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Results for “cervical screening”

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PubMed1993

Rationale for stopping cervical screening in women over 50.

OBJECTIVE: To investigate whether the currently recommended age at which to stop cervical screening (64) can be lowered and what criteria should be used for safely doing so. DESIGN: Retrospective case analysis study. SETTING: Dundee and Angus districts of Scotland. SUBJECTS: Women diagnosed as having cervical intraepithelial neoplasia and microinvasive or invasive cancer of the cervix in 1989 and 1990 (798 cases). MAIN OUTCOME MEASURE: History of cervical cytology results according to age (age groups of five years) and screening interval (three years and five years). RESULTS: Cervical intraepithelial neoplasia was most common in women under 45 (711 cases in women of 45 and under v 38 cases in those of 46 and over). Cervical intraepithelial neoplasia occurring de novo was not seen in women over 50 who had been screened every three years. Microinvasive or invasive cancer of the cervix was diagnosed in 26 women over 50. None of these women had participated adequately in the cervical screening programme. CONCLUSION: Cervical intraepithelial neoplasia typically occurs in younger women. All women over 50 with an adequate history of negative results on smear testing every three years may be safely discharged from further screening if these findings are confirmed in other populations.

Adult↗

PubMed2006

Participation in cervical screening by Indigenous women in the Northern Territory: a longitudinal study.

OBJECTIVE: To investigate the effectiveness of the Northern Territory Women's Cancer Prevention Program in improving cervical screening participation for Indigenous women. DESIGN: Descriptive longitudinal period prevalence study. PARTICIPANTS: All NT resident women aged 20-69 years who had at least one Pap smear recorded on the NT Pap Smear Register between 1997 and 2004. MAIN OUTCOME MEASURES: Indirectly estimated percentage of NT Indigenous women in rural and remote areas with a predominantly Indigenous population (accounting for 55% of the NT Indigenous population) who participated in screening, in biennial periods between 1997 and 2004. Participation by all eligible NT women (both Indigenous and non-Indigenous) is also reported by region for the same period. RESULTS: In 1997-1998, estimated participation for Indigenous women was about half the national rate (33.9% [95% CI, 32.6%-35.2%] v 63.9% [95% CI, 63.8%-63.9%]). Participation increased to 44.0% (95% CI, 42.7%-45.4%) in 1999-2000, and changed little thereafter; participation was higher in the Top End compared with Central Australia, and varied from 16.6% to 75.0% between remote areas. Participation rates for all women living in rural/remote regions were lower than those in urban regions. CONCLUSIONS: Recruitment of Indigenous women for cervical screening has improved since 1999. This may have partly contributed to the fall in their cervical cancer incidence and mortality in recent years. Although in most areas Indigenous participation is lower than national levels, in one area it was considerably higher. Improvements can be achieved by learning from these communities, to further close the gap in morbidity and mortality between Indigenous and non-Indigenous women.

Adult↗

PubMed1988

Cervical screening in an inner city area: response to a call system in general practice.

To determine whether a cervical screening call system based in general practice in a deprived inner city area would increase the numbers of women who came forward for cervical smears the response to letters of invitation for screening was monitored for one year in one general practice in the Paddington and North Kensington district of London. Women aged 20-64 were identified from the computerised age-sex register. Only 16% of these women had had a smear test. A total of 750 call letters was sent out. Initially the response was poor (57 women; 22%), and 85 (32%) letters were returned marked "address unknown." After the age-sex register was updated the response to call was 330 women (44%). The response of women aged over 35 was better than the response of women aged 35 and under (229 (53%) v 101 (32%)). In the year of the study the number of women aged 20-64 on the revised register who had been screened rose by 330 (14%). A general practice based call system can improve uptake of cervical screening even in a highly mobile, socially underprivileged population.

Adult↗

PubMed2004

Media interventions to increase cervical screening uptake in South Africa: an evaluation study of effectiveness.

Successful cervical cancer prevention depends on reaching, screening and treating women with pre-invasive disease. We aimed to evaluate the effectiveness of two media interventions-a photo-comic and a radio-drama-in increasing cervical screening uptake. A randomized controlled trial compared a photo-comic on cervical cancer screening with a placebo comic. One month after the comics were distributed a radio-drama paralleling the photo-comic was broadcast on the community radio station and a retrospective evaluation was carried out. The trial was set in Khayelitsha, a peri-urban squatter community near Cape Town, South Africa. A random sample consisted of 658 women between the ages of 35 and 65 years, from a stratified sample of census areas. The main outcome measure was self-reported cervical screening uptake 6 months after distribution of the comics. Seven percent (18 of 269) of women who received the intervention photo-comic reported cervical screening during the 6 months follow-up, compared with 6% (25 of 389) of controls (P = 0.89). Women who recalled hearing the radio-drama were more likely to report attending screening (nine of 53, 17%) than those who did not (19 of 429, 4%; P < 0.001). We conclude that the photo-comic was ineffective in increasing cervical screening uptake in this population. The radio-drama may have had more impact, but only a minority of women recalled being exposed to it. Future research must concentrate not only on achieving high level of exposure to health messages, but also on investigating the links between exposure and action.

Adult↗

PubMed1997

Video colpography: a new technique for secondary cervical screening.

OBJECTIVE: To assess the diagnostic accuracy of a new technique of cervical imaging and to consider its potential as a secondary cervical screening method. DESIGN: A prospective cross-sectional study with each case acting as its own control, comparing video colpography with colposcopy. SETTING: University of Birmingham colposcopy clinics, City Hospital and Birmingham Women's Hospital. PARTICIPANTS: Fifty women referred for colposcopy. INTERVENTIONS: The women had a video colpogram recording made prior to colposcopy. MAIN OUTCOME MEASURES: The proportion of technically suitable colpograms obtained and the level of agreement between colposcopist and video screener. RESULTS: The images were satisfactory or good in 94% cases, and there was a very high level of agreement between colposcopist and video screener (kappa = 0.79). If the technique had been used in a primary health care setting as a secondary screening method for women with low grade cervical smear abnormalities, 61% would have avoided referral for colposcopy. CONCLUSIONS: Video colpography is an accurate, portable and quick method of cervical imaging. It combines the simplicity of a video camera with the versatility of computerised digital imaging and has great potential in the fields of teaching, audit and screening of low grade smear abnormalities.

Colposcopy↗

PubMed1993

The Fitzroy Valley Pap Smear Register. Cervical screening in a population of Australian aboriginal women.

OBJECTIVE: To describe the operation of the Fitzroy Valley Pap Smear Register, a population-based call and recall system for cervical screening for Aboriginal women, and the prevalence of cervical abnormalities in the women screened. DESIGN: Descriptive study. SETTING: An Aboriginal community in the far north-west of Western Australia. PARTICIPANTS: Aboriginal women aged 15 to 69 years, living in the Fitzroy Valley, Kimberley region. MAIN OUTCOME MEASURES: Proportion of eligible women on the Register; age distribution of women screened; prevalence of squamous cell abnormalities. RESULTS: In December 1990, there were 507 Aboriginal women on the Register, being 86.9% of the Aboriginal women in the Fitzroy Valley aged 15-69 years. During 1990, 53.6% of the target population were screened; 369 Pap smears were taken from 312 Aboriginal women. Seventy-six (24.3%) had never previously been screened. Considering only the first smear for each woman in the study period, 10.6% showed minor abnormalities, and 1.6% (95% confidence interval [CI], 0.2%-3.0%) had cervical intraepithelial neoplasia (CIN I, II or III); 2.6% has smears showing definite evidence of human papillomavirus (HPV) infection. For 15-19 year olds the prevalence of CIN was 4.7% (95% CI, 1.0%-13.3%). CONCLUSIONS: The study shows how an inexpensive call and recall system can ensure good coverage of cervical screening in a group of women who would otherwise be under-screened. The overall prevalence of CIN in Aboriginal women in the Fitzroy Valley was lower than the figure for all Victorian women (3.6%--data from the Victorian Cytology Service). Although the numbers are small, the relatively high prevalence of CIN in young women is of some concern, and emphasises the importance of regular screening in this group.

Adolescent↗

PubMed1988

Preliminary results of a district call scheme for cervical screening organised in general practice.

A recognised problem with the cervical screening programme in the United Kingdom is the failure to include women who have never had a cervical smear test, who are a high risk group. The implementation of a district based call scheme in East Berkshire in 1986 is described whereby women aged 20-64 with no record of a cervical smear test who were judged to be eligible for testing by their general practitioner were sent a personal invitation from their general practitioner to attend for a test. A list of high risk unscreened women was kept by each practice, and a duplicate sent to the cytology laboratory to update the central records. Six months after each batch of invitations had been sent the resulting number of women having a smear test was assessed. Forty three of 51 practices approached agreed to participate in the five year scheme. During the first year lists were sent to the 43 participating practices. The first list was returned to the cytology laboratory by 37 practices and the second by 33; practices varied in their responses, however, some needing considerable persuasion to return the lists. Of 972 identified unscreened women from the total 3757 women listed in the lists of the family practitioner committee, 247 (25%) had a cervical smear test in response to the invitation, representing an overall increase of 7% in the screened population. The preliminary findings of the five year study have shown that screening can be improved by a systematic call scheme. Coordinated support from the area health authority in health education, monitoring of screening, and feedback of data from the scheme to practices is required to reduce the proportion of unscreened women.

Adult↗

PubMed1997

An evaluation of educational outreach to general practitioners as part of a statewide cervical screening program.

OBJECTIVES: The purpose of this study was to determine the acceptability, effectiveness, and cost of a face-to-face educational outreach intervention in the context of a program aimed at increasing cervical screening in Victoria, Australia. METHODS: All identified general practitioners in a specified intervention area were offered a visit by a general practitioner educator. Practitioners completed a questionnaire evaluating the acceptability of the visit. Odds ratios for a woman being screened in the 3 months following the visits were determined. RESULTS: Fifty-nine general practitioners (69.4%) accepted the offer of a visit. Most found both the process and the content of the intervention to be acceptable. The intervention and nonintervention regions did not differ either before or after the intervention. In both regions, there was a statistically significant increase in number of Pap tests performed. There was no difference in the change in screening between the two regions. Costs were estimated at Au$34 per general practitioner visited. CONCLUSIONS: This strategy cannot be recommended for widespread use in a cervical screening program.

Adult↗

PubMed2004

Response patterns to a postal survey using a cervical screening register as the sampling frame.

This study compared different types of respondent to a postal survey. A random sample of women aged 20-64 years (n = 4057) was selected from a population-based cervical screening register to examine their information experience during the screening programme. The initial response rate was 57%, and this increased to 81% after one reminder. Respondents were older (P < 0.0001) than non-respondents, but both groups were comparable with regard to attendance history for cervical screening (respondents 89.3%; non-respondents 89.1%) and normal smear test results (respondents 84.0%; non-respondents 81.4%). Early and late respondents were similar in age. Compared with late respondents, early respondents were more likely to live in highly affluent (P < 0.0001) and rural areas (P = 0.026). They were also more likely to be non-attenders (P < 0.0001), but they were less likely to have had inadequate smear results (P = 0.030) than late respondents. These results suggest that consideration should be given to factors other than sociodemographic differences when examining response patterns to postal surveys.

Adult↗

PubMed2004

Cervical screening in women over the age of 50: results of a population-based multicentre study.

OBJECTIVE: It has been suggested that women over 50 with a satisfactory negative smear history are at low risk for dyskaryosis and might be suitable for withdrawal from the cervical screening programme. The objectives of this study are to document the pattern of dyskaryosis in the cervical smears of women over 50 and to relate the risk of dyskaryosis in these women to the prior smear history. DESIGN: Available computerised smear data were analysed. SETTING: Five regions in England and Scotland; Aberdeen, Dundee, Birmingham, Gateshead and Nottingham. POPULATION: All women aged 50 or over who had a satisfactory smear between 1988 and 1996. METHODS: Smear results were sorted into individual smear records. The first smear after the age of 50 was identified as well as all smears before and after the age of 50. MAIN OUTCOME MEASUREMENTS: The smear history before and after the age of 50 was determined for all women. The relative risk of dyskaryosis as well as the time to dyskaryosis was calculated for women whose raw data were available. RESULTS: The study included 170,436 women with at least one satisfactory smear after 50. No results of previous smears were available in 90,546 (54%) of women but 36,512 (21%) of women had a satisfactory negative smear history. Women with prior dyskaryosis or borderline nuclear abnormalities (BNA) had an increased risk of dyskaryosis after the age of 50 compared with women with a negative history (RR 4.39 and 3.08 respectively). It was notable that 1.8% of women with a negative history still demonstrated subsequent dyskaryosis. CONCLUSIONS: Women with either dyskaryosis or BNA before 50 are not suitable for withdrawal from cervical screening. Well-screened women with a negative smear history at the age 50 still have a residual risk of subsequently developing a new abnormality.

Aged↗

PubMed1993

More information equates with less anxiety. Reducing anxiety in cervical screening.

1. Anxiety may be a factor influencing attendance for cervical screening. 2. Anxiety may be caused by stress and embarrassment of the test procedure and/or misunderstanding its purpose. 3. Women who were given the routine procedure were compared with a study group who were given an extra 10 minutes discussion by nurses. 4. The study group rated the explanation as being clearer, and after receiving the result they reported significantly less anxiety than those in the routine group.

Anxiety↗

PubMed1999

Cervical screening among immigrant Vietnamese women seen in general practice: current rates, predictors and potential recruitment strategies.

OBJECTIVE: To ascertain cervical screening rates among Vietnamese women attending Vietnamese-speaking general practitioners (GPs) in Sydney, their recall of opportunistic recruitment by these GPs and their preferences for strategies to encourage screening. METHOD: Women born in Vietnam aged 18-69 years were recruited through the waiting room of their GP and completed questionnaires in either Vietnamese or Chinese before and after their consultation. RESULTS: Of 355 women seen during the survey period, 170 were ineligible. Of those eligible, 118 women (64% response rate) completed waiting room questionnaires. Of 86 women 'at risk', 56 (65%) reported having a cervical smear within two years or due on that day; 26 (86%) of those 30 women overdue for screening reported visiting a GP at least twice in the past six months. After adjustment for age and education, women who were more acculturated or had resided in Australia for the most years remained significantly more likely to be screened (p = 0.027 and p = 0.037 respectively). In the follow-up questionnaire, returned by 49 women (52%) who agreed to receive it, recall of opportunistic advice from the GP was low. Female GPs, free screening and more information in Vietnamese were the three most popular recruitment strategies. CONCLUSION: Study confirms low participation rates in cervical screening by Vietnamese women using self-report. Recent immigrants and the least acculturated are least likely to be screened. IMPLICATIONS: A community-based strategy involving Vietnamese-speaking GPs shows promise, inviting behavioural evaluation.

Adolescent↗

PubMed1995

Psychological response to cervical screening.

BACKGROUND: Few studies have examined the psychological costs of cervical screening, despite expressed concern over possible negative sequelae. METHODS: Seventy-five women with mild or moderately dyskaryotic smears, under cytological surveillance, 75 women referred for colposcopy after a first-ever abnormal smear showing severe dyskaryosis, and 75 controls with recent negative cytology were interviewed at home, and their psychological adjustment was assessed. RESULTS: Levels of distress were higher among women with an abnormal smear than among controls with a recent negative smear. Anxiety (Hospital Anxiety and Depression Scale range 0-21, "normal" range 0-7) was highest among those referred for colposcopy (mean 8.12, controls 5.88, P < 0.001); afterward, distress fell (mean 6.61, P < 0.001) but more problems of social adjustment were evident (surveillance vs controls, P < 0.01). High anxiety was associated with social maladjustment (colposcopy, P < 0.001; surveillance, P < 0.01) and negative feelings about the self (P < 0.05). Current anxiety was unrelated to knowledge about abnormal smears, but in the surveillance group was related to satisfaction with the explanation provided (P < 0.05). CONCLUSION: A positive cervical smear may by psychologically traumatic for a significant minority of women, irrespective of management strategy.

Adaptation, Psychological↗

PubMed1997

Cleaning the womb: constructions of cervical screening and womb cancer among rural black women in South Africa.

In South Africa problems with current cervical screening uptake, including low coverage and loss of screened women to follow-up, have been identified. This paper presents the findings of an anthropological study of rural Black women's perceptions and understandings of cervical symptomatology, screening and cancer conducted among three different language groups in South Africa. The data collected indicate that women were screened when presenting with symptoms of reproductive tract infection, with the result that for many the smear came to be associated with the diagnosis and treatment of sexually transmitted diseases (STDs). In some cases the smear was said itself to "clean" the womb. The results were often interpreted by women as signifying womb "dirtiness" and confirming the presence of symptomatic reproductive disease for which they had initially presented to the biomedical facility. Several barriers to screening were identified including fear of vaginal exposure, expectation of pain, being asymptomatic, and gender of the practitioner. In addition women perceived womb cancer to be invariably terminal, knowledge which was constructed from personal and community experience of the illness. The illness was closely associated with (usually female) "promiscuity". The authors discuss the implications of the data for healthworkers and health promotion specialists, in particular the association of the smear with STDs, the way in which women are recruited for screening, the perceived terminality of womb cancer, and the processes by which local knowledge about illness is constructed. The findings demonstrate the importance of medical anthropology in contributing towards the provision of effective and locally appropriate healthcare.

Adult↗

PubMed2006

Social and psychological impact of HPV testing in cervical screening: a qualitative study.

OBJECTIVE: Human papillomavirus (HPV) testing has been proposed for inclusion in the UK cervical screening programme. While testing may bring some benefits to the screening programme, testing positive for HPV, a sexually transmitted virus, may have adverse social and psychological consequences for women. The aim of this study was to examine the social and psychological impact of HPV testing in the context of cervical cancer screening. METHOD: In-depth interviews generating qualitative data were carried out with 74 women participating in HPV testing in England between June 2001 and December 2003. Purposive sampling was used to ensure heterogeneity in age, ethnic group, marital status, socioeconomic background, cytology, and HPV results among participants. RESULTS: Testing positive for HPV was associated with adverse social and psychological consequences, relating primarily to the sexually transmitted nature of the virus and its link to cervical cancer. Women described feeling stigmatised, anxious and stressed, concerned about their sexual relationships, and were worried about disclosing their result to others. Anxiety about the infection was widespread, but the impact of testing positive varied. The psychological burden of the infection related to women's relationship status and history, their social and cultural norms and practices around sex and relationships, and their understanding of key features of HPV. CONCLUSION: HPV testing should be accompanied by extensive health education to inform women and to de-stigmatise infection with the virus to ensure that any adverse impact of the infection on women's wellbeing is minimised.

Adult↗

PubMed1991

The accuracy of Pap smear utilization self-report: a methodological consideration in cervical screening research.

One method used to determine utilization rates of cervical screening is women's self-report. Few studies have assessed the accuracy of this measure--none has been conducted in Australia--although there are a number of reasons for suspecting its validity. This study examined and quantified the accuracy of self-report of Pap smear use among a randomly selected sample of women from an Australian community. Accuracy of Pap smear utilization self-report within a three-year period was assessed by comparison with pathology records. Results indicated that almost half of the women who have not had Pap smears within three years will be missed by a self-report measure of utilization. Some implications for the measurement and use of self-report data are discussed.

Adolescent↗

PubMed2005

Validity of combined cytology and human papillomavirus (HPV) genotyping with adjuvant DNA-cytometry in routine cervical screening: results from 31031 women from the Bonn-region in West Germany.

Our aim was to improve the accuracy of routine cervical screening by a risk-adapted multimodal protocol with special focus on possible reduction and prognostic assessment of false positive results. A cohort of 31031 women from the Bonn-region in West Germany, median age 36 years, were screened by cytology (conventional or liquid-based), followed by PCR-based HVP detection with genotyping and adjuvant DNA image cytometry, if indicated, in a sequential manner. The true prevalence of high-grade cervical intraepithelial neoplasia and carcinoma (>/=CIN2) was 0.32% in the population as projected from cervical biopsies of 123 women (0.4%), of whom 100 showed >/=CIN2. Sensitivity of the cytology screening program at PapIIID/HSIL threshold for detecting histologically confirmed >/=CIN2 cases was 81%, with specificity, positive predictive value (PPV) and negative predictive value (NPV) of 99, 20.9 and 99.9%, respectively. Of 38 women receiving the complete screening protocol, all the 31 >/=CIN2 cases were correctly detected by cytology alone, 30 by positive high-risk HPV genotype and 30 by aneuploid DNA profile. The combination of the three methods resulted in an up to 6.9% increase in PPV for >/=CIN2 at practically unchanged detection rate with the additional benefit of being able to predict the probable outcome of CIN1 lesions detected as false positives with any single test. Multimodal cervical screening might permit identification of those women with low-grade squamous intraepithelial lesions likely to progress at an earlier and curable stage of disease and lengthen the screening interval in those with transient minor lesions caused by productive HPV infection.

Adult↗

PubMed1991

The extent of cervical screening in New Zealand women.

To estimate the extent of cervical screening coverage of New Zealand women, a national survey of 1000 randomly selected women with a supplement of 200 Maori women was carried out by the National Research Bureau in August 1990 for the Department of Health. The results indicate a high level of screening in women aged 20-64 and improvements in coverage over the last three years, probably in response to the Cartwright inquiry. Overall, 77% of women reported having had a smear test within the previous three years and after adjustment for hysterectomy, this proportion increased to 82%. Screening coverage, however, was unevenly spread according to ethnic group, age and household income. Only 15% of European women reported no smear test in the last three years compared with 27% of Maori and Pacific Island women. The likelihood of having had a smear test in the last three years increased with increasing income. The survey confirms a high level of very frequent screening throughout New Zealand (2.4 smear tests per woman in the previous three years); the most frequent screening occurred in women 20-24 years of age (2.9 smears). Because an organised national screening programme has the potential to maintain and extend screening coverage to all age and ethnic groups, as well as reduce the number of unnecessary smears, it is likely to be more cost effective than the current screening practice.

Adolescent↗