Women's perspectives on the acceptability of risk-based cervical cancer screening.
Humans
Female
Uterine Cervical Neoplasms
/ diagnosis
Middle Aged
Adult
Early Detection of Cancer
/ psychology
Patient Acceptance of Health Care
/ psychology
Aged
Qualitative Research
Prospective Studies
Mass Screening
/ methods
Risk Assessment
/ methods
Health Knowledge, Attitudes, Practice
Estonia
Risk Factors
Acceptability of healthcare interventions, qualitative research
Cervical cancer screening
Risk-based screening
Journal
BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800
Informations de publication
Date de publication:
25 Oct 2024
25 Oct 2024
Historique:
received:
06
12
2023
accepted:
08
10
2024
medline:
26
10
2024
pubmed:
26
10
2024
entrez:
25
10
2024
Statut:
epublish
Résumé
The increased knowledge of cervical cancer (CC) risk factors and suboptimal performance of present screening programs has generated interest in shifting from a universal screening approach to one based on individual risk assessment. To inform the future development of risk-based CC screening programs, it is crucial to gain insight into the factors influencing the acceptability of such approach among screening target group women. The aim of this study was to prospectively investigate the acceptability of risk-based CC screening and to identify potential barriers. In this qualitative study, one-to-one semi-structured interviews were conducted with a purposeful sample including women aged 30-65 years to explore women's perspectives on the acceptability of risk-based CC screening. The study was conducted in Estonia, and interviews were conducted from March to September 2023. Potential participants were approached in person by a member of the study team or by their healthcare providers at primary care or gynaecology clinics. The interview guides were developed based on the concept of acceptability of healthcare interventions. Twenty participants (mean age 44.5, SD = 8.6) with diverse backgrounds were interviewed. The seven components of acceptability (affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, self-efficacy, and intervention coherence) were explored as key themes. Generally, women supported risk-based screening. However, we identified several factors that may compromise the acceptability of risk-based screening. The participants were reluctant to accept less intense screening for low-risk women and anticipated that if risk-based approach was implemented, more frequent testing would remain an option. Providing in-person clinician support was expected, requiring additional healthcare resources. Knowledge gaps in CC prevention highlighted the need for accessible information and education. Most women were unworried about sensitive data inclusion in risk score calculations. However, some participants were concerned about potential confidentiality breaches by healthcare workers. This study indicates that risk-based CC screening is acceptable, except for testing low-risk women less frequently. Our findings underscore the necessity for comprehensive understanding of the needs and concerns of the target group women for program development. Healthcare organizations are required to proactively address these needs by implementing comprehensive information dissemination and efficient communication approaches.
Sections du résumé
BACKGROUND
BACKGROUND
The increased knowledge of cervical cancer (CC) risk factors and suboptimal performance of present screening programs has generated interest in shifting from a universal screening approach to one based on individual risk assessment. To inform the future development of risk-based CC screening programs, it is crucial to gain insight into the factors influencing the acceptability of such approach among screening target group women. The aim of this study was to prospectively investigate the acceptability of risk-based CC screening and to identify potential barriers.
METHODS
METHODS
In this qualitative study, one-to-one semi-structured interviews were conducted with a purposeful sample including women aged 30-65 years to explore women's perspectives on the acceptability of risk-based CC screening. The study was conducted in Estonia, and interviews were conducted from March to September 2023. Potential participants were approached in person by a member of the study team or by their healthcare providers at primary care or gynaecology clinics. The interview guides were developed based on the concept of acceptability of healthcare interventions.
RESULTS
RESULTS
Twenty participants (mean age 44.5, SD = 8.6) with diverse backgrounds were interviewed. The seven components of acceptability (affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, self-efficacy, and intervention coherence) were explored as key themes. Generally, women supported risk-based screening. However, we identified several factors that may compromise the acceptability of risk-based screening. The participants were reluctant to accept less intense screening for low-risk women and anticipated that if risk-based approach was implemented, more frequent testing would remain an option. Providing in-person clinician support was expected, requiring additional healthcare resources. Knowledge gaps in CC prevention highlighted the need for accessible information and education. Most women were unworried about sensitive data inclusion in risk score calculations. However, some participants were concerned about potential confidentiality breaches by healthcare workers.
CONCLUSION
CONCLUSIONS
This study indicates that risk-based CC screening is acceptable, except for testing low-risk women less frequently. Our findings underscore the necessity for comprehensive understanding of the needs and concerns of the target group women for program development. Healthcare organizations are required to proactively address these needs by implementing comprehensive information dissemination and efficient communication approaches.
Identifiants
pubmed: 39455985
doi: 10.1186/s12885-024-13050-7
pii: 10.1186/s12885-024-13050-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1314Subventions
Organisme : EEA Grants/Norway Grants
ID : EMP416
Organisme : EEA Grants/Norway Grants
ID : EMP416
Organisme : EEA Grants/Norway Grants
ID : EMP416
Organisme : EEA Grants/Norway Grants
ID : EMP416
Organisme : EEA Grants/Norway Grants
ID : EMP416
Organisme : EEA Grants/Norway Grants
ID : EMP416
Organisme : EEA Grants/Norway Grants
ID : EMP416
Organisme : EEA Grants/Norway Grants
ID : EMP416
Organisme : EEA Grants/Norway Grants
ID : EMP416
Organisme : EEA Grants/Norway Grants
ID : EMP416
Informations de copyright
© 2024. The Author(s).
Références
Marcus PM, Pashayan N, Church TR, Paul Doria-Rose V, Gould MK, Hubbard RA et al. Population-Based Precision Cancer Screening: A Symposium on Evidence, Epidemiology, and Next Steps HHS Public Access. Cancer Epidemiol Biomarkers Prev. 2016;25(11):1449–55.
Roberts MC. Implementation challenges for risk-stratified screening in the era of precision medicine. JAMA Oncol. 2018;4(11):1484–5.
pubmed: 29978191
doi: 10.1001/jamaoncol.2018.1940
Hall AE, Chowdhury S, Hallowell N, Pashayan N, Dent T, Pharoah P, et al. Implementing risk-stratified screening for common cancers: a review of potential ethical, legal and social issues. J Public Health (Oxf). 2014;36(2):285–91.
pubmed: 23986542
doi: 10.1093/pubmed/fdt078
Dent T, Jbilou J, Rafi I, Segnan N, Törnberg S, Chowdhury S, et al. Stratified cancer screening: the practicalities of implementation. Public Health Genomics. 2013;16(3):94–9.
pubmed: 23363703
doi: 10.1159/000345941
Taylor LC, Hutchinson A, Law K, Shah V, Usher-Smith JA, Dennison RA. Acceptability of risk stratification within population-based cancer screening from the perspective of the general public: a mixed-methods systematic review. Health Expect. 2023;26:989–1008.
pubmed: 36852880
pmcid: 10154794
doi: 10.1111/hex.13739
Pinsky PF. Principles of Cancer Screening. Surgical clinics of North America. Volume 95. W.B. Saunders; 2015. pp. 953–66.
Pashayan N, Antoniou AC, Ivanus U, Esserman LJ, Easton DF, French D, et al. Personalized early detection and prevention of breast cancer: ENVISION consensus statement. Nature Reviews Clinical Oncology. Nat Res. 2020;17:687–705.
Hull MA, Rees CJ, Sharp L, Koo S. A risk-stratified approach to colorectal cancer prevention and diagnosis. Nat Rev Gastroenterol Hepatol. 2020;17(12):773–80.
pubmed: 33067592
pmcid: 7562765
doi: 10.1038/s41575-020-00368-3
Tammemägi MC, Ruparel M, Tremblay A, Myers R, Mayo J, Yee J, et al. USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study. Lancet Oncol. 2022;23(1):138–48.
pubmed: 34902336
pmcid: 8716337
doi: 10.1016/S1470-2045(21)00590-8
Nordström T, Discacciati A, Bergman M, Clements M, Aly M, Annerstedt M, et al. Prostate cancer screening using a combination of risk-prediction, MRI, and targeted prostate biopsies (STHLM3-MRI): a prospective, population-based, randomised, open-label, non-inferiority trial. Lancet Oncol. 2021;22(9):1240–9.
pubmed: 34391509
doi: 10.1016/S1470-2045(21)00348-X
Huntley C, Torr B, Sud A, Rowlands CF, Way R, Snape K, et al. Utility of polygenic risk scores in UK cancer screening: a modelling analysis. Lancet Oncol. 2023;24(6):658–68.
pubmed: 37178708
doi: 10.1016/S1470-2045(23)00156-0
Harrison H, Thompson RE, Lin Z, Rossi SH, Stewart GD, Griffin SJ, et al. Risk prediction models for kidney Cancer: a systematic review. Eur Urol Focus. 2021;7(6):1380.
pubmed: 32680829
pmcid: 8642244
doi: 10.1016/j.euf.2020.06.024
Geller AC. Screening for melanoma. Dermatol Clin. 2002;20(4):629–40.
pubmed: 12380050
doi: 10.1016/S0733-8635(02)00034-7
Charlton BM, Carwile JL, Michels KB, Feldman S. A cervical abnormality risk prediction model: can we use clinical information to predict which patients with ASCUS/LSIL pap tests will develop CIN 2/3 or AIS? J Low Genit Tract Dis. 2013;17(3):242–7.
pubmed: 23486071
pmcid: 3696437
doi: 10.1097/LGT.0b013e3182730fec
Wu Z, Li T, Han Y, Jiang M, Yu Y, Xu H et al. Development of models for cervical cancer screening: construction in a cross-sectional population and validation in two screening cohorts in China. BMC Med. 2021;19(1).
van der Waal D, Bekkers RLM, Dick S, Lenselink CH, Massuger LFAG, Melchers WJG et al. Risk prediction of cervical abnormalities: the value of sociodemographic and lifestyle factors in addition to HPV status. Prev Med (Baltim). 2020;130.
Rothberg MB, Hu B, Lipold L, Schramm S, Jin XW, Sikon A, et al. A risk prediction model to allow personalized screening for cervical cancer. Cancer Causes Control. 2018;29(3):297–304.
pubmed: 29450667
doi: 10.1007/s10552-018-1013-4
Austin RM, Onisko A, Druzdzel MJ. The Pittsburgh Cervical Cancer Screening Model A Risk Assessment Tool. Arch Pathol Lab Med. 2010; 134.
Nygård M, Nygård S. The future of Cervical Cancer Prevention: from one-size-fits-all to personalized screening. J Pers Med. 2023;13(2):161.
pubmed: 36836396
pmcid: 9966965
doi: 10.3390/jpm13020161
Langberg GSRE, Nygård JF, Gogineni VC, Nygård M, Grasmair M, Naumova V. Towards a data-driven system for personalized cervical cancer risk stratification. Sci Rep. 2022;12(1).
Stankūnas M, Pärna K, Tisler A, Ķīvīte-Urtāne A, Kojalo U, Zodzika J, et al. Cervical Cancer in the Baltic States: can Intelligent and Personalised Cancer Screening change the Situation? Acta Med Litu. 2022;29(1):18.
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. International Agency for Research on Cancer. Human papillomaviruses. World Health Organization, International Agency for Research on Cancer; 2007. p. 670.
Vaccarella S, Herrero R, Snijders PJF, Dai M, Thomas JO, Hieu NT, et al. Smoking and human papillomavirus infection: pooled analysis of the International Agency for Research on Cancer HPV prevalence surveys. Int J Epidemiol. 2008;37(3):536–46.
pubmed: 18316350
doi: 10.1093/ije/dyn033
Vaccarella S, Herrero R, Dai M, Snijders PJF, Meijer CJLM, Thomas JO, et al. Reproductive factors, oral contraceptive use, and human papillomavirus infection: pooled analysis of the IARC HPV prevalence surveys. Cancer Epidemiol Biomarkers Prev. 2006;15(11):2148–53.
pubmed: 17119039
doi: 10.1158/1055-9965.EPI-06-0556
Vaccarella S, Franceschi S, Herrero R, Muñoz N, Snijders PJF, Clifford GM, et al. Sexual behavior, condom use, and human papillomavirus: pooled analysis of the IARC human papillomavirus prevalence surveys. Cancer Epidemiol Biomarkers Prev. 2006;15(2):326–33.
pubmed: 16492924
doi: 10.1158/1055-9965.EPI-05-0577
Charach R, Sheiner E, Beharier O, Sergienko R, Kessous R. Recurrent pregnancy loss and future risk of female malignancies. Arch Gynecol Obstet. 2018;298(4):781–7.
pubmed: 30116931
doi: 10.1007/s00404-018-4868-4
Johnson CA, James D, Marzan A, Armaos M. Cervical Cancer: an overview of pathophysiology and management. Seminars in Oncology Nursing. Volume 35. W.B. Saunders; 2019. pp. 166–74.
Bruni L, Serrano B, Roura E, Alemany L, Cowan M, Herrero R, et al. Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: a review and synthetic analysis. Lancet Glob Health. 2022;10(8):e1115.
pubmed: 35839811
pmcid: 9296658
doi: 10.1016/S2214-109X(22)00241-8
Maver PJ, Poljak M. Primary HPV-based cervical cancer screening in Europe: implementation status, challenges, and future plans. Clin Microbiol Infect Elsevier B V. 2020;26:579–83.
doi: 10.1016/j.cmi.2019.09.006
Greenley R, Bell S, Rigby S, Legood R, Kirkby V, McKee M. Factors influencing the participation of groups identified as underserved in cervical cancer screening in Europe: a scoping review of the literature. Front Public Health. 2023;11.
Suk R, Hong YR, Rajan SS, Xie Z, Zhu Y, Spencer JC. Assessment of US Preventive Services Task Force Guideline–Concordant Cervical Cancer Screening Rates and reasons for underscreening by Age, race and ethnicity, sexual orientation, rurality, and insurance, 2005 to 2019. JAMA Netw Open. 2022;5(1):e2143582–2143582.
pubmed: 35040970
pmcid: 8767443
doi: 10.1001/jamanetworkopen.2021.43582
Globocan. (2022). Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. Retrieved from https://gco.iarc.fr/today/en
Veerus P, Hallik R, Jänes J, Jõers K, Paapsi K, Laidra K, Innos K. Human papillomavirus self-sampling for long-term non-attenders in cervical cancer screening: a randomised feasibility study in Estonia. J Med Screen. 2022;29(1):53–60.
pubmed: 34694179
doi: 10.1177/09691413211052499
Kojalo U, Tisler A, Parna K, Kivite-Urtane A, Zodzika J, Stankunas M, et al. An overview of cervical cancer epidemiology and prevention in the Baltic States. BMC Public Health. 2023;23(1):660.
pubmed: 37029357
pmcid: 10080753
doi: 10.1186/s12889-023-15524-y
Orumaa M, Innos K, Suurna M, Veerus P. Cervical cancer screening history among women diagnosed with cervical cancer in Estonia 2017–18. Eur J Public Health. 2022;33(1):64–8.
pmcid: 9898000
doi: 10.1093/eurpub/ckac176
Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1).
Bradshaw C, Atkinson S, Doody O. Employing a qualitative description Approach in Health Care Research. Glob Qual Nurs Res. 2017;4.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.
pubmed: 17872937
doi: 10.1093/intqhc/mzm042
Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Adm Policy Mental Health Mental Health Serv Res. 2015;42(5):533–44. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research.
Judah G, Dilib F, Darzi A, Huf S. A population survey on beliefs around cervical cancer screening: determining the barriers and facilitators associated with attendance. BMC Cancer. 2022;22(1).
Suurna M, Orumaa M, Ringmets I, Pärna K. Inequalities in reported use of cervical screening in Estonia: results from cross-sectional studies in 2004–2020. BMC Womens Health. 2022;22(1).
Bouvard V, Wentzensen N, Mackie A, Berkhof J, Brotherton J, Giorgi-Rossi P, et al. The IARC Perspective on Cervical Cancer Screening. N Engl J Med. 2021;385(20):1908–18.
pubmed: 34758259
doi: 10.1056/NEJMsr2030640
Sekhon M, Cartwright M, Francis JJ. Development of a theory-informed questionnaire to assess the acceptability of healthcare interventions. BMC Health Serv Res. 2022;22(1).
Van Der Sraten A, Sekhon M. Pregnant and breastfeeding women’s prospective acceptability of two biomedical HIV prevention approaches in Sub Saharan Africa: a multisite qualitative analysis using the theoretical Framework of Acceptability. PLoS ONE. 2021;16.
Dijkstra MG, van Zummeren M, Rozendaal L, van Kemenade FJ, Helmerhorst TJM, Snijders PJF, et al. Safety of extending screening intervals beyond five years in cervical screening programmes with testing for high risk human papillomavirus: 14 year follow-up of population based randomised cohort in the Netherlands. BMJ. 2016;355:i4924.
pubmed: 27702796
doi: 10.1136/bmj.i4924
Berkhof J, Coupé VM, Bogaards JA, Van Kemenade FJ, Helmerhorst TJ, Snijders PJ, et al. The health and economic effects of HPV DNA screening in the Netherlands. Int J Cancer. 2010;127(9):2147–58.
pubmed: 20112339
doi: 10.1002/ijc.25211
Maguire M, Delahunt B. Doing a Thematic Analysis: A Practical, Step-by-Step Guide for Learning and Teaching Scholars. 2017.
Guest G, Bunce A, Johnson L. How many interviews are Enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.
doi: 10.1177/1525822X05279903
Dodgson JE. Reflexivity in qualitative research. J Hum Lactation. 2019;35(2):220–2.
doi: 10.1177/0890334419830990
Grove J. Researching a marginalised group: reflections on being an outsider. Couns Psychother Res. 2017;17(3):176–80.
doi: 10.1002/capr.12120
Vaccarella S, Franceschi S, Engholm G, Lönnberg S, Khan S, Bray F. 50 years of screening in the nordic countries: quantifying the effects on cervical cancer incidence. Br J Cancer. 2014;111(5):965–9.
pubmed: 24992581
pmcid: 4150271
doi: 10.1038/bjc.2014.362
IACR. Cervical cancer screening. IARC Handb Cancer Prev. 2022; 18:1–456.
Keogh LA, Steel E, Weideman P, Butow P, Collins IM, Emery JD, et al. Consumer and clinician perspectives on personalising breast cancer prevention information. Breast. 2019;43:39–47.
pubmed: 30445378
doi: 10.1016/j.breast.2018.11.002
Rainey L, Jervaeus A, Donnelly LS, Evans DG, Hammarström M, Hall P, et al. Women’s perceptions of personalized risk-based breast cancer screening and prevention: an international focus group study. Psychooncology. 2019;28(5):1056–62.
pubmed: 30848018
pmcid: 6593462
doi: 10.1002/pon.5051
van der Rainey L, Wengström Y, Jervaeus A, Broeders MJM. Women’s perceptions of the adoption of personalised risk-based breast cancer screening and primary prevention: a systematic review. Acta Oncol. 2018;57:1275–83.
pubmed: 29882455
doi: 10.1080/0284186X.2018.1481291
Ojamaa K, Innos K, Baburin A, Everaus H, Veerus P. Trends in cervical cancer incidence and survival in Estonia from 1995 to 2014. BMC Cancer. 2018;18(1).
Ryzhov A, Corbex M, Piñeros M, Barchuk A, Andreasyan D, Djanklich S, et al. Comparison of breast cancer and cervical cancer stage distributions in ten newly independent states of the former Soviet Union: a population-based study. Lancet Oncol. 2021;22(3):361–9.
pubmed: 33556324
pmcid: 8014987
doi: 10.1016/S1470-2045(20)30674-4
Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. 2006;489–98.
Sharp L. After-effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial. BJOG. 2009;116(11):1506–14.
pubmed: 19583712
doi: 10.1111/j.1471-0528.2009.02263.x
Drolet M, Brisson M, Maunsell E, Franco EL, Coutlée F, Ferenczy A, et al. The psychosocial impact of an abnormal cervical smear result. Psychooncology. 2012;21(10):1071–81.
pubmed: 21695747
doi: 10.1002/pon.2003
Habbema D, Weinmann S, Arbyn M, Kamineni A, Williams AE, de Kok MCM. Harms of cervical cancer screening in the United States and the Netherlands. Int J Cancer. 2017;140(5):1215–22.
pubmed: 27864938
pmcid: 5423652
doi: 10.1002/ijc.30524
Crane JMG. Pregnancy outcome after loop electrosurgical excision procedure: a systematic review. Obstet Gynecol. 2003;102:1058–62.
pubmed: 14672487
WHO. Global strategy to accelerate the elimination of cervical cancer as a public health problem [Internet]. 2020. https://iris.who.int/handle/10665/336583
Sidani S, Epstein DR, Bootzin RR, Moritz P, Miranda J. Assessment of preferences for treatment: validation of a measure. Res Nurs Health. 2009;32(4):419–31.
pubmed: 19434647
pmcid: 4446727
doi: 10.1002/nur.20329