Showing papers by "Mona Saraiya published in 2017"

Environmental and Psychosocial Barriers to and Benefits of Cervical Cancer Screening in Kenya

Abstract: Background Cervical cancer is the second most commonly diagnosed cancer in females and is a leading cause of cancer-related mortality in Kenya; limited cervical cancer screening services may be a factor. Few studies have examined men's and women's perceptions on environmental and psychosocial barriers and benefits related to screening. Materials and methods In 2014, 60 women aged 25-49 years and 40 male partners participated in 10 focus groups (6 female and 4 male), in both rural and urban settings (Nairobi and Nyanza, Kenya), to explore perceptions about barriers to and benefits of cervical cancer screening. Focus groups were segmented by sex, language, geographic location, and screening status. Data were transcribed, translated into English, and analyzed by using qualitative software. Results Participants identified screening as beneficial for initiating provider discussions about cancer but did not report it as a beneficial method for detecting precancers. Perceived screening barriers included access (transportation, cost), spousal approval, stigma, embarrassment during screening, concerns about speculum use causing infertility, fear of residual effects of test results, lack of knowledge, and religious or cultural beliefs. All participants reported concerns with having a male doctor perform screening tests; however, men uniquely reported the young age of a doctor as a barrier. Conclusion Identifying perceived barriers and benefits among people in low- and middle-income countries is important to successfully implementing emerging screening programs. The novel findings on barriers and benefits from this study can inform the development of targeted community outreach activities, communication strategies, and educational messages for patients, families, and providers. The Oncologist 2017;22: 173-181Implications for Practice: This article provides important information for stakeholders in clinical practice and research when assessing knowledge, beliefs, and acceptability of cervical cancer screening and treatment services in low- and middle-resourced countries. Formative research findings provide information that could be used in the development of health interventions, community education messages, and materials. Additionally, this study illuminates the importance of understanding psychosocial barriers and facilitators to cervical cancer screening, community education, and reduction of stigma as important methods of improving prevention programs and increasing rates of screening among women.

Questions About Cervical and Breast Cancer Screening Knowledge, Practice, and Outcomes: A Review of Demographic and Health Surveys

Abstract: United Nation's Sustainable Development Goals and the World Health Organization's Global Monitoring Framework support a strong global commitment to reducing the high burden of cervical and breast cancers among low- and middle-income countries. Strategies include vaccination, screening, and early diagnosis. Population-based surveys, such as those conducted by the Demographic and Health Surveys (DHS) Program, can collect the information needed to guide cancer control efforts in a standardized comparable manner. We identified and evaluated the breadth of breast and cervical cancer screening information that was collected by the DHS from 1984 through 2015. Then, we determined if these surveys currently provide the specific and measurable data about both the quantity and quality of cancer screening needed to guide national efforts to reduce the overall effects of cervical and breast cancers. We searched the DHS website to identify surveys conducted between the start of the DHS Program in 1984 and Nove...

Synergies between Communicable and Noncommunicable Disease Programs to Enhance Global Health Security

Abstract: Noncommunicable diseases are the leading cause of death and disability worldwide. Initiatives that advance the prevention and control of noncommunicable diseases support the goals of global health security in several ways. First, in addressing health needs that typically require long-term care, these programs can strengthen health delivery and health monitoring systems, which can serve as necessary platforms for emergency preparedness in low-resource environments. Second, by improving population health, the programs might help to reduce susceptibility to infectious outbreaks. Finally, in aiming to reduce the economic burden associated with premature illness and death from noncommunicable diseases, these initiatives contribute to the objectives of international development, thereby helping to improve overall country capacity for emergency response.

CDC Activities for Improving Implementation of Human Papillomavirus Vaccination, Cervical Cancer Screening, and Surveillance Worldwide

Abstract: Cervical cancer incidence and mortality rates are high, particularly in developing countries. Most cervical cancers can be prevented by human papillomavirus (HPV) vaccination, screening, and timely treatment. The US Centers for Disease Control and Prevention (CDC) provides global technical assistance for implementation and evaluation of HPV vaccination pilot projects and programs and laboratory-related HPV activities to assess HPV vaccines. CDC collaborates with global partners to develop global cervical cancer screening recommendations and manuals, implement screening, create standardized evaluation tools, and provide expertise to monitor outcomes. CDC also trains epidemiologists in cancer prevention through its Field Epidemiology Training Program and is working to improve cancer surveillance by supporting efforts of the World Health Organization in developing cancer registry hubs and assisting countries in estimating costs for developing population-based cancer registries. These activities contribute to the Global Health Security Agenda action packages to improve immunization, surveillance, and the public health workforce globally.

Trends in Cervical Cancer Screening in Title X-Funded Health Centers - United States, 2005-2015.

Abstract: Cervical cancer screening is critical to early detection and treatment of precancerous cells and cervical cancer. In 2015, 83% of U.S. women reported being screened per current recommendations, which is below the Healthy People 2020 target of 93% (1,2). Disparities in screening persist for women who are younger (aged 21-30 years), have lower income, are less educated, are uninsured, lack a source of health care, or who self-identify as Asian or American Indian/Alaska Native (2). Women who are never screened or rarely screened are more likely to develop cancer and receive a cancer diagnosis at later stages than women who are screened regularly (3). In 2013, cervical cancer was diagnosed in 11,955 women in the United States, and 4,217 died from the disease (4). Aggregated administrative data from the Title X Family Planning Program were used to calculate the percentage of female clients served in Title X-funded health centers who received a Papanicolaou (Pap) test during 2005-2015. Trends in the percentage of Title X clients screened for cervical cancer were examined in relation to changes in cervical cancer screening guidelines, particularly the 2009 American College of Obstetricians and Gynecologists (ACOG) update that raised the age for starting cervical cancer screening to 21 years (5) and the 2012 alignment of screening guidelines from ACOG, the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) on the starting age (21 years), screening interval (3 or 5 years), and type of screening test (6-8). During 2005-2015, the percentage of female clients screened for cervical cancer dropped continually, with the largest declines occurring in 2010 and 2013, notably a year after major updates to the recommendations. Although aggregated data contribute to understanding of cervical cancer screening trends in Title X centers, studies using client-level and encounter-level data are needed to assess the appropriateness of cervical cancer screening in individual cases.

Control of HPV-associated cancers with HPV vaccination.

Abstract: In the Lancet Infectious Diseases, Eric Chow and colleagues present evidence of remarkable population eff ectiveness against human papillomavirus (HPV), with virtual eradication of targeted types, among heterosexual men within a few years after vaccination of the young Australian female population with the quadrivalent HPV vaccine (4vHPV). Their study is notable because of its inventive observational methods and compelling implications. To study the eff ectiveness of the vaccine in this population, they tracked trends in the prevalence of specifi ed HPV genotypes in mainly urine specimens from 1466 heterosexual men aged 25 years or younger who had tested positive for Chlamydia trachomatis at the Melbourne Sexual Health Centre from 2004 to 2015. By studying men with chlamydia, which is also transmitted by sexual contact, the investigators had a population with high exposure to HPV, including to the 13 highrisk genotypes that cause almost all cases of cervical cancer and many oropharyngeal, anal, penile, vaginal, and vulvar cancers (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68; Chow and colleagues also included genotype 66 in their analysis although there is limited evidence that it causes cervical cancer). The Centre routinely stores frozen urine from men who test positive for chlamydia. Although urine testing for HPV DNA in men is an indirect and seldom-used measure of vaccine effi cacy in women, in this study it proved to be an acceptable and appropriate measure of population eff ect; the fi ndings from Chow and colleagues study showed reductions in the prevalence of the genotypes targeted by the vaccine between 2004 and 2015: genotypes 6 and 11 (from 12% [95% CI 6–21%] to 3% [1–7%], ptrend=0·008), 16 and 18 (from 13% [95% CI 7–22%] to 3% [1–6%], ptrend<0·0001), and all 4vHPV-targeted genotypes together (from 22% [95% CI 14–33%] to 6% [3–10%], ptrend<0·0001). To strengthen their point using a natural comparison, Chow and colleagues showed that the prevalence of the remaining oncogenic HPV types not targeted by the vaccine did not decrease over the study period. The untargeted HPV types served as ideal controls for the four targeted genotypes, and provided convincing evidence of population eff ectiveness without a clinical trial. Finally, a substantial proportion of the men in the clinic had recently arrived in Australia (within 2 years) from England, Scotland, Wales, Cook Islands, Northern Ireland, or the Netherlands, all of which at that time were off ering women HPV vaccination with the bivalent vaccine (2vHPV) against genotypes 16 and 18. Among these men, the prevalence of genotypes 16 and 18 decreased in the postvaccination period compared with the prevaccination period (adjusted prevalence ratio [PR] 0·32, 95% CI 0·14–0·74; p=0·008) but types 6 and 11 did not (adjusted PR 0·50, 0·16–1·56; p=0·234). The investigators made excellent scientifi c use of country-of-birth data, a risk stratifi er, and by doing so they were able to further strengthen their ability to attribute decreases in HPV prevalence by type to the specifi c vaccine off ered to girls in the men’s country of birth. Country-of-birth data are not routinely collected in many countries, and obtaining them can be sensitive because they are sometimes related to immigration status. Nonetheless, in countries with a large immigrant population, strategies such as screening among vaccinated populations might need to consider diff erential risks by country-of-birth. These encouraging data regarding herd immunity and interruption of HPV transmission are thoughtprovoking. The 4vHPV-vaccine programme started among Australian girls aged 12–13 years in April, 2007, and quickly achieved high population coverage. Eradication of targeted HPV types took only a few years after high coverage was achieved. Although the programme in Australia used a three-dose schedule, two doses of HPV vaccine are now considered suffi cient by WHO and could conceivably produce similar herd immunity. In fact, data from a study show that one dose of the bivalent vaccine protects against HPV for at least several years, if not longer, prompting a new clinical trial of one-dose effi cacy. The results will show whether a one-dose campaign might produce substantial population immunity, such as that noted with the Australian three-dose programme. In framing prevention strategies, it is important to remember that HPV typically causes cancer in three broad, necessary steps: acquisition, persistence linked to development of precancer, and invasion, and that sexual transmission of HPV peaks in young adults. Precancer begins to appear within a few years of the usual age of HPV acquisition, whereas invasion usually Lancet Infect Dis 2016

Cervical Cancer Screening and Prevention in 78 Sexually Transmitted Disease Clinics-United States, 2014-2015.

Abstract: Background Human papillomavirus (HPV) infections cause approximately 30,700 cancers annually among US men and women, cervical cancer being the most common. Human papillomavirus vaccination is recommended routinely for US girls and boys at age 11 to 12 years, and for those not previously vaccinated, through age 26 and 21 years for women and men, respectively. Our objective was to assess current cervical cancer screening and HPV vaccination practices among sexually transmitted disease (STD) clinics in the United States. Methods We surveyed a geographically diverse convenience sample of US STD clinics identified by members of the National Coalition of STD Directors within 65 state, territorial, and local jurisdictions. An online multiple-choice survey about clinical services was administered to clinic directors or designees during October 2014 to February 2015. Results Survey respondents included 78 clinics from 46 states and territories. Of these clinics, 31 (39.7%) offered both cervical cancer screening and HPV vaccination, 6 (7.7%) offered cervical cancer screening only, 21 (26.9%) offered HPV vaccination only, and 20 (25.6%) offered neither cervical cancer prevention service. Among those not offering the service, the most commonly reported barrier to cervical cancer screening was time constraints (25/41, 61.0%); for HPV vaccination it was reimbursement (11/26, 42.3%). Conclusions By early 2015, in a geographically diverse group of 78 STD clinics, 39.7% provided nationally recommended HPV vaccination and cervical cancer screening, whereas 25.6% provided neither. Further research could identify strategies for STD clinics to reduce HPV-associated cancers by increasing provision of HPV vaccination and cervical cancer screening services, particularly among medically underserved populations.