Objectives To describe the attitudes about and experiences with cervical cancer, Pap smear screenings and the HPV vaccine among a sample of Inuit women from Nunavik, Quebec, Canada. We also evaluated demographic and social predictors of maternal interest in HPV vaccination. Study design A mixed method design was used with a cross-sectional survey and focus group interviews. Methods Women were recruited through convenience sampling at 2 recruitment sites in Nunavik from March 2008 to June 2009. Differences in women's responses by age, education, and marital status were assessed. Unconditional logistic regression was used to determine predictors of women's interest in HPV vaccination for their children. Results Questionnaires were completed by 175 women aged 18–63, and of these women a total of 6 women aged 31–55 participated in 2 focus groups. Almost half the survey participants had heard of cervical cancer. Women often reported feelings of embarrassment and pain during the Pap smear and older women were more likely to feel embarrassed than younger women. Only 27% of women had heard of the HPV vaccine, and 72% of these women were interested in vaccinating their child for HPV. No statistically significant predictors of maternal interest in HPV vaccination were found. Conclusions Our findings indicate that health service planners and providers in Nunavik should be aware of potential barriers to Pap smear attendance, especially in the older age groups. Given the low awareness of cervical cancer, the Pap smear and the HPV vaccine, education on cervical cancer and prevention strategies may be beneficial. 1

Objective To assess the comparability of self-collected cervicovaginal samples and provider-collected cervical samples for the detection of human papillomavirus (HPV) DNA among Inuit women in Nunavik, Quebec, avoiding the use of liquid-based storage and transport of the self-collected samples. Methods Ninety-three women aged 18–69 years were recruited from a previously formed cohort on the natural history of HPV to this cross-sectional measurement study. This study utilized HPV DNA test results from 89 paired specimens collected by study participant and health provider with Dacron swabs. Samples were tested for 36 HPV types with the PGMY-primer PCR protocol and genotyping with the linear array method. Unweighted kappa statistics and McNemar tests were used to measure the agreement between sampling techniques. Results In the self-collected samples, 30 different HPV types were found, compared with 29 types found in the provider-collected samples. The prevalence of high-risk (HR) HPV was 38.2% in the self-collected samples and 28.1% in the provider-collected samples. The agreement between collection methods for the detection of HR-HPV DNA (85.4%) was good. HR-HPV and type-specific HPV 16/18 were as likely to be detected in the self-collected samples compared with the provider-obtained samples. Conclusions Women in this population were easily able to collect adequate cervicovaginal specimens for HPV testing. As self-sampling has a high recovery of HR-HPV and is comparable with provider-sampling, we conclude that self-sampling with dry storage and transport could be a good cervical cancer screening alternative for Inuit women in Nunavik who have traditionally avoided speculum examination.

There is a higher incidence of cervical cancer and prevalence of genital human papillomavirus (HPV) infection among the Inuit in Canada than the general population. Self-sampling of cervicovaginal cells for HPV testing has the potential to increase cervical cancer screening coverage in this population, but only if it is acceptable to women. We sought to determine acceptance of and preference for self-collection of cervicovaginal samples for HPV testing in comparison with provider-collection, and to explore demographic characteristics of preference for self-collection among a sample of Inuit women from Nunavik, Quebec. Women aged 18–69 years were recruited from a previously formed cohort on the natural history of HPV in Nunavik. Both self-collected and provider-collected specimens were collected with polyester-tipped swabs, and women completed a short written questionnaire immediately after specimen collection. Logistic regression was used to estimate predictors of preference. Of the 109 eligible women who were approached to participate, 93 (85%) accepted. Self-sampling was preferred by 56% of the women over provider-sampling. Education was the only predictor of preference for self-sampling, where having at least a grade 9 education was inversely associated with preference for self-sampling (OR = 0.29, 95% CI [0.09, 0.92]). Self-sampling has the potential to increase cervical cancer screening coverage, but any implementation of self-sampling should be concurrent with an education campaign on the importance of cervical cancer screening, the relationship between HPV virus and cervical cancer, and the accuracy of self-sampling.

The high incidence and persistence of HPV infections found demonstrate that this population is at high risk for HPV infection. These data provide a deeper understanding of the HPV infection experience of Inuit women, but they may also help evaluate vaccination strategies currently used for this high-risk population.

BackgroundThe Canadian circumpolar Inuit population has a higher incidence rate of cervical cancer than the general population and the majority of cases occur among underscreened women. The objectives of this study were to determine Pap smear utilization rates and to determine factors associated with time-inappropriate use of cervical cancer screening among a cohort of Inuit women from Nunavik, Quebec, Canada.MethodsThis study utilizes baseline information collected from a cohort formed between January 2002 and December 2007 to study the natural history of HPV among Inuit women aged 21–69 years in Nunavik, Quebec. Cervical cancer screening history and other variables were obtained from a baseline questionnaire and medical chart review. Unconditional logistic regression was used to estimate the odds ratios and 95% confidence intervals for potential predictors of not having a Pap smear within the previous 3 years prior to cohort entry.ResultsA total of 403 Inuit women who had a baseline questionnaire and chart review were included. The mean age of the study population was 34.2 years. In the three years prior to study entry, 25% of women did not have a Pap smear. Older age and never giving birth were significant predictors of time-inappropriate Pap smear use.ConclusionsOur results suggest that older women and women who are not accessing reproductive care have a lower compliance with time-appropriate cervical cancer screening and future research should address potential strategies to increase screening coverage among this group.