Julia M. Brotherton (Australia)

VCS Foundation Population health

Presenter of 4 Presentations

 Conference Calendar
Oral Session 6: SCREENING III. Implementation, dissemination, and communication  Hall E

AUSTRALIA’S NEW CERVICAL SCREENING PROGRAM: FINDINGS FROM THE STAKEHOLDERS OPINIONS OF RENEWAL IMPLEMENTATION AND EXPERIENCES STUDY (STORIES) (ID 708)

Session Date
07/22/2020
Session Time
11:35 - 13:15
Room
Hall E
Session Type
Public Health Oral Session
Session Name
Oral Session 6: SCREENING III. Implementation, dissemination, and communication 
Lecture Time
12:11 - 12:23
Presenter
Authors

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Public Health / Epidemiology / Vaccination: Implementation, Evaluation and Impact ePoster

CERVICAL CANCER INCIDENCE IN YOUNG WOMEN IN AUSTRALIA BY VACCINATION STATUS: A NATIONAL LINKED DATA ANALYSIS (ID 1080)

Session Date
07/21/2020
Session Time
10:00 - 17:00
Room
ePoster
Session Type
Poster Viewing - 20-24 July
Session Name
Public Health / Epidemiology / Vaccination: Implementation, Evaluation and Impact
Lecture Time
10:02 - 10:03
Presenter
Authors

Abstract

Introduction

Quadrivalent HPV vaccination commenced in 2007 in Australia, with a 3-year catch-up program vaccinating >50% of females 12-26 years. The median age of sexual debut is 16-17 years, meaning many vaccinated women were already HPV-exposed. Australia maintains registries of HPV vaccination and cancer.

Methods

The Australian Institute of Health and Welfare linked data using name-based probabilistic methods between the HPV vaccination register and the Australian cancer database. National cancer data depend upon timely data from 8 jurisdictions and was only available up to 2012 at linkage. Following the methods of Luostarinen et al 2018, we compared the incidence of cervical cancer in young women, as well as breast and thyroid cancer as control cancers, by HPV vaccination status between April 2007-Dec 2012. The population cohort comprised 6.4 million females born 1 Jan 1981- 1 January 2000 (oldest age 26 in 2007, youngest 12 in 2012). We also evaluated cancer type and vaccination history of all women diagnosed with cervical cancer after vaccination.

Results

Crude incidence rates of cervical, breast and thyroid cancer were low and comparable between fully vaccinated and unvaccinated women (cervix 1.6 vs 2.2, breast 1.8 vs 2.1, thyroid 3.9 vs 3.6). Cervical cancer incidence increased over time with cohort ageing; in 2012 rates were 2.5 (95%PoissonCI 1.7- 3.4) and 5.9 (95%PoissonCI 4.6-7.4) per 100,000 amongst fully vaccinated and unvaccinated women respectively. Of 102 cases of cervical cancer diagnosed in vaccinated women 2007-2012, only two cases, of non-HPV associated clear cell adenocarcinoma, occurred in women unlikely to have been sexually active prior to vaccination (as determined by age, screening history and dose dates).

Conclusions

Six years follow-up is too early to observe a population level decline in cervical cancers in Australian women who received catch up HPV vaccination. However these data suggest that significant reductions may be commencing.

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Public Health / Epidemiology / Other Public Health/Epidemiology Research ePoster

THE EXPERIENCES AND PERSPECTIVES OF ABORIGINAL AND TORRES STRAIT ISLANDER WOMEN WHO NEVER/RARELY PARTICIPATE IN CERVICAL SCREENING (ID 492)

Session Date
07/21/2020
Session Time
10:00 - 17:00
Room
ePoster
Session Type
Poster Viewing - 20-24 July
Session Name
Public Health / Epidemiology / Other Public Health/Epidemiology Research
Lecture Time
10:36 - 10:37
Presenter
Authors

Abstract

Introduction

In Australia, stark differences persist in cervical cancer outcomes for Aboriginal and Torres Strait Islander women, who experience two-fold higher incidence and four-fold higher mortality than other Australian women. Estimates suggest that two-thirds of Aboriginal and Torres Strait Islander women do not participate in cervical screening, despite a national program. We aimed to describe the perceptions of cervical screening among Aboriginal and Torres Strait Islander women who have not participated in cervical cancer screening.

Methods

We conducted semi-structured interviews with 30 Aboriginal and Torres Strait Islander women aged from 25–70 years who had not participated in cervical screening in the past 5 years. Participants were purposively sampled from Primary Health Care Centres from three jurisdictions. Transcripts are being analysed thematically.

Results

Preliminary results showed loss of control and shame caused women to avoid or refuse screening. The experience of screening and a potential diagnosis of cancer evoked fear, shame, embarrassment, feelings of stupidity, and of being violated. These emotions were amplified for women with experiences of trauma. Some women described unwelcome pressure from health professionals/family to screen. For many women, doctor’s gender, lack of trust and privacy, and fear of pain were mentioned as obstacles to screening. Some women felt self-collection was a good strategy to overcome barriers to screening, while others noted concerns about doing the self-collection properly. Women suggested strategies to overcome barriers, including group screening days and greater availability of information.

Conclusions

Our findings suggest that cervical screening elicits a range of negative emotions as well as an unwelcome surrendering of control. Overcoming these barriers requires a range of strategies, including explicitly addressing women’s fears and negative emotions, providing emotional support and appropriate information, ensuring that clinical care and screening are trauma-informed, and promoting and supporting self-collection to reclaim control.

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Public Health / Epidemiology / Other Public Health/Epidemiology Research ePoster

PERSPECTIVES OF ABORIGINAL AND TORRES STRAIT ISLANDER WOMEN WHO PARTICIPATE IN CERVICAL SCREENING (ID 495)

Session Date
07/21/2020
Session Time
10:00 - 17:00
Room
ePoster
Session Type
Poster Viewing - 20-24 July
Session Name
Public Health / Epidemiology / Other Public Health/Epidemiology Research
Lecture Time
10:03 - 10:04
Presenter
Authors

Abstract

Introduction

In Australia, Aboriginal and Torres Strait Islander women experience a higher burden of cervical cancer than other Australian women. Cervical cancer is largely preventable through cervical screening, but many Aboriginal and Torres Strait Islander women do not screen. However, approximately one third of Aboriginal and Torres Strait Islander women do participate in cervical screening and screen regularly but the factors involved in commencing and continuing to screen remain less known. We aimed to describe Aboriginal and Torres Strait Islander women’s experiences of and views about participation in cervical screening.

Methods

We conducted semi-structured yarns with 50 Aboriginal and Torres Strait Islander women aged 25 – 70 years who had completed cervical screening in the past 5 years, purposively sampled via Primary Health Care Centres (PHCCs) from three jurisdictions. All interviews were conducted by an Aboriginal or Torres Strait Islander woman.

Results

Two authors conducted iterative thematic analysis using a grounded theory approach. Major themes included women’s desire for control over their health, including the responsibility to be healthy for themselves and their families, importance of passing on knowledge, and overcoming emotional obstacles to screening; knowledge about cancer and cervical screening; access to appropriate services; and impact of past experiences, including having children and early experiences of cervical screening, on screening attitudes.

Conclusions

This study centred the views and experiences of Aboriginal and Torres Strait Islander women. Through this approach, the findings offer insights into factors that support Aboriginal and Torres Strait Islander women to take part in screening and highlight ways in which women feel empowered and in control of their health through participation in the cervical screening program. Understanding these factors will ensure screening services continue to support women to screen regularly and may inform strategies to better facilitate under or never screened women to start screening and increase screening rates overall

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Moderator of 2 Sessions

 Conference Calendar
Public Health Oral Session

00560 - Oral Session 2: VACCINATION I. Impact and effectiveness (ID 30)

Session Type
Public Health Oral Session
Session Date
07/21/2020
Session Time
15:00 - 16:00
Room
Hall A
Chair(s)

Session Webcast

Clinical Science Oral Session

00620 - Oral Session 3: Clinical Aspects of Cervical Prevention and Treatment (ID 75)

Session Type
Clinical Science Oral Session
Session Date
07/22/2020
Session Time
07:45 - 08:35
Room
Hall C
Chair(s)

Session Webcast