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PubMedDate not supplied

Cervical screening: patients' negative attitudes and experiences.

BACKGROUND: This article explores the negative attitudes some women have towards the cervical screening programme. These attitudes could ultimately prevent them from participating in the programme. The negative experiences of women who receive a positive result are also explored. CONCLUSION: Women's negative attitudes towards cervical screening can largely be countered by improving their understanding of the process and diagnosis of cervical cancer. Women who receive a positive smear should be offered support to reduce their anxiety.

Attitude to Health↗
PubMed1992

Cervical screening: what do Auckland general practitioners do?

AIMS: To assess the frequency of cervical screening; average age of screened women and adequacy of decontamination practices of vaginal specula by Auckland general practitioners. METHODS: A random sample of 96 Auckland general practitioners completed a questionnaire at the time of consultation describing the screening history and decontamination practices for vaginal specula from five consecutive patients having a cervical smear test. RESULTS: Of the 96 doctors 68 completed the questionnaire for the five consecutive patients. The majority of women were aged below 50 years and the median time since the last smear for women with a previously normal smear was 18 months. Although the majority of doctors adhered to Health Department guidelines for decontamination, deviations occurred by: reusing plastic specula; using only disinfection as a means of decontamination and not boiling specula for 30 minutes. CONCLUSIONS: The majority of women being screened are young and there is a high level of very frequent screening in women with previously normal smears. Closer adherence to the 1991 cervical screening recommendations and Health Department guidelines for decontamination of vaginal specula is required for some Auckland general practitioners.

Adolescent↗
PubMed1998

[Analysis of the intralaboratory diagnostic variability in the Imola cervical screening program].

The value of the assessment of intralaboratory variability as a method for quality control of cervical screening is an ill-defined one. This model has been advocated and utilized by some Authors and only indirectly addressed by others. In Italy, only occasional studies have been published. The present analysis is part of a series of studies for the evaluation and quality control of the population cervical screening programme in the area of Imola. The agreement between the 5 cytologists was tested over a series of 150 smears selected from the routine material. The data were analyzed with the k statistic and the degree and direction of discrepancies were assessed by the percent distribution of paired diagnoses. The k values for agreement between the 10 possible pairs of cytologists varied between 0.25 and 0.49 (average value, 0.37). The indexes for agreement as based on three classes ('Negative'/ASCUS + LGSIL + HGSIL/'Unsatisfactory') varied from 0.35 to 0.56 (average value, 0.46). The cytologist-specific k values (as based on five classes) ranged from 0.29 to 0.43. For the observer with the lowest specific coefficient (designated as C4), the excess disagreement was restricted to the ASCUS class and the 'Unsatisfactory' notation. In particular, C4 diagnosed more often 'Negative' smears (74% vs. 44-55%) and less frequently ASCUS (11% vs. 22-31%) and 'Unsatisfactory' smears (3% vs. 6-11%). ASCUS was the least reproducible diagnosis (k = 0.22). The evaluation of the degree and direction of the diagnostic discrepancies between the five cytologists showed that the frequency of concordant diagnoses of ASCUS was as low as 39.7%. However, the discrepancies were almost always of one degree and were directed towards the 'Negative' class. Conversely, ASCUS was associated with considerable proportions of the 'Negative' diagnoses (17.3%) and those of LGSIL (31.8%). In the occasions when one observer interpreted a smear as 'Unsatisfactory' the paired diagnoses were almost evenly distributed among 'Unsatisfactory' (49.2%) and 'Negative' (43.0%). In absolute terms, the k coefficients in this study were compatible with moderate agreement. However, they were unfavourably influenced by the modalities for smear selection. The study specimens were selected by all cytologists from the routine material over a short time period and did not include smears interpretable as showing carcinoma. A comprehensive evaluation of the diagnostic performance of C4 showed that the disagreement with other cytologists was restricted to the diagnosis of ASCUS and the 'Unsatisfactory' notation and was accounted for by a lower frequency of such reports coupled with a greater frequency of the 'Negative' diagnoses. A conservative approach to lesions of minor significance is the most likely explanation for that pattern of disagreement. Although characterized by the poorest k value, the ASCUS diagnosis proved to be generally matched with reports of minor cytology changes. This was consistent with the formal definition for ASCUS in the original Bethesda System. The observation that the ASCUS diagnosis is applied to those changes is a prerequisite for a more conservative utilization of such report. In conclusion, the study revealed important correlates of the k coefficients and provided an encouraging picture of the cytologic substrates of the diagnosis of ASCUS.

Carcinoma↗
PubMedDate not supplied

Population-based cervical screening with a 5-year interval in The Netherlands. Stabilization of the incidence of squamous cell carcinoma and its precursor lesions in the screened population.

OBJECTIVE: To evaluate the outcome of population-based cervical screening at 5-year intervals. STUDY DESIGN: Results from the west region of the Netherlands (population 2 million) were used. The 1995-2000 round was compared with the first 2 years of the second (2001-2002). All results were prospectively collected in a central database. Positive cytologies and histoscores per 1,000 screened for preinvasive squamous cervical intraepithelial neoplasia (CIN) lesions and invasive squamous cell carcinoma were calculated. RESULTS: In the first round, 378,081 women were screened; in the second round, 100,561 women were screened. In both rounds the youngest screenees had the highest cytoscores. Cytoscores in the first round did not differ significantly from those in the second. The histoscore for CIN 1 and 2 was 1.42 per 1,000 in the first round and 1.18 per 1,000 (NS, P < .01) in the second. The histoscore for CIN 3 was 2.07 per 1,000 in the first round and 2.13 per 1,000 (NS, P < .01) in the second. Histoscores for invasive squamous cell carcinoma remained virtually the same (0.16 per 1,000 in the first, 0.14 per 1,000 in the second round). CONCLUSION: Population-based screening at 5-year intervals in the Netherlands may result in stabilization of positive cytology and of the incidence of CIN and (histologic) invasive squamous cell carcinoma. The program seems more cost effective than that of 2 decades ago, with a screening interval of 3 years.

Adult↗
PubMed1998

The value of cervical screening in women over 50 years of age--time for a multicentre audit.

This study reviews the cervical smear history of women developing CIN aged over 50 years to consider if they might be discharged sooner from the cervical screening programme in Tayside Region. From the OCCURS database all women over 50 years who developed CIN between 1 Jan 1993 and 30 June 1996 were identified and their smear history obtained. Results show that had women been discharged from the screening programme at age 50 following three consecutive negative smears and a negative exit smear then only two women with CIN 3 and one with microinvasive disease would have been missed in the subsequent three and a half years. A wider geographical survey of the incidence of CIN in this older age group is needed to determine whether it is cost beneficial and cost effective to continue cervical screening beyond the age of 50 years.

Adult↗
PubMed1990

Cervical screening performance in general practice. An evaluation in a single health district.

This paper describes a study of cervical screening in 50 general practices in the East Berkshire Health District over a period of 2 1/2 years. Six practices organized their own practice based screening scheme. Thirty-nine participated in a district organized scheme and five did not actively participate in any scheme. The proportion of women screened was highest among the practices which organized their own scheme. These practices were large, in non-urban locations and employed a practice nurse. In contrast, practices which had a poor record of screening were small, single handed, in an urban location and were unwilling to participate in a district call scheme or organize their own scheme. It is recommended that the practices which are prepared to organize their own screening programmes should be encouraged to do so. The resources which are saved could then be more usefully spent on providing assistance to the practices which do not offer a cervical screening service to women on their practice lists.

Adult↗
PubMedDate not supplied

Cervical screening.

Jane Hurley presents the results of a study that set out to establish women's attitudes towards a cervical screening programme and whether this affected their use of the service. The majority of women participating had used the service, but a clear need for improvement was identified. The need for more information about the purpose of cervical screening was highlighted, as was the need for health professionals to improve their communication skills.

Attitude to Health↗
PubMed2000

[Effectiveness of cervical screening - expectation and reality].

The aim of the present study was to establish the effectiveness of the conducted in Bulgaria cervical screening program for the period 1975-1996. The dynamics of the ratio invasive cancer/in situ cancer, as well as the share of the diagnosed from cytologically signalized women were analyzed. The tendency of deterioration of each of the indices was evident. The crude incidence varies between 12.7 and 22.7 x 10(5) women, while the frequency of CIS is from 3.2 and 6.2 x 10(5) women. This defines unfavorable ratio of the cases with invasive cancer toward CIS, which varies from 2:1 for 1982 to more than 5:1 for 1996 year. The study demonstrates the prevalence of a low rate of confirmed by biopsy, cytologically signalized women--from 15.6% and 30% (total for country--33.3%), except DOD Blagoevgrad--50.6%, Plovdiv--46.4% and Sofia-city--63.8%. The results of our study demonstrate the low effectiveness of to date conducted cervical screening program. The lake of a screening register is another weakness of the program, which lead to a deteriorated registration and reading of the detected precancer lesions, as well as, their diagnostic follow and therapy.

Biopsy↗
PubMed2003

Cervical screening and health inequality in England in the 1990s.

STUDY OBJECTIVE: s: To examine changing inequality in the coverage of cervical screening and its relation to organisational aspects of primary care and to inequality in cervical cancer incidence and mortality. DESIGN: Retrospective time trends analysis (1991-2001) of screening coverage and cervical cancer incidence and mortality in England. SETTING: The 99 district health authorities in England, as defined by 1999 boundaries were used to create a time series of incidence and mortality rates from cervical cancer per 100 000 population. A subset of 60 district health authorities were used to construct a time series of screening coverage data and GP and practice characteristics. Health authorities were categorised into one of three "deprivation" groups using the Townsend Deprivation Index. PARTICIPANTS: Women aged <35 and 35-64 were selected from health authority populations as the main focus of the study. RESULTS: Cervical cancer screening coverage was consistently higher in affluent areas from 1991-9 but ratio rates of inequality between affluent and deprived health authorities narrowed over time. The increase in coverage in deprived areas was most closely associated with an increase in the number of practice nurses. Cervical cancer incidence and mortality rates were consistently higher in deprived health authorities, but inequality decreased. Screening coverage and cervical cancer rates were highly negatively correlated in deprived health authorities. CONCLUSION: A primary health care intervention such as an organised programme of cervical screening can contribute to reducing inequality in population health.

Adult↗
PubMed1991

1991 cervical screening recommendations: a working group report.

The Department of Health and the Cancer Society invited a working group to review the 1985 recommendations on cervical screening. Minor modifications have been made to the earlier recommendations in the light of more information about the effectiveness of different screening policies, and in the expectation that comprehensive cytology registers to ensure recall and follow up of abnormalities will be in place shortly. All women from the age of 20 up to 70 years should be offered cervical screening every three years. Any woman who has never had sexual intercourse or who has had a hysterectomy with complete removal of the cervical epithelium for a benign condition need not be screened. Women should have a second smear within one year if they have never had a smear before or if more than five years have passed since their last smear. But recall through the register should not be more frequently than three yearly for women with a history of normal smears.

Adult↗
PubMed1990

Trends in the organization of cervical cancer screening.

Cervical cytological screening has been available in the UK for several decades, but has not achieved a significant reduction in the incidence of and mortality from cervical cancer. In this paper we describe past problems of cervical screening, discuss the impact of recent innovations to computerize call and recall, and suggest further improvements for the future.

Appointments and Schedules↗
PubMed1994

Intercultural consultations: investigation of factors that deter non-English speaking women from attending their general practitioners for cervical screening.

OBJECTIVES: To determine the factors that deter ethnic minority women living in east London from attending their general practitioner for cervical cytology screening. DESIGN: Qualitative study by means of focus group discussions between October 1993 and March 1994. SETTING: East London. SUBJECTS: Non-health specific established community groups and specially convened groups of Bengali, Kurdish, Turkish, Urdu and Punjabi, and Chinese speaking women. MAIN OUTCOME MEASURES: The spontaneous views of non-English speaking women resident in east London on cervical screening, focusing on attitudes to screening, their experiences of the cervical cytology screening services as currently provided, and their knowledge and beliefs about cervical screening. RESULTS: Some reported attitudinal barriers to cervical cytology screening such as fear of cancer were not deterrents. Administrative and language barriers were more important, as were inadequate surgery premises and concerns about sterility. CONCLUSION: Contrary to popular belief among general practitioners in east London, women from ethnic minorities are enthusiastic about cervical cytology screening once they understand the purpose of the test and the call and recall procedures. It is possible to consult with community groups in their own language through focus group discussions, working with bilingual health advocates who have had a short practical training in facilitating small group discussions. This form of user consultation could be carried out focusing on other aspects of health promotion.

Asia↗
PubMed2004

A population-based study of primary care predictors of non-attendance for cervical screening.

OBJECTIVE: To identify and estimate the population impact of primary care service delivery factors that independently predict non-attendance for cervical screening. SETTING: Screening records of all eligible women aged 30 years and over and resident in the former Manchester Health Authority area were analysed (n=72,613). METHODS: Practice-level and GP-level explanatory variables, along with area-level covariates, were obtained and merged to the study data set. Logistic regression models were used to identify factors associated with having no recorded history of attending NHS cervical screening services. A multivariate model was created to identify independent predictors of non-attendance with comprehensive adjustment for women's age, area-level socio-demographic factors, and other primary care factors. Attributable fraction estimates were used to assess the population impact of the independent predictors. RESULTS: Large practice size (>4,000 patients), single-handed practice, South Asian male GP, part-time GP employment status, older age and birthplace overseas, and area-level measures of deprivation and transience independently predicted non-attendance. Women born overseas and registered at larger practices were especially unlikely to have ever attended. The combined population attributable fraction estimate for the independent predictors reflecting primary care service delivery was almost 40%, and that for all variables in the final model was over 70%. CONCLUSIONS: Independent predictors of non-attendance reflecting general practice structure, workload and GP characteristics were identified. Although relative risks were modest, the collective population impact of these factors was considerable, which has implications for the implementation of informed targeting and the development of new screening services by Primary Care Trusts.

Adult↗
PubMed1990

Increasing cervical screening in women of more than 40 years of age: an intervention in general practice.

An intervention that was aimed at increasing cervical screening in women of more than 40 years of age was undertaken, with general practitioners as the primary point of contact. The intervention consisted of the practice receptionist giving female patients pamphlets about Papanicolaou smear-tests and the general practitioner offering a Papanicolaou smear-test. Nineteen general practitioners and their female patients (n = 466) of more than 40 years of age who presented for consultation over a 10-day period were involved in this study. Each woman in the study was asked when she had last undergone a Papanicolaou smear-test. All women who were found to be "at risk", that is, who had not undergone a Papanicolaou smear-test in the previous two years (57% of those women who were asked) were offered cervical screening. Over-all about 50% of the women who were found to be "at risk" underwent a Papanicolaou smear-test at the general practitioner initiated request, either at the same consultation (26% of those "at risk") or on their return at a later date (23% of those "at risk"). Therefore, the intervention appears to have been effective in encouraging a relatively high-risk group of patients to undergo Papanicolaou smear-tests. However, the strategy was differentially effective depending on age: more women of less than 65 years of age underwent a Papanicolaou smear-test than did women of more than 65 years of age. The feasibility of using the intervention in everyday general practice depends on the willingness of medical practitioners to ask female patients to undergo a Papanicolaou smear-test, the ability to take a Papanicolaou smear during the consultation or soon after, and the acceptance of the invitation by women as based on an understanding of the need.

Adult↗
PubMed1985

Recommendations for routine cervical screening.

Because of concern about the rising incidence of cervical cancer in young women, the Department of Health and the Cancer Society invited a working group to make recommendations on cervical screening. There is now compelling evidence that cytological screening is an effective preventive measure. All women who have had sexual intercourse should be offered screening. They should be screened as soon as possible after commencing sexual activity, or when first receiving contraceptive advice, antenatal care, or treatment of a sexually transmitted disease. If the first smear is negative, it should thereafter be repeated at least every three years. A special effort must be made to reach women who have never been screened, including those who are middle-aged, or elderly. The cervical smear test should be part of the assessment of women with gynaecological symptoms regardless of whether there has been a negative smear within the previous three years. The three-yearly schedule also does not apply to women who have had an abnormal smear.

Adult↗
PubMed1998

Planning and producing an educational videotape on the cervical screening programme in Wales.

Planning and producing an instructional videotape for health care workers require attention to educational principles but also depend on project management skills. The paper describes an approach to the planning and production of a programme on the cervical screening service in Wales that used focus groups to obtain information about needs assessment and developmental testing. Learning objectives need to be married with content accuracy and policy consensus, often difficult to achieve for health care areas such as cervical screening. For these reasons, effective and close liaison is required between sponsor, content experts, scriptwriter, producer and director.

Education, Continuing↗
PubMed2004

Testing positive for human papillomavirus in routine cervical screening: examination of psychosocial impact.

OBJECTIVE: To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening. DESIGN: Cross sectional survey. Measures were taken at baseline and one week after the receipt of HPV and cytology screening results. SETTING: Well women's clinic in London, UK. Population or Sample Four hundred and twenty-eight women aged 20-64 years. METHODS: Postal questionnaire survey. MAIN OUTCOME MEASURES: Psychosocial and psychosexual outcomes were anxiety, distress and feelings about current, past and future sexual relationships. RESULTS: Women with normal cytology who tested positive for HPV (HPV+) were significantly more anxious and distressed than women who were negative (HPV-) using both a state anxiety measure [F(1,267) = 29, P < 0.0001] and a screening specific measure of psychological distress [F(1,267) = 69, P < 0.0001]. Women with an abnormal or unsatisfactory smear result, who tested HPV+, were significantly more distressed than HPV- women with the same smear result [F(1,267) = 8.8, P = 0.002], but there was no significant difference in state anxiety. Irrespective of cytology result, HPV+ women reported feeling significantly worse about their sexual relationships. Approximately one-third of women who tested positive reported feeling worse about past and future sexual relationships compared with less than 2% of HPV- women. CONCLUSION: The findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety, distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening.

Adult↗