Patient knowledge and beliefs as barriers to extending cervical cancer screening intervals in Federally Qualified Health Centers

Hawkins, Nikki A.; Benard, Vicki B.; Greek, April; Roland, Katherine B.; Manninen, Diane L.; Saraiya, Mona

doi:10.1016/j.ypmed.2013.08.021

Cited by 45 publications

(52 citation statements)

References 16 publications

(25 reference statements)

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“…Data were collected from 984 women from 2009 to 2011 as part of the Centers for Disease Control and Prevention’s (CDC) Cervical Cancer Screening (C×3) Study—a multi-component educational intervention to identify facilitators and barriers to guideline-consistent cervical cancer screening in an under-served population (Benard et al, 2014; Hawkins et al, 2013). The study was conducted in 15 clinics associated with six Federally Qualified Health Centers (FQHCs) across Illinois.…”

Section: Methodsmentioning

confidence: 99%

Racial and ethnic differences in human papillomavirus positivity and risk factors among low-income women in Federally Qualified Health Centers in the United States

Lin

Benard

Greek

et al. 2015

Preventive Medicine

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Reasons for racial/ethnic disparities in HPV infection are unclear. This study assessed racial/ethnic differences in and risk factors for HPV positivity among low-income women. Data were collected from 984 low-income women visiting Federally Qualified Health Centers across Illinois (2009–2011). Pearson chi square and Logistic regression analyses were used to examine associations with HPV positivity. Our results showed Mexican-born Hispanics had the lowest HPV positivity (16%), followed by non-Hispanic whites (29%), US-born Hispanics (35%), and non-Hispanic blacks (39%). Mexican-born Hispanics reported fewer risk behaviors for HPV positivity, including first sexual intercourse before age 16 years (9% versus 27%), multiple sexual partners in lifetime (48% versus 90%), and current cigarette smoking status (10% versus 35%) when compared to non-Hispanic whites (p < 0.001). In multivariate-adjusted logistic regression, being non-Hispanic black, first sexual intercourse before age 16 years, increasing numbers of recent or lifetime sexual partners and current cigarette smoking status were associated with a higher likelihood of HPV positivity. Our findings highlight racial/ethnic differences in HPV positivity and risk factors in a population of women with similar socioeconomic characteristics. When measuring HPV risk factors within the Hispanic population, foreign-born status and other mediating factors, such as social norms and cultural characteristics, may be relevant to assess the intragroup heterogeneity.

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Section: Methodsmentioning

confidence: 99%

Racial and ethnic differences in human papillomavirus positivity and risk factors among low-income women in Federally Qualified Health Centers in the United States

Lin

Benard

Greek

et al. 2015

Preventive Medicine

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“…Studies have noted that women's concerns about an extended screening interval for hpv could affect the acceptability of hpv screening 44,45 . This stems from the misconception that the longer interval could result in missed detection of pre-cancerous lesions, and it could lead to over-screening if women present for screening more frequently 46 . Regional guidelines on screening interval, age of screening commencement, and appropriate triage pathways, coupled with comprehensive education and dissemination throughout the health care system play an important role in mitigating over-screening.…”

Section: Health Care System Considerationsmentioning

confidence: 99%

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

et al. 2018

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The success of cytology (Pap screening) programs is undeniable and has drastically reduced cervical cancer rates in high-income settings where it has been implemented 1 . However, cytology for primary cervical cancer screening has a number of limitations including poor sensitivity, a taxing demand on human and operational infrastructure, high health system costs, and limited uptake rates, leading researchers and policy-makers to question whether further gains in public health are possible using this approach 2 . Persistent infection with high-risk genotypes of human papillomavirus (hpv) is well established as the necessary cause for development of cervical cancer 3 . Research has shown a 30% improvement in sensitivity in detecting high-grade lesions, cervical squamous intraepithelial neoplasia (cin) grade 2 or greater (cin2+), can be achieved with high-risk hpv dna testing compared with cytology 4 . A negative hpv test confers two-fold greater reassurance against the development of cervical cancer over three years compared with a negative cytology test 2,5 . The Netherlands has recently transitioned from cytology to hpv testing for primary cervical cancer screening in their National program. Many organized screening programs intend to implement primary hpv screening 6-9 , including Australia, which will begin implementation in December 2017.A consistent barrier to cytology-based cervical cancer screening is non-attendance, which can be addressed through hpv testing using self-collected samples. Primary cervical cancer screening with hpv dna testing allows for the opportunity of self-collected samples, which is not possible with cytology. In hpv self-collection the sample is obtained vaginally by the woman herself, using a device such as a swab or brush. The swab is subsequently tested for high-risk strains of hpv in a laboratory. With this approach to screening, programs can mail self-collection kits directly to women who are overdue for screening as an alternative to a clinic-based visit. Self-collected cervical samples receiving hpv testing show comparable cin2+ sensitivity compared with clinician-collected samples tested with cytology and with hpv 10-12 . Self-collection has proven to be highly acceptable among women 13 .Huma n papillomav ir us self-collection has t he potential to overcome many of the personal and systemlevel barriers to screening that exist for cytology or other clinic-based screening methods. Some women, particularly those who have experienced abuse 14 or are otherwise marginalized, may find self-sampling preferable because of such things as cultural/religious embarrassment or discomfort associated with a pelvic exam 13,[15][16][17] . Time, transportation, inconvenient clinic hours, or not having a regular practitioner are also relevant factors associated with under-screening that can be mitigated through hpv self-collection using mailed samples 13,16,17 . However, there are psychosocial barriers to hpv screening, including women's lack of awareness and fears around hpv and cervical cancer...

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“…These findings help inform the larger Cx3 Study designed to understand the barriers associated with cotest use and the extension of the interval between screenings in the underserved population 8,9 by providing information on the cotest results and the number that may require additional management. To improve cervical cancer screening among medically underserved women, Congress authorized the CDC to develop the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in 1990.…”

Section: Discussionmentioning

confidence: 80%

Type-specific HPV and Pap test results among low-income, underserved women: providing insights into management strategies

Saraiya

Benard

Greek

et al. 2014

American Journal of Obstetrics and Gynecology

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OBJECTIVE The primary cervical cancer screening strategy for women over age 30 is high-risk human papillomavirus (HPV) testing combined with Papanicolaou (Pap) testing (cotesting) every 5 years. This combination strategy is a preventive service that is required by the Affordable Care Act to be covered with no cost-sharing by most health insurance plans. The cotesting recommendation was made based entirely on prospective data from an insured population that may have a lower proportion of women with HPV positive and Pap negative results (ie, discordant results). The discordant group represents a very difficult group to manage. If the frequency of discordant results among underserved women is higher, health care providers may perceive the cotesting strategy to be a less favorable screening strategy than traditional Pap testing every 3 years. STUDY DESIGN The Centers for Disease Control and Prevention’s Cervical Cancer Study was conducted at 15 clinics in 6 federally qualified health centers across Illinois. Providers at these clinics were given the option of cotesting for routine cervical cancer screening. Type-specific HPV detection was performed on residual extracts using linear array. RESULTS Pap test results were abnormal in 6.0% and HPV was positive in 7.2% of the underserved women screened in this study (mean age, 45.1 years). HPV prevalence decreased with age, from 10.3% among 30- to 39-year-olds to 4.5% among 50- to 60-year-olds. About 5% of the women had a combination of a positive HPV test and normal Pap test results; HPV 16/18 was identified in 14% of discordant women. CONCLUSION The rate of discordant results among underserved women was similar to those reported throughout the US in a variety of populations. Typing for HPV 16/18 appears to assist in the management in a small proportion of women with discordant results.

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Patient knowledge and beliefs as barriers to extending cervical cancer screening intervals in Federally Qualified Health Centers

Cited by 45 publications

References 16 publications

Racial and ethnic differences in human papillomavirus positivity and risk factors among low-income women in Federally Qualified Health Centers in the United States

Racial and ethnic differences in human papillomavirus positivity and risk factors among low-income women in Federally Qualified Health Centers in the United States

Implementation Considerations Using HPV Self-Collection to Reach Women Under-Screened for Cervical Cancer in High-Income Settings

Type-specific HPV and Pap test results among low-income, underserved women: providing insights into management strategies

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