESULTS: One hundred and fifty women assigned to each educational group; 99% Hispanic. Of all, 85.7% completed the follow-up survey. Differences in screening rate at follow-up were analyzed by education type. Overall screening rate at follow-up was 73.2%, no significant difference by education type (individual: 77.6%, group: 68.9% P = .124). Significant increases among group education at follow-up for knowledge, perceived susceptibility, perceived seriousness, and subjective norms and significant decrease for perceived benefits. CONCLUSION: This study provides evidence to support the effectiveness of group education to promote cervical cancer screening among vulnerable Hispanic women and offers an additional method to address cervical cancer disparities.


Assuntos
Competência Cultural , Detecção Precoce de Câncer , Educação em Saúde , Hispano-Americanos , Programas de Rastreamento , Área Carente de Assistência Médica , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Idoso , Análise por Conglomerados , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , México/etnologia , Pessoa de Meia-Idade , Texas , Adulto Jovem
15.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1439-1444, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838818

RESUMO

Objective: To understand the infection rate and genotype distribution of high risk-human papillomavirus (HR-HPV) and the detection rate of different grades of cervical lesions in Han and Mongolian women in China and provide evidence for the development of screening and vaccination strategies for the prevention and control of cervical cancer in different ethnic groups. Methods: In June 2017, a multicenter, population-based study for cervical cancer screening in low-resource settings in China was conducted in three rural areas: Xiangyuan and Yangcheng counties in Shanxi province, and Etuoke county in Inner Mongolia Autonomous Region. A total of 9 517 women aged 30-65 years were included in the study, and two cervical and vaginal secretion samples were collected from them for HPV and PCR-based HPV DNA tests. The positive samples in any of two tests were used for PCR-based HPV genotyping test by using Sansure-pioneered One-Step Fast Release technology. Women with positive results in any the HPV tests were referred for colposcopy and punch biopsy was given if cervical intraepithelial neoplasia lesion (low-grade lesion or worse) was suspected in colposcopy evaluation. Endocervical curettage was performed if women had an unsatisfactory colposcopy exam (the squamocolumnar junction was not completely visible). Pathological detection result was used as the golden standard of diagnosis. Results: HR-HPV infection rates in Han and Mongolian women were 21.83% (1 842/8 438) and 24.93% (269/1 079), respectively. There were statistical differences in HPV infection rates between the two ethnic groups (χ(2)=5.328, P=0.021). The detection rate of cervical intraepithelial neoplasia grade 1 in Mongolian women (2.83%) was higher than that in Han women (0.87%), and the difference was statistically significant (χ(2)=33.509, P<0.001). There were no significant differences in cervical intraepithelial neoplasia grade 2 or worse detection rate between the two ethnic groups [Mongolian woman: 1.04% (11/1 059), Han Woman: 0.95% (80/8 378), χ(2)=0.069, P=0.793]. Among Han and Mongolian women with cervical intraepithelial neoplasia grade 2 or worse, the three most common HR-HPV types were HPV16, HPV52 and HPV58. There was no significant difference for multiple infection rate between Han and Mongolian women (41.37% vs. 44.35%, χ(2)=0.764, P=0.382). Conclusions: The results show that HPV infection rate in Mongolian women was higher than that in Han women. Close attention should be paid to HPV16, 52 and 58 in the prevention and control of cervical cancer in Han and Mongolian women.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/virologia , Lesões Pré-Cancerosas/virologia , Neoplasias do Colo do Útero/virologia , Adulto , Idoso , China/epidemiologia , Colposcopia , Detecção Precoce de Câncer , Feminino , Genótipo , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Humanos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Papillomaviridae/classificação , Infecções por Papillomavirus/etnologia , Infecções por Papillomavirus/genética , Reação em Cadeia da Polimerase , Vigilância da População , Lesões Pré-Cancerosas/etnologia , Lesões Pré-Cancerosas/genética , Gravidez , Prevalência , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/genética
16.
J Health Care Poor Underserved ; 30(4): 1331-1359, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31680101

RESUMO

BACKGROUND: In Canada, data on race/ethnicity are not routinely collected. Black Canadian women may be under-screened for cervical/breast cancer and may be predisposed to worse outcomes, however data are difficult to find. OBJECTIVES: A scoping review was conducted to identify common themes and gaps in the literature regarding cervical/breast cancer prevention and management in Black Canadian women. METHODS: Medline, Embase, the Cochrane Library, CINAHL, PsycINFO, and Scopus databases (2003-2018) and grey literature were searched. Relevant studies were selected, data were charted, and themes were extracted. RESULTS: Twenty-three studies met inclusion criteria. Women from sub-Saharan Africa appear to have lower cervical and breast cancer screening rates; those of Caribbean/Latin American origin appear to have screening rates comparable to the general population; no studies reported prevalence or mortality rates for Black Canadian women. CONCLUSION: There is a paucity of health research on breast and cervical cancer specific to Black Canadian women.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Neoplasias da Mama/terapia , Neoplasias do Colo do Útero/terapia , Neoplasias da Mama/etnologia , Neoplasias da Mama/prevenção & controle , Canadá , Feminino , Humanos , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/prevenção & controle
17.
Afr J Prim Health Care Fam Med ; 11(1): e1-e6, 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31588773

RESUMO

BACKGROUND: Cervical cancer is the most common form of cancer in black women in South Africa and has almost a 60% mortality rate. However, adherence to cervical screening programmes of black women living in rural South Africa is not universal. AIM: The aim of this study was to gain a better understanding of rural Zulu women's knowledge of and attitudes towards Pap smear tests, and their reasons for participation or non-compliance with cervical screening. SETTING: This study was conducted at the gynaecology and antenatal clinics in a secondary referral hospital in rural KwaZulu-Natal. METHODS: A hospital-based cross-sectional study was undertaken in the form of a semi-structured patient questionnaire survey with open and closed questions. The responses to the open-ended questions were manually analysed by the authors using a thematic approach. Outcome measures included whether the woman had a previous Pap smear, her understanding of the cervical screening programme and causes of cervical cancer. RESULTS: This study included a total analysis of 234 responses. The mean age was 29 years (s.d. = 8.3 years). Overall, 32.5% of women had previously had a Pap smear. Among the responders, 33.3% were human immunodeficiency virus (HIV)-positive and 53.0% were HIV-negative. Only 19.2% of women understood that a Pap smear was related to screening for cervical cancer. CONCLUSIONS: This study illustrated a poor understanding of cervical screening, which may result in the low level of uptake of Pap smear reported; this is particularly concerning in HIV-positive women, who are at higher risk of developing cervical cancer. Urgent and extensive public health campaigning is required within rural South Africa to improve cervical screening uptake and decrease cervical cancer mortality.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Teste de Papanicolaou/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Anticoncepção , Estudos Transversais , Feminino , Infecções por HIV/etnologia , Humanos , Pessoa de Meia-Idade , População Rural , Fatores Socioeconômicos , África do Sul , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/etnologia , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-31569670

RESUMO

Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20-64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29-67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia's public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.


Assuntos
Detecção Precoce de Câncer/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde do Indígena/normas , Disparidades em Assistência à Saúde/estatística & dados numéricos , Grupo com Ancestrais Oceânicos , Atenção Primária à Saúde/normas , Adulto , Austrália/epidemiologia , Auditoria Clínica , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Seguimentos , Serviços de Saúde do Indígena/estatística & dados numéricos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Melhoria de Qualidade , Neoplasias do Colo do Útero/etnologia , Adulto Jovem
19.
Cancer Epidemiol ; 63: 101620, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31634776

RESUMO

BACKGROUND: Little is known about outcomes in patients after being hospitalized for care of cancer or comorbid conditions and the disparity between African-American and White cervical cancer patients. METHODS: Using the national inpatient sample (HCUP-NIS) database of the Healthcare Cost and Utilization Project between 2002-2014, we included 5217 African-American and 21,752 White patients hospitalized with a primary diagnosis of cervical cancer. We examined racial differences in hospitalization outcomes; length of stay (LOS) in hospital, mortality in hospital, post-operative complications in patients who underwent hysterectomy and discharge disposition. Patients were matched on age at primary diagnosis, insurance status, residential region, and median income of residential area, modified Deyo comorbidity index, stage of disease and treatment. Categorical outcomes were analyzed by conditional logistic regression accounting for matched study design and odds ratios (95%CI) were reported. LOS was analyzed using t-test and beta estimate for difference in means was reported. RESULTS: The LOS was significantly lower for Whites compared to African-American cervical cancer patients when matched on demographic only (ß=-0.41, p-value<0.0005, presentation + demographic (ß=-0.41, p-value<0.0006) and treatment + presentation + demographic variables (ß=-0.46, p-value<0.0001). White cervical cancer patients were commonly discharged to other intermediate nursing facility (OR = 1.30, 95%CI = 1.20-1.41, matched on demographic only; OR = 1.31, 95%CI = 1.21-1.43, matched on presentation + demographic; and OR = 1.32, 95%CI = 1.22-1.43), matched on treatment + presentation + demographic). Similar trends were seen in both older (≥65 years) and younger (<65 years) patients, when stratified by age. CONCLUSION: Disparities in hospitalization outcomes in cervical patients are not observed when different characteristics of African-American and White cervical patients are accounted for and matched.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia , Neoplasias do Colo do Útero/terapia
20.
Obstet Gynecol ; 134(3): 559-569, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31403593

RESUMO

OBJECTIVE: To evaluate the effects of race and insurance status on the use of brachytherapy for treatment of cervical cancer. METHODS: This is a retrospective cohort study of the National Cancer Database. We identified 25,223 patients diagnosed with stage IB2 through IVA cervical cancer who received radiation therapy during their primary treatment from 2004 to 2015. A univariate analysis was used to assess covariate association with brachytherapy. A multivariable regression model was used to evaluate the effect of race and insurance status on rates of brachytherapy treatment. The Cox proportional hazards model and the multiplicative hazard model were used to evaluate overall survival. P<.05 indicated a statistically significant difference for comparisons of primary and secondary outcomes. RESULTS: Non-Hispanic black patients received brachytherapy at a significantly lower rate than non-Hispanic white patients (odds ratio [OR] 0.93; 95% CI 0.86-0.99; P=.036); Hispanic (OR 0.93; 95% CI 0.85-1.02; P=.115) and Asian (OR 1.13; 95% CI 0.99-1.29; P=.074) patients received brachytherapy at similar rates. Compared with patients with private insurance, those who were uninsured (OR 0.72; 95% CI 0.65-0.79; P<.001), had Medicaid (OR 0.83; 95% CI 0.77-0.89; P<.001) or Medicare insurance (OR 0.85; 95% CI 0.78-0.92; P<.001) were less likely to receive brachytherapy. Brachytherapy was not found to be a mediator of race and insurance-related disparities in overall survival. CONCLUSION: Racial and insurance disparities exist for those who receive brachytherapy, with many patients not receiving the standard of care, but overall survival was not affected.


Assuntos
Braquiterapia/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/radioterapia , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Feminino , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Estados Unidos , Neoplasias do Colo do Útero/etnologia
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