Women with obesity participate less in cervical cancer screening and are more likely to have unsatisfactory smears: Results from a nationwide Danish cohort study

Urbutė, Aivara; Kjær, Susanne K.; Kesmodel, Ulrik Schiøler; Frederiksen, Kirsten; Thomsen, Louise T.

doi:10.1016/j.ypmed.2022.107072

Cited by 19 publications

(14 citation statements)

References 41 publications

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“…Based on the results of this study the Korean obese women with diabetes have reduced ever cervical cancer screening rates in adults compared to those without diabetes and obesity. This is believed not to be a good idea to the National Cancer Screening Program existing in the Korea which is thought to have caused an increase however similar studies done in Denmark and France [27,28] had shown results not different from that of this study and stipulates that this may be due to the fact that cervical cancer process itself is challenging and the uterine lining may not be easy to be appreciated not forgetting the fact that the gynecological chair usage and sampling devices including speculum may be uncomfortable and also lack well trained healthcare personnel for its usage causing general fear of participation. Participants diabetes also showed lower screening rates than their non diabetic counterparts and recent studies done in USA 2022 with similar objectives also had similar objectives and attributed this reduced screening to socio-demographic inequality in access to healthcare services and insu cient attribution of recommended screening to participants by physicians [29,30].…”

Section: Discussionmentioning

confidence: 99%

Chronic Comorbidities and Cervical Cancer Screening adherence in the Korean Population using KHNANES

Chuck

Hong

Lee

2022

Preprint

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Purpose To investigate the cervical cancer screening rates in women with comorbidities – obesity, diabetes, and hypertension in the Korean Population. Methods Data of 2,972 people came from the Korean National Health and Nutrition Examination Survey (KNHANES) data 2019. Cancer-free women 30 years old and over were included. Recommended and ever cervical cancer screening rates were compared in participants with and without comorbidities. Comorbidities involving obesity were measured using body mass index in kilograms (BMI ≥ 30kg/m2), The presence of hypertension were measured by complete measurement of diastolic and systolic blood pressures while diabetes were defined based on people who had been diagnosed with diabetes by a physician and had received treatment for diabetes using insulin or other medication and those with fasting blood glucose of ≥ 126mg/dl. Baseline characteristics and cervical cancer screening rates were calculated using weighted frequencies and multivariable regression at 95% confidence interval in both participants. Results Ever and recommended cervical screening rates were significantly lower in diabetic patients P < 0.009 and p < 0.001 respectively than in those without diabetes. Recommended screening rate in hypertensive participants was lower, p < 0.036 compared to those without hypertension. Obese patients received lower screening rates, p < 0.013 compared with the non-obese participants. Conclusion Comorbidities including diabetes and obesity were less likely to have ever and recommended screening compared with those without diabetes and obesity. Greater efforts need to be made by physicians in high-risk groups to increase cervical cancer screening rates and to achieve parity.

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Section: Discussionmentioning

confidence: 99%

Chronic Comorbidities and Cervical Cancer Screening adherence in the Korean Population using KHNANES

Chuck

Hong

Lee

2022

Preprint

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“…Patients with higher‐than‐recommended BMIs face a greater risk of many health conditions for a variety of interrelated reasons. Although some studies have found higher rates of cervical cancer in obese women, the direct oncogenic nature of HPV has raised the question of whether this difference is due to challenges with adequate detection instead of some underlying pathological process related to intrinsic health and immunity status 2–4 …”

Section: Obesity Impacts Adherence To Cervical Cancer Screeningmentioning

confidence: 99%

Systematic Reviews to Inform Practice, November/December 2023

Harris,

Howe‐Heyman

2023

J Midwife Womens Health

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Adherence to cervical cancer screening guidelines is essential to the prevention of cervical cancer. Given the known targeted effects of the human papilloma virus (HPV), HPV vaccination, and routine screening to monitor for HPV and precancerous lesions, it is one of the most preventable cancers. 1 However, disparities persist across various groups, including patients in overweight or obese body mass index (BMI) categories. Patients with higher-than-recommended BMIs face a greater risk of many health conditions for a variety of interrelated reasons. Although some studies have found higher rates of cervical cancer in obese women, the direct oncogenic nature of HPV has raised the question of whether this difference is due to challenges with adequate detection instead of some underlying pathological process related to intrinsic health and immunity status. [2][3][4] A previous meta-analysis of 11 studies from the United States conducted in 2009 demonstrated a decrease in cervical cancer screening rates in women with obesity. 5 However, the authors were not able to identify this relationship when they analyzed the data for Black women alone. Almost 30 studies have been published since then, so Sand et al aimed to update the evidence to compare the influence of overweight and obesity for those with recommended weight on cervical cancer screening adherence rates. They also examined adherence by obesity class I to III, race, and geographical region. 6 Sand et al identified 32 eligible studies conducted from 2000 through September 1, 2022, for their systematic review and meta-analysis, with 66% conducted in North America, 28% in Europe, and 6% in Oceania. They selected studies that compared participation in cervical cancer screening for those within the range of recommended BMIs and those with higher BMIs. Three studies could not be included in the pooled analysis due to an odds ratio (OR) not being reported or insufficient data provided to calculate an OR; data for approximately one million women were available for the analysis across the 29 remaining studies. 6 All studies used the World Health Organization BMI categories. Studies with a quality score below 5 were excluded, and Egger's test was used to detect publication bias of the studies included in the final analysis. In addition to demographic information, data extraction included BMI categories, method for measuring BMI, number of participants in BMI categories,

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“…The social issues involved with obesity, including di culty and discomfort with a speculum exam, have been linked to the increased cervical cancer mortality present in women with obesity; the increased risk go beyond what would be expected from purely biologic reasons [10][11][12]. This is multifactorial including social stigma and patient embarrassment, physician reluctance to perform the exam on women with obesity [13,16,17], inadequate appropriately-sized medical equipment or formal training [7], exam-related patient discomfort due to increased maneuvering to obtain a good visual eld, and decreased diagnostic accuracy of the testing from incomplete cervical visualization [9]. Many of these may be mitigated with improved retraction of the lateral vaginal walls.…”

Section: Relevance In the Broader Contextmentioning

confidence: 99%

“…Clarke et al estimated that 20% of the cancers could be prevented if our tests for detecting precancer (secondary cancer prevention) reached a sensitivity that was the same in our patients who are overweight or obese as it is in those who are not [8]. This decreased sensitivity of detecting precancer is likely due to the decreased ability to visualize the cervix in this population leading to an inadequate tissue sample obtained during the Papanicolaou (Pap) smear [8,9].…”

Section: Introductionmentioning

confidence: 99%

Improving visualization of the cervix during pelvic exams: A physical model and a steppingstone to reducing disparities in gynecological cancers

Yerrabelli

Palsgaard

Hojati

et al. 2022

Preprint

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PURPOSE Pelvic exams are frequently complicated by collapse of the lateral vaginal walls, obstructing the view of the cervix. To overcome this, physicians frequently repurpose a glove or a condom as a sheath placed over the speculum blades to retract the lateral vaginal walls. Despite their regular use in clinical practice, little research has been done comparing the relative efficacy of these methods. Better visualization of the cervix can benefit patients by decreasing examination-related discomfort, improving cancer screening accuracy, and preventing the need to move the examination to the operating room under general anesthesia. METHODS This study presents a physical model that simulates vaginal pressure being exerted around a speculum. Using it, we then compare the efficacy of different condom types, glove materials, glove sizes, and application methods onto the speculum. RESULTS The results show that the best sheath is the middle finger of nitrile-material gloves. They provide adequate lateral wall retraction without significantly restricting the opening of the speculum. In comparison, condoms provide a smaller amount of retraction due to loosely fitting the speculum. They may still be a reasonable option for a different speculum size. However, vinyl-material gloves are an impractical option for sheaths; they greatly restrict speculum opening, occasionally even breaking the speculum, which overcome its retraction benefits. Glove size, condom brand, and condom material (latex vs polyisoprene) had minimal impact. CONCLUSION This study serves as a guide for clinicians as they use easily accessible tools to perform difficult pelvic exams. We recommend that physicians consider nitrile gloves as the preferred option for a sheath around a speculum. Additionally, this study demonstrates proof-of-concept of a physical model that quantitatively describes different materials on their ability to improve cervical access. This model can be used in future research with more speculum and material combinations, including with materials custom-designed for vaginal retraction.

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Women with obesity participate less in cervical cancer screening and are more likely to have unsatisfactory smears: Results from a nationwide Danish cohort study

Cited by 19 publications

References 41 publications

Chronic Comorbidities and Cervical Cancer Screening adherence in the Korean Population using KHNANES

Chronic Comorbidities and Cervical Cancer Screening adherence in the Korean Population using KHNANES

Systematic Reviews to Inform Practice, November/December 2023

Improving visualization of the cervix during pelvic exams: A physical model and a steppingstone to reducing disparities in gynecological cancers

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