On the path toward cervical cancer elimination in Canada: a national survey of factors influencing women's intentions to participate in human papillomavirus test-based primary cervical screening

Ovidiu Tatar^{1

2}, Ben Haward^{1

3

4}, Samara Perez^{5

6

7

8}, Patricia Zhu¹, Julia Brotherton⁹, Kathleen Decker^{10

11}, Aisha K Lofters^{12

13}, Marie-Hélène Mayrand^{2

14}, Emily McBride¹⁵, Gina Ogilvie^{16

17

18}, Gilla K Shapiro¹⁹, Laurie W Smith^{16

17}, Marc Steben^{7

20}, Jo Waller²¹, Gregory D Zimet²², Zeev Rosberger^{1

6

7

23

6

24}

Affiliations

¹ Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada.
² Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
³ Harvard Law School, Harvard University, Cambridge, MA, United States.
⁴ Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, United States.
⁵ Psychosocial Oncology Program, Division of Supportive and Palliative Care, Cedars Cancer Centre, McGill University Health Centre, Montreal, QC, Canada.
⁶ Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada.
⁷ HPV Global Action, Montreal, QC, Canada.
⁸ Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
⁹ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
¹⁰ Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹¹ Paul Albrechtsen Research Institute Cancer Care Manitoba, Winnipeg, MB, Canada.
¹² Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
¹³ Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada.
¹⁴ Département d'obstétrique-gynécologie, Université de Montreal, Montreal, QC, Canada.
¹⁵ Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.
¹⁶ BC Centre for Disease Control, Vancouver, BC, Canada.
¹⁷ Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
¹⁸ Women's Health Research Institute, Vancouver, BC, Canada.
¹⁹ Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
²⁰ School of Public Health, Université de Montréal, Montreal, QC, Canada.
²¹ Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
²² Emeritus School of Medicine, Indiana University, Indianapolis, IN, United States.
²³ Department of Psychiatry, McGill University, Montreal, QC, Canada.
²⁴ Department of Psychology, McGill University, Montreal, QC, Canada.

PMID: 39493836
PMCID: PMC11530915
DOI: 10.1016/j.lana.2024.100901

On the path toward cervical cancer elimination in Canada: a national survey of factors influencing women's intentions to participate in human papillomavirus test-based primary cervical screening

Ovidiu Tatar et al. Lancet Reg Health Am. 2024.

. 2024 Oct 15:39:100901.

doi: 10.1016/j.lana.2024.100901. eCollection 2024 Nov.

Authors

Affiliations

¹ Lady Davis Institute for Medical Research, McGill University, Jewish General Hospital, Montreal, QC, Canada.
² Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
³ Harvard Law School, Harvard University, Cambridge, MA, United States.
⁴ Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, United States.
⁵ Psychosocial Oncology Program, Division of Supportive and Palliative Care, Cedars Cancer Centre, McGill University Health Centre, Montreal, QC, Canada.
⁶ Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada.
⁷ HPV Global Action, Montreal, QC, Canada.
⁸ Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
⁹ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
¹⁰ Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹¹ Paul Albrechtsen Research Institute Cancer Care Manitoba, Winnipeg, MB, Canada.
¹² Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
¹³ Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada.
¹⁴ Département d'obstétrique-gynécologie, Université de Montreal, Montreal, QC, Canada.
¹⁵ Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.
¹⁶ BC Centre for Disease Control, Vancouver, BC, Canada.
¹⁷ Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
¹⁸ Women's Health Research Institute, Vancouver, BC, Canada.
¹⁹ Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
²⁰ School of Public Health, Université de Montréal, Montreal, QC, Canada.
²¹ Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
²² Emeritus School of Medicine, Indiana University, Indianapolis, IN, United States.
²³ Department of Psychiatry, McGill University, Montreal, QC, Canada.
²⁴ Department of Psychology, McGill University, Montreal, QC, Canada.

PMID: 39493836
PMCID: PMC11530915
DOI: 10.1016/j.lana.2024.100901

Abstract

Background: HPV test-based primary cervical screening is replacing cytology in Canada. In other countries, women's unpreparedness and concerns hindered the transition and post-implementation screening uptake. We investigated psychosocial correlates of intentions of screening in eligible individuals to participate in HPV-based primary cervical screening.

Methods: We conducted a nationwide web-based survey of individuals aged 21-70 years in 2022 and oversampled under-screened individuals. We used five Canadian-validated scales to measure HPV test-based screening knowledge, attitudes, and beliefs. Using the multistage Precaution Adoption Process Model, we assessed women's stage of intentions to participate in HPV testing and self-sampling. We estimated associations of psychosocial factors with intentions' stage using multinomial logistic regression.

Findings: In both groups (adequately screened n = 1778; under-screened n = 1570), higher HPV knowledge was associated with intention for HPV testing and more personal barriers to the HPV test were associated with lower intentions to participate in HPV testing or use of self-sampling. In both groups, higher self-sampling concerns were associated with lower intentions for self-sampling and higher women's need for autonomy was associated with increased intentions for self-sampling. In the under-screened group, increased age was associated with lower intentions for HPV testing and self-sampling, while living in Canada for <10 years was associated with higher intentions.

Interpretation: Our results could be used by policymakers and healthcare professionals to design communication strategies and ensure a smooth transition to HPV-based primary cervical screening, especially for under-screened individuals.

Funding: Canadian Institutes of Health Research project grant 165905.

Keywords: Attitudes and beliefs; Behavioural sciences; Cancer prevention; Cervical screening; HPV testing; Human papillomavirus; Obstetrics and gynecology; Public health; Reproductive health; Screening intentions; Self-sampling; Women's health.

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Conflict of interest statement

OT received support from the Canadian Institutes of Health Research (CIHR) through the Frederick Banting and Charles Best Doctoral award (Award No. FBD-170837) outside the scope of the submitted work. OT also serves as a part-time Research Associate Research Associate at the Lady Davis Institute for Medical Research (Montreal, Canada). GKS is supported by the Edith Kirchmann Postdoctoral Fellowship at Princess Margaret Cancer Centre and holds a CIHR 2019 fellowship award (CIHR MFE 171271) unrelated to the submitted study. GZ has received grants, contracts and consulting fees from Merck, has participated on the Data Safety Monitoring Board or Advisory Board for Merck and Moderna, and is a member of the Board of Directors of Unity Consortium, a non-profit organization. JW reports consultancy payments from Hologic to her institution for attending a cervical cancer patient advocacy workshop and participating in a discussion panel. She also received support from Hologic for travel expenses to attend patient advocacy meetings. MS has received grants and lecture honoraria from Abbott, Roche Diagnostics, Laboratories Biron and Attila Diagnostic. MS is the President of the International Society for STD Research, Co-President of the STI&HIV 2025 World Congress, and a board member of the International Papillomavirus Society. MS also reports receiving equipment from the National Cancer Institute. ZR reports unpaid leadership involvement as Vice-President of HPV Global Action, in a non-governmental organization, outside of the submitted work. LS reports consulting fees from the Canadian Partnership Against Cancer (Non-profit organization) EM, JB, KD, PZ, AL, BH, GO, SP, and MHM declare no conflicts of interest.

Figures

**Fig. 1**
**Questionnaire structure**. HPV, human papillomavirus; PAPM, Precaution Adoption Process Model.

See this image and copyright information in PMC

References

1. Brenner D.R., Weir H.K., Demers A.A., et al. Projected estimates of cancer in Canada in 2020. CMAJ. 2020;192(9):E199–E205. - PMC - PubMed
1. World Health Organization Cervical cancer elimination initiative. 2023. https://www.who.int/initiatives/cervical-cancer-elimination-initiative
1. Canadian Partnership Against Cancer Cervical cancer screening in Canada: environmental scan (2019-2020) 2020. https://www.partnershipagainstcancer.ca/topics/cervical-cancer-screening...
1. Canadian Partnership Against Cancer Action plan for the elimination of cervical cancer in Canada, 2020–2030. 2020. https://www.partnershipagainstcancer.ca/topics/elimination-cervical-canc...
1. Canadian Partnership Against Cancer Canadian strategy for cancer control 2019–2029. 2019. https://www.partnershipagainstcancer.ca/cancer-strategy/what-is-the-stra...

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On the path toward cervical cancer elimination in Canada: a national survey of factors influencing women's intentions to participate in human papillomavirus test-based primary cervical screening

Affiliations

On the path toward cervical cancer elimination in Canada: a national survey of factors influencing women's intentions to participate in human papillomavirus test-based primary cervical screening

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources