Correlates of women’s intentions to be screened for human papillomavirus for cervical cancer screening with an extended interval

Abstract

BackgroundHigh-risk HPV DNA testing has been proposed as a primary tool for cervical cancer screening (HPV-CCS) as an alternative to the Papanicolaou cytology- method. This study describes factors associated with women’s intentions to attend cervical cancer screening if high-risk HPV DNA testing (HPV-CCS) was implemented as a primary screening tool, and if screening were conducted every 4 years starting after age 25.MethodsThis online survey was designed using the Theory of Planned Behaviour to assess factors that impact women’s intentions to attend HPV-CCS among women aged 25–69 upon exit of the HPV FOCAL trial. Univariate and regression analyses were performed to compare the demographic, sexual history, and smoking characteristics between women willing and unwilling to screen, and scales for intention to attend HPV-CCS. A qualitative analysis was performed by compiling and coding the comments section of the survey.ResultsOf the 981 women who completed the survey in full, only 51.4 % responded that they intended to attend HPV-CCS with a delayed start age and extended screening interval. Women who intended to screen were more likely to have higher education (AOR 0.59, 95 % CI [0.37, 0.93]), while both positive attitudes (AOR 1.26, 95 % CI [1.23, 1.30]) and perceived behavior control (AOR 1.06, 95 % CI [1.02, 1.10]) were significant predictors of intention to screen. Among women who provided comments in the survey, a large number of women expressed fears about not being checked more than every 4 years, but 12 % stated that these fears may be alleviated by having more information.ConclusionsAcceptability of increased screening intervals and starting age could be improved through enhanced education of benefits. Program planners should consider measures to assess and improve women’s knowledge, attitudes and beliefs prior to the implementation of new screening programs to avoid unintended consequences.

Factors associated with human papillomavirus (HPV) test acceptability in primary screening for cervical cancer: A mixed methods research synthesis

“…The study selection flow diagram is presented in Figure 2. We retained 22 primary studies: 5 of qualitative methodology [29][30][31][32][33], 15 of quantitative methodology [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] and 2 in which both methodologies were used [49,50]. Seventeen studies originate in high income countries (8-USA, 2-Canada, 5-Europe and 2 in Australia) and five in low and middle income countries (1-Mexico, 1-El Salvador, 1-China, 1-India and 1 in Nigeria).…”

“…Attitudes towards cervical cancer screening include delayed start of screening e.g., "Age 25 is too late. I had a 19-year-old staff member with cervical cancer" [50] and/or increased screening interval e.g., "I worry that only being tested every 4 years gives plenty of time for issues to arise and go untreated" [50], Pap versus HPV test preference [32,48,50] and general attitudes and beliefs e.g., presence of early signs and symptoms in cervical cancer [29] or…”

“…[32]. When both HPV testing and Pap are available, womens' decision depends on the screening test preference [48,50].…”

“…Perceived benefits of the HPV test synthesize women's beliefs of the HPV test being accurate for early detection of cancer [29,38,46,50] despite possible concerns about the HPV test safety [29,50] and negative emotions and perceptions related to HPV testing such as anxiety about the test results [29], stigma and problems with communicating of positive results to significant others [33].…”

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

“…The screening interval between hpv tests is also longer (4 to 5 years) 5,6 because a negative hpv test provides greater reassurance than negative cytology. 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 .…”