Vahabi Mandana, Hynes Jenna, Wong Josephine Pui-Hing, Kithulegoda Natasha, Moosapoor Masoomeh, Akbarian Abdolreza, Lofters Aisha
Mandana Vahabi, Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8, Canada.
Li Ka Shing Knowledge Institute, Unity Health-St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
Curr Oncol. 2024 Dec 17;31(12):7994-8009. doi: 10.3390/curroncol31120590.
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.
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.
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.
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.
尽管宫颈癌（CC）可通过适当的筛查方法（如巴氏试验）高度预防，该试验能够早期检测恶性和癌前病变，但不同社会群体获得此类筛查的机会并不均等。性工作者和有监禁记录的人是安大略省筛查率最低的人群之一。关于人乳头瘤病毒自我采样（HPV-SS）作为这些群体宫颈癌筛查替代方法的可接受性和可行性知之甚少。这项基于社区的在线混合方法试点研究旨在填补这一知识空白。
由社区同伴招募了84名年龄在25 - 69岁之间、居住在大多伦多地区且未接受过筛查或从未接受过筛查的性工作者和刑满释放人员。参与者完成了一项在线调查，并观看了关于宫颈癌以及巴氏试验和HPV-SS筛查的短视频。选择HPV-SS的参与者在两个合作组织之一进行检测。
参与者的中位年龄为36.5岁。大多数人对宫颈癌和筛查的了解有限。约13%的人认定为非二元性别，5%为双灵或跨性别男性，大多数人完成了中等教育。在参与者中，88%选择了HPV-SS，三分之一的人高危HPV类型检测呈阳性。能够在没有医疗保健提供者评判的情况下自行采样被视为一个关键优势。然而，需要对正确的HPV-SS技术进行培训。
为了提高性工作者中的宫颈癌筛查率，通过参与性社区共同创造性健康教育来提高认识至关重要。此外，鉴于HPV-SS在该人群中已证明的可接受性和可行性，提供HPV-SS作为一种筛查选择至关重要，因为该人群中的许多人缺乏初级保健提供者，并且在医疗环境中面临歧视性态度。
