Action and Impact: Prevention and Screening Strategies Contributing to the Elimination of Cervical Cancer

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Gynecologic Oncology".

Deadline for manuscript submissions: 31 March 2025 | Viewed by 8913

Special Issue Editor


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Guest Editor
1. Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC H4A 3J1, Canada
2. Department of Oncology, McGill University, Montreal, QC H4A 3T2, Canada
Interests: psychosocial oncology; HPV; cervical cancer; vaccine decision-making; cancer prevention; vaccine hesitancy; COVID-19

Special Issue Information

Dear Colleagues,

Cervical cancer is a preventable public health problem. Currently, it is one of the only cancers that has a clear preventable cause, the human papillomavirus (HPV). There are several HPV vaccines; they are safe and effective in preventing cervical cancer. We can also screen for cervical cancer using safe, effective and inexpensive methods, e.g., HPV DNA testing. Although we have the tools available to eliminate cervical cancer, one woman dies every two minutes from this disease worldwide.

For this Special Issue, we are pleased to invite you to submit original research articles and commentaries related to the behavioural and implementation sciences of HPV vaccination and/or screening practices that are contributing to the goal of eliminating cervical cancer. We welcome articles that examine ways to increase acceptability or projects that were able to increase knowledge, or modify behaviours related to cervical cancer prevention practices. This Special Issue focuses on the behavioural and implementation sciences i.e., the knowledge, attitudes and beliefs of  HPV vaccine acceptability, HPV vaccine hesitancy, the acceptability, knowledge and attitudes of women towards HPV and HPV self-sampling. This includes actionable suggestions or examples, e.g., the implementation of new programs, health care provider (physicians, dentists, nurses and allied health professionals) communication strategies and interventions to increase the acceptability of health behaviours that will lead toward the attainable goal of cervical cancer elimination.

I look forward to receiving your contributions.

Dr. Samara Perez
Guest Editor

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Keywords

  • HPV vaccine acceptability
  • cervical cancer health behaviours
  • implementation sciences
  • behavioural sciences

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Published Papers (7 papers)

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Research

16 pages, 594 KiB  
Article
Breaking Barriers: Empowering Cervical Cancer Screening with HPV Self-Sampling for Sex Workers and Formerly Incarcerated Women in Toronto
by Mandana Vahabi, Jenna Hynes, Josephine Pui-Hing Wong, Natasha Kithulegoda, Masoomeh Moosapoor, Abdolreza Akbarian and Aisha Lofters
Curr. Oncol. 2024, 31(12), 7994-8009; https://doi.org/10.3390/curroncol31120590 - 17 Dec 2024
Viewed by 374
Abstract
Background: Although cervical cancer (CC) is highly preventable through appropriate screening methods like the Papanicolaou (Pap) test, which enables early detection of malignant and precancerous lesions, access to such screening has not been equitable across social groups. Sex workers and people with records [...] Read more.
Background: Although cervical cancer (CC) is highly preventable through appropriate screening methods like the Papanicolaou (Pap) test, which enables early detection of malignant and precancerous lesions, access to such screening has not been equitable across social groups. Sex workers and people with records of incarceration are among the most under-screened populations in Ontario. Little is known about the acceptability and feasibility of HPV self-sampling (HPV-SS) as an alternative cervical cancer screening method for these groups. This online, community-based mixed-methods pilot study aimed to address this knowledge gap. Methods: Eighty-four under- and never-screened sex workers and ex-prisoners aged 25–69 years and residing in the Greater Toronto Area, were recruited by community peer associates. Participants completed an online survey and viewed short videos about CC and screening with Pap and HPV-SS. Those who opted for HPV-SS conducted the test at one of two collaborating organizations. Results: The median age of participants was 36.5 years. Most had limited knowledge about CC and screening. Approximately 13% identified as non-binary, and 5% as two-spirit or trans men, with the majority having completed secondary education. Of the participants, 88% chose HPV-SS, and one-third tested positive for high-risk HPV types. The ability to self-sample without judgment from healthcare providers was noted as a key advantage. However, there was a need for training on proper HPV-SS techniques. Conclusions: To improve cervical cancer screening among sex workers, increasing awareness through participatory community co-creation of sexual health education is essential. Additionally, offering HPV-SS as a screening option is crucial, given its demonstrated acceptability and feasibility within this population, many of whom lack a primary care provider and face discriminatory attitudes in healthcare settings. Full article
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18 pages, 2541 KiB  
Article
Addressing Underscreening for Cervical Cancer among South Asian Women: Using Concept Mapping to Compare Service Provider and Service User Perspectives of Cervical Screening in Ontario, Canada
by Kimberly A. Devotta, Patricia O’Campo, Jacqueline L. Bender and Aisha K. Lofters
Curr. Oncol. 2024, 31(11), 6749-6766; https://doi.org/10.3390/curroncol31110498 - 1 Nov 2024
Viewed by 715
Abstract
Cervical cancer is largely preventable through screening and treatment of cervical lesions. In the province of Ontario, South Asian women have some of the lowest rates of screening. The roles of service providers—those in healthcare and community services—and their interactions with screen-eligible people [...] Read more.
Cervical cancer is largely preventable through screening and treatment of cervical lesions. In the province of Ontario, South Asian women have some of the lowest rates of screening. The roles of service providers—those in healthcare and community services—and their interactions with screen-eligible people can greatly impact the uptake of screening. In our study, we used concept mapping (CM) to engage over 70 South Asian service users (i.e., those eligible for cervical screening) and service providers to identify a range of ideas and experiences that impact uptake of cervical screening for South Asian women, which were then rated by 45 participants in terms of ‘importance’ and ‘ease to address’ to encourage participation in cervical screening. Overall, ideas related to knowledge and education were rated as most important and easiest to address by both groups. Some differences were seen with South Asian service users valuing the importance of addressing ‘cultural beliefs and influences specific to sexual health’ more than service providers, while service providers valued the importance of addressing ‘lack of comfort and supportive relationships’ more than South Asian service users. Future interventions should target the knowledge and education needs of service users and increase service providers’ awareness of cultural beliefs and influences specific to sexual health. Full article
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12 pages, 444 KiB  
Article
Progress and Challenges in Canada’s Path Toward the Elimination of Cervical Cancer
by Samara Perez
Curr. Oncol. 2024, 31(10), 5850-5861; https://doi.org/10.3390/curroncol31100435 - 29 Sep 2024
Viewed by 1068
Abstract
Cervical cancer is almost entirely preventable and treatable when detected early, making its elimination within reach for Canada and the world. However, cervical cancer is now the fastest-increasing cancer (+3.7% per year since 2015) in Canada as of 2023, marking the first significant [...] Read more.
Cervical cancer is almost entirely preventable and treatable when detected early, making its elimination within reach for Canada and the world. However, cervical cancer is now the fastest-increasing cancer (+3.7% per year since 2015) in Canada as of 2023, marking the first significant increase in cervical cancer incidence since 1984. The human papillomavirus (HPV) vaccine and cervical screening are key preventive measures, with targets set by the WHO and the Canadian Partnership Against Cancer (CPAC) to eliminate cervical cancer in Canada by 2030 and 2040, respectively. These targets include increasing HPV vaccination rates, implementing primary HPV screening, and improving follow-up for abnormal HPV+ results. However, Canada’s progress has been impeded by significant challenges. As of the most recent data, HPV vaccine coverage rates in Canada range from 47% to 81%, with an estimated national HPV vaccination completion rate of 64% in Canada, far below the target of 90% by 2025 set by the CPAC. With the exception of British Columbia and Prince Edward Island, the adoption of HPV DNA testing as the primary screening method has been slow across the Canadian provinces and territories despite its superior sensitivity compared with traditional cytology. This article reviews the current state of HPV vaccination and screening in Canada, emphasizing the need for coordinated efforts, transparency, and resource sharing to overcome barriers. Key recommendations include the dissemination of accessible educational materials, partnerships, and collaboration, including nationwide task forces and roundtables, and the implementation of standardized guidelines for HPV screening. Achieving cervical cancer elimination requires a united approach involving federal, provincial, and territorial health authorities, researchers, clinicians, NGOs, community groups, and patients’ voices working together to ensure consistent, effective, timely, and meaningful cervical cancer prevention strategies are used across the country. Full article
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13 pages, 652 KiB  
Article
Self-Screening for Cervical Cancer Offered through a Digital Platform in a Region of British Columbia with Lower Screening Rates
by Laurie W. Smith, Amy Booth, C. Sarai Racey, Brenda Smith, Ashwini Prabhakaran, Smritee Dabee, Quan Hong, Nazia Niazi and Gina S. Ogilvie
Curr. Oncol. 2024, 31(9), 5399-5411; https://doi.org/10.3390/curroncol31090399 - 13 Sep 2024
Viewed by 1268
Abstract
Cervical cancer is highly preventable through vaccination, early detection, and treatment, yet is the fourth most common cancer globally. HPV testing is superior to cytology for the detection of cervical pre-cancer, and jurisdictions around the world are implementing HPV primary screening, which offers [...] Read more.
Cervical cancer is highly preventable through vaccination, early detection, and treatment, yet is the fourth most common cancer globally. HPV testing is superior to cytology for the detection of cervical pre-cancer, and jurisdictions around the world are implementing HPV primary screening, which offers the opportunity for self-screening, an important self-care intervention. Digital health solutions are also increasingly important components of self-care. In this study, we assessed the acceptability and completion of self-screening for cervical cancer offered through a digital platform within a low screening uptake region of British Columbia. The primary objective of this study was to evaluate the acceptability of self-screening for cervical cancer offered through a digital platform as measured by return rates of self-screening kits. Patients due or overdue for cervix screening were invited to participate. Eligible participants registered online to receive a self-screening kit, which included a device for vaginal self-screening, instructions, and a return envelope, sent to their home. After self-screening using the vaginal device, HPV testing was conducted. HPV-negative participants were returned to routine screening, and HPV-positive participants were recommended for cytology or colposcopy. Attendance rates at follow-up were evaluated. Participants were invited to complete an acceptability survey. From April 2019 to December 2023, 283 participants were sent kits, with 207 kits returned for a completion rate of 73%. Of valid samples (n = 202), 15 were HPV positive, and 93% attended follow-up care. Most respondents found the CervixCheck website easy to use, informative, and secure and were satisfied with receiving their results online. CervixCheck had a high completion rate among participants who were sent a self-screening kit. High compliance with recommended follow-up and high acceptability of self-screening for cervical cancer was observed. Most participants indicated they would self-screen again in the future. Innovative approaches to cervical screening, including self-screening and the use of digital health interventions, are ways to enhance equity and improve uptake of cervical screening. Full article
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9 pages, 239 KiB  
Article
HPV Self-Sampling for Cervical Cancer Screening in Under-Screened Saskatchewan Populations: A Pilot Study
by Erin Vink, Gabriella Antaya, Camille Hamula, Carla Holinaty, Jessica Minion, Gregory R. Pond, Sabryna McCrea, Lynn Dwernychuk, Holly Graham, Gordon Broderick, Mary Kinloch and Jennifer Brown Broderick
Curr. Oncol. 2024, 31(8), 4261-4269; https://doi.org/10.3390/curroncol31080317 - 26 Jul 2024
Viewed by 1274
Abstract
Of all cancers in female Canadians, the most rapidly increasing incidence is that of cervical cancer. The objective of this pilot study was to assess how HPV self-sampling might improve cervical cancer screening participation in both urban and rural settings in Saskatchewan, one [...] Read more.
Of all cancers in female Canadians, the most rapidly increasing incidence is that of cervical cancer. The objective of this pilot study was to assess how HPV self-sampling might improve cervical cancer screening participation in both urban and rural settings in Saskatchewan, one of the most sparsely populated provinces in Canada. Study groups consisted of n = 250 participants to whom self-swabbing kits were mailed with instructions and n = 250 participants to whom kits were handed out in 6 urban and rural clinics. The inclusion criteria selected subjects aged 30–69 years who were Saskatchewan residents for at least 5 years with valid health coverage, had a cervix, and had no record of cervical cancer screening in 4 years. The returned samples were analyzed for specific HPV strains using the Roche Molecular Diagnostics Cobas 4800® System. The overall response rate was ~16%, with the response to the handout distribution being roughly double that of the mailout. While HPV positivity did not differ across the distribution groups, participants at a specific inner-city clinic reported significantly higher positivity to at least one HPV strain as compared to any other clinic and all mailouts combined. For this high-risk population, in-person handout of self-sampling kits may be the most effective means of improving screening. Full article
14 pages, 511 KiB  
Article
Important and Feasible Actions to Address Cervical Screening Participation amongst South Asian Women in Ontario: A Concept Mapping Study with Service Users and Service Providers
by Kimberly Devotta, Patricia O’Campo, Jacqueline Bender and Aisha K. Lofters
Curr. Oncol. 2024, 31(7), 4038-4051; https://doi.org/10.3390/curroncol31070301 - 17 Jul 2024
Cited by 1 | Viewed by 1767
Abstract
Regular cervical screening can largely prevent the development of cervical cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some of the lowest rates of screening in the province. In this study, we [...] Read more.
Regular cervical screening can largely prevent the development of cervical cancer and innovative methods are needed to better engage people in screening. In Ontario, Canada, South Asian women have some of the lowest rates of screening in the province. In this study, we used concept mapping to engage two stakeholder groups—South Asian service users and service providers—to identify and prioritize points of intervention to encourage the uptake of cervical screening. After participants brainstormed a master list of statements, 45 participants rated the statements based off ‘importance’ and ‘ease to address’ in relation to encouraging cervical screening. A bivariate plot (X-Y graph) that shows the average rating values for each statement across the two rating variables (a ‘go-zone’ display) was produced to display priorities for implementation. Statements that were considered high priority to address reflected issues around education and awareness including understanding and communication related to cervical screening and preventative care, as well as the need for trusted sources of information. Statements that were considered high priority but challenging to implement were centered around fear, stigma, discomfort, family and personal priorities. This study highlighted that stigma, norms and social relations that impact the uptake of screening must be addressed in order for education and awareness raising to be effective and to move people from conviction around screening to action. Full article
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12 pages, 7187 KiB  
Article
Mother–Child Approach to Cervical Cancer Prevention in a Low Resource Setting: The Cameroon Baptist Convention Health Services Story
by Lorraine Elit, Florence Manjuh, Lillian Kila, Beatrice Suika, Manuela Sinou, Eliane Bozy, Ethel Vernyuy, Amandine Fokou, Edith Welty and Thomas Welty
Curr. Oncol. 2024, 31(6), 3227-3238; https://doi.org/10.3390/curroncol31060244 - 3 Jun 2024
Viewed by 1438
Abstract
Introduction: The rates of cervical cancer screening in Cameroon are unknown and HPV vaccination coverage for age-appropriate youths is reported at 5%. Objectives: To implement the mother–child approach to cervical cancer prevention (cervical screening by HPV testing for mothers and HPV vaccination for [...] Read more.
Introduction: The rates of cervical cancer screening in Cameroon are unknown and HPV vaccination coverage for age-appropriate youths is reported at 5%. Objectives: To implement the mother–child approach to cervical cancer prevention (cervical screening by HPV testing for mothers and HPV vaccination for daughters) in Meskine, Far North, Cameroon. Methods: After the sensitization of the Meskine–Maroua region using education and a press-release by the Minister of Public Health, a 5-day mother–child campaign took place at Meskine Baptist Hospital. The Ampfire HPV Testing was free for 500 women and vaccination was free for age-appropriate children through the EPI program. Nurses trained in cervical cancer education conducted group teaching sessions prior to having each woman retrieve a personal sample. Self-collected samples were analyzed for HPV the same day. All women with positive tests were assessed using VIA–VILI and treated as appropriate for precancers. Results: 505 women were screened, and 92 children vaccinated (34 boys and 58 girls). Of those screened, 401 (79.4%) were aged 30–49 years old; 415 (82%) married; 348 (69%) no education. Of the HPV positive cases (101): 9 (5.9%) were HPV 16, 11 (10.1%) HPV 18, 74 (73%) HPV of 13 other types. Those who were both HPV and VIA–VILI positive were treated by thermal ablation (63%) or LEEP (25%). Conclusion: The mother–child approach is an excellent method to maximize primary and secondary prevention against cervical cancer. Full article
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