The cervical cancer screening program from a midwife's perspective

Ideström, Monica; Milsom, Ian; Andersson-Ellström, Agneta

doi:10.1080/00016340701371272

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…The obstacles to attending CCS were found to be complex and multifactorial. In accordance with other studies, the most common reasons for non-participation are practical [15][16][17], particularly among younger women [18]. CCS scheduling is too rigid for today's busy lifestyle [17] and there is a need improve access.…”

Section: Discussionsupporting

confidence: 81%

Attending cervical cancer screening, opportunities and obstacles: A qualitative study on midwives’ experiences telephoning non-attendees in Sweden

Broberg

Strander

Ellis

et al. 2014

Scand J Public Health

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Section: Discussionsupporting

confidence: 81%

Attending cervical cancer screening, opportunities and obstacles: A qualitative study on midwives’ experiences telephoning non-attendees in Sweden

Broberg

Strander

Ellis

et al. 2014

Scand J Public Health

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“…This may be a manifestation of poor accessibility in the regular screening program and scheduling of appointments can no doubt be improved. 34 Offering appointments at different times of the day and the week and simplifying re-booking would make it easier for women who wish to attend. Twenty-nine percent of women made an appointment, but about a third of them never showed up to take a Pap smear.…”

Section: Discussionmentioning

confidence: 99%

Increasing participation in cervical cancer screening: Telephone contact with long‐term non‐attendees in Sweden. Results from RACOMIP, a randomized controlled trial

Broberg

Jonasson

Ellis

et al. 2013

Intl Journal of Cancer

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Non-participation is the foremost screening-related risk factor for cervical cancer. We studied the effectiveness and costeffectiveness of an intervention to increase participation in the context of a well-run screening program. Telephone contact with non-attendees, offering an appointment to take a smear, was compared with a control group in a population-based randomized trial in western Sweden. Of 8,800 randomly selected women aged 30-62, without a registered Pap smear in the two latest screening rounds, 4,000 were randomized to a telephone arm, another 800 were offered a high-risk human papillomavirus (HPV) self-test by mail (not reported in this article) and 4,000 constituted a control group. Endpoints were frequency of testing, frequency of abnormal smears and further assessment of abnormal tests. Participation during the following 12 months was significantly higher in the telephone arm than in the control group, 718 (18.0%) versus 422 (10.6%) [RR: 1.70, 95% confidence interval (CI): 1.52-1.90]. The number of detected abnormal smears was 39 and 19, respectively (RR: 2.05, 95% CI: 1.19-3.55). The respective numbers of further assessed abnormalities were 34 and 18 (RR: 1.89, 95% CI: 1.07-3.34). Twice as many high-grade intraepithelial neoplasia (CIN21) were detected and treated in the telephone arm: 14 and 7, respectively. Telephone contact with women who have abstained from cervical cancer screening for long time increases participation and leads to a significant increase in detection of atypical smears. Cost calculations indicate that this intervention is unlikely to be cost-generating and this strategy is feasible in the context of a screening program.Cervical cancer is considered to be a preventable disease. Screening by Papanicolaou (Pap) smear has markedly reduced incidence and mortality. [2][3][4] Vaccines to prevent infection with specific oncogenic human papillomavirus (HPV), the main cause of cervical cancer, 5 are available but it will be long before effects on cancer will be measurable. 6,7 At least until then, screening programs will remain the key defense against this disease.8 A recent audit of the Swedish screening program, in which all cases of invasive cervical epithelial carcinoma during 3 years were evaluated, showed that

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“…However, although family and general physicians were more likely to follow the speci ed guidelines used by gynecologists [26], some nonexpert physicians feel that there are some barriers in accurately taking Pap smears, such as the lack of a training system [30]. Similar problems have been suggested in studies conducted in European countries [28,29,31]. On the other hand, even if general physicians have no constraint in taking Pap smears, they often hesitate to perform them because they believe that women are better served if Pap smears are taken by gynecologists [30,31].…”

Section: Consent Publicationmentioning

confidence: 96%

“…To increase the participation rate and improve treatment results, sharing various screening works with other health professionals, particularly taking Pap smears, should be considered in Japan. In several countries, medical systems that permit general physicians and midwives to take Pap smears for cervical cancer screening are now seeing the bene t [27][28][29][30][31]. These systems can help improve access to cancer screening programs, although they can also serve as a barrier to referring abnormal results to gynecologists.…”

Section: Consent Publicationmentioning

confidence: 99%

“…These systems can help improve access to cancer screening programs, although they can also serve as a barrier to referring abnormal results to gynecologists. In Sweden, midwives have the responsibility of taking Pap smears during cervical cancer screening and of simultaneously conducting consultations on health problems [29]. In the U.S., most primary care physicians provide Pap tests to their patients following the speci ed guidelines [27].…”

Section: Consent Publicationmentioning

confidence: 99%

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National data analysis and systematic review for human resources for cervical cancer screening in Japan: Who should take Pap smears for cervical cancer screening?

Hamashima¹,

Sasaki²,

Hoshi³

et al. 2020

Preprint

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Background: Although cervical cancer screening has been performed as a national program since 1983 in Japan, taking Pap smears from the cervix has usually been performed by gynecologists and obstetricians in their offices. Conventionally, general physicians and midwives cannot take Pap smears of cervical cancer screening in Japan. Accessibility is one of the important factors to consider when planning to increase the participation rate in cancer screening programs. Gynecologists also play a primary role in the diagnosis and treatment of cervical cancers. Discussions regarding the needed human resources for cancer screening programs have remained scared in Japan. Methods: We examined the number of gynecologists and obstetricians based on a national survey. Candidate literature was searched using Ovid-MEDLINE and Ichushi-Web until the end of January 2019. Then, a systematic review regarding accessibility to cervical cancer screening was performed. The results of the selected articles were summarized in the tables.Results: Although the total number of all physicians in Japan increased from 1996 to 2016, the proportion of gynecologists and obstetricians has remained at approximately 5% over the last 2 decades. However, 43.6% of municipalities have no gynecologists and obstetricians in 2016. Five articles identified from Ovid-MEDLINE and Ichushi-Web were eligible and assessed. Two Japanese studies showed consistent results regarding the association of resources as gynecologists and obstetricians with participation rates in cervical cancer screening. Another article reported on the national distribution of gynecological oncologists and compared the treatment outcomes between hospitals with and without certified gynecologists. The number of certified gynecological oncologists has remained insufficient with a biased distribution. Thus, the survival rate of cervical cancer patients was different between hospitals with and without accreditation by academic society. Although the perspectives of selected articles were different, the results suggested the burden to access to cervical cancer screening and consequent diagnosis and treatment.Conclusions: The human resources for taking Pap smears for cervical cancer screening has remained insufficient with a huge disparity among municipalities in Japan. Enabling general physicians to take Pap smears or the introduction of self-sampling HPV testing may be considered to augment the limited access to cervical cancer screening.

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The cervical cancer screening program from a midwife's perspective

Cited by 5 publications

References 29 publications

Attending cervical cancer screening, opportunities and obstacles: A qualitative study on midwives’ experiences telephoning non-attendees in Sweden

Attending cervical cancer screening, opportunities and obstacles: A qualitative study on midwives’ experiences telephoning non-attendees in Sweden

Increasing participation in cervical cancer screening: Telephone contact with long‐term non‐attendees in Sweden. Results from RACOMIP, a randomized controlled trial

National data analysis and systematic review for human resources for cervical cancer screening in Japan: Who should take Pap smears for cervical cancer screening?

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