The topic of my thesis is cervical cancer and its prevention with emergence on vaccination against cervical cancer. The aim of my diploma thesis is to use analyzation of the campaign against cervical cancer, All I can, and analyzation of interviews with mothers who have decided to vaccinate their daughters to find out how the responsibility of mothers for health of daughters is constructed in the connection with cervical cancer. I am interested in how campaign promoting a vaccination articulates what is good or bad motherhood and how mothers construct a good motherhood. I am also interested in gender consequences of campaign that it brings and how mothers prevent health of their daughters. The thesis shows that health is our project and is as good as we care about it. In the connection with reproductive health there is mainly appear a theme of considering risks which participate on creation of good parenthood. The thesis talks about different medicalization of child body that is set up and reproduce by interviewed mothers and by campaign. It brings gender inequalities and stereotypical gender constructions and questions of who is responsible for reproductive health.

Bakgrund I majoriteten av länderna världen över klassas livmoderhalscancer som den näst vanligaste eller den vanligaste cancerdiagnosen hos kvinnor. Sjukdomen som till största del orsakas av ihållande infektioner med humant papillomvirus (HPV) kan bilda cellförändringar som senare utvecklar cancertumörer i livmoderhalsen. Aggressiva behandlingsformer i olika kombinationer sätts in och ger vanligen en rad olika biverkningar som påverkar kvinnorna på olika sätt. Ett sjukdomslidande är ett lidande som orsakas av sjukdomen i sig samt dess behandlingar. Kvinnor som får livmoderhalscancer har därav en ökad tendens till att uppleva ett lidande.  Syfte Syftet med studien var att belysa kvinnors erfarenheter och upplevelser av att leva med livmoderhalscancer.  Metod En icke-systematisk litteraturöversikt tillämpades och författarna baserade resultatet på 15 vetenskapliga artiklar med kvantitativ samt kvalitativ design. Via databaserna Public Medline (PubMed) samt Cumulative Index to Nursing & Allied Health literature (CINAHL) inhämtades artiklarna med hjälp av olika sökkombinationer. Artiklarna som inkluderades i studien kvalitetsgranskades utifrån bedömningsunderlaget framtaget av Sophiahemmet högskola. Därefter genomfördes en integrerad dataanalys där artiklarna till resultatdelen sorterades in i kategorier och underkategorier, genom detta utformades fyra huvudrubriker med tillhörande underrubriker.  Resultat I litteraturöversiktens resultat beskrivs hur kvinnor upplever livmoderhalscancer. I resultatet framkommer det att beskedet om diagnosen, genomförandet av behandling samt dess biverkningar påverkat majoriteten av kvinnornas fysiska, psykiska och sexuella förmåga. I resultatet framkommer det även att majoriteten av kvinnorna som lever med sjukdomen upplever en förändrad vardag med anledning av detta.  Slutsats Litteraturöversiktens resultat visar sammanfattningsvis att upplevelsen av livmoderhalscancer är varierande hos kvinnor, framför allt på grund av val av behandlingsmetod. Det framgår i resultatet att lidandet hos kvinnor är tydligt inom flertalet områden. Kvinnor upplever fysiska och psykiska hinder i livet både under och efter att ha diagnostiserats med livmoderhalscancer. / Background In the majority of countries around the world, cervical cancer is classified as the second most common or the most common cancer diagnosis in women. The disease, which is largely caused by persistent infections with human papillomavirus (HPV), can form cell changes that later develop cancerous tumors in the cervix. Aggressive forms of treatment in different combinations are used and usually cause a number of different side effects that affect women in different ways. The suffering of illness is a suffering caused by the disease itself and its treatments. Women who get cervical cancer therefore have an increased tendency to experience suffering.  Aim The purpose of this study was to illustrate women's experiences of living with cervical cancer.  Method A non-systematic literature overview was applied and the authors based their results from 15 scientific articles with quantitative and qualitative design. The articles are collected from the databases Public Medline (PubMed) and Cumulative Index to Nursing & Allies Health Literature (CINAHL), using different search combinations. The articles included in the study has been quality audited based on the assessment data produced by Sophiahemmet Högskola. Thereafter, an integrated data analysis was carried out where the articles were sorted into categories, and under categories, through this, four main headings with associated subheadings were designed.  Results In the result of the literature overview, it is described how women experience cervical cancer. The results show that the information about the diagnosis, the implementation of treatment and its side effects affected the majority of the women's physical, mental and sexual abilities. The results also show that the majority of women living with the disease experience a changed everyday life due to this.  Conclusions In summary, the result of the literature overview show that the experience of cervical cancer varies in women, mainly due to the choice of treatment method. The results show a clear suffering of women and in many areas. Women experience physical and mental barriers in life both during and after being diagnosed with cervical cancer.

In Swaziland, cases of cervical cancer among Human Immunodeficiency Virus (HIV)-positive adolescent girls and young women (AGYW) are increasing, but there is low uptake of cervical cancer screening. This study was conducted using the systems thinking theory to explore the relationships between the uptake of cervical cancer screening among HIV-positive AGYW in Swaziland and the availability of trained health providers, cervical screening services, and the provision of referrals for cervical screening. The study also investigated any differences in uptake of cervical screening based on age group. For this quantitative cross-sectional study, secondary HIV program data that were collected routinely between January 2016 and March 2018 were accessed. Data were described with univariate analysis while relationships were tested using bivariate analysis and logistic regression. Most facilities (97%) had staff who had been trained; facilities with greater numbers of trained staff were more likely to have a higher uptake (OR: 30.3, p = 0.000). Facilities with cervical screening services were also more likely to have a higher uptake (x2 = 16.94, p = 0.000), and facilities with all the core components for screening had the highest uptake (p = 0.002). AGYW who had a positive screen were referred equally but the referral rate was low (20.45%). There was no difference in uptake by age group. The results of the study can increase knowledge of the institutional factors that contribute to the low uptake of cervical cancer screening among HIV-positive AGYW and has implications for social change by informing interventions for improving cervical cancer screening uptake in HIV-positive AGYW in similar settings, ultimately reducing the high costs, morbidity, and mortality related to cervical cancer in this population.

Despite the availability of the human papillomavirus (HPV) vaccine, African American women are still at risk for contracting HPV. This is significant because HPV is one of the main risk factors for cervical cancer. The purpose of this quantitative study was to explore the relationship between the use of HPV vaccination for cervical cancer prevention and personal history of HPV, reduced access to healthcare, and risky sexual behaviors in African American women. The theoretical framework used for this study was the health belief model (HBM). Two hundred twenty-nine (n=229) African American women living in the United States, ages 18-49, who participated in the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were the sample under study. A univariate analysis was performed to describe the population and obtain frequencies and percentages for all covariates. A bivariate analysis was conducted to determine whether there was an association between any of the independent variables and the dependent variable. A multivariable logistic regression was conducted to build a predictor model for use of HPV vaccination. Women between the ages of 18 and 34 were 7.22 times as likely to receive the HPV vaccine as women aged 35-49 years, and this was statistically significant (OR: 7.22; 95% CI: 2.36 - 22.13). This study can contribute to positive social change within the community and public health profession through an increased awareness and knowledge of HPV and cervical cancer, especially for African American women.

Background: Cervical cancer is reportedly the easiest gynecologic cancer to prevent, and measures that have the most impact are regular screening and timely follow-up. Although the Papanicolaou (Pap) test used to screen for cervical cancer has been recognized as one of the most valuable clinical preventive service for women, variation in screening and tracking remain a barrier for some women achieving optimal health. Missed opportunities for care in the form of inadequate follow-up is a patient safety and quality of care issue that can be appropriately addressed through implementation of a tool to be used as a component of a cervical cancer surveillance program. Purpose: The purpose of this quality improvement (QI) project was to develop an evidence-based, tracking tool for cervical cytology screening to facilitate surveillance measures in a community health center. Theoretical Framework: The theoretical framework applied was Donebedian’s quality of care framework that incorporates the Structure-Process-Outcome model. Methods: The study was conducted in five phases over a period of 14 months. After permission was granted to implement the study, the tracking tool was developed with input from the mentor. The final two phases consisted of training, implementation, and evaluation of tool’s effectiveness towards improving practice. A survey questionnaire measuring the staff’s opinion of the tool was administered and verbal feedback regarding perception of the tool’s capability to impact clinical practice was collected. Results: Informal surveys were performed by asking stakeholders to share their attitudes and opinions of the surveillance tool. Conclusion: Consistent evidence-based practice among those charged with providing care is paramount to helping patients achieve their best outcome. Surveillance is an internal process and improving surveillance is pivotal to the goal of optimizing outcomes. The findings of the QI project indicate that through the provision of this evidence-based practice, clinical resource, quality of care will be improved. Additionally, the surveillance tool will be incorporated into clinical practice and used as the official method for tracking abnormal cervical cancer screenings, scheduling follow up care, and tracking patients until resolution of cervical pathology.

No description available.

Cervical carcinoma is a major cause of morbidity and mortality among women worldwide. Histological subtype, lymphovascular space invasion and tumor grade could have a prognostic and predictive value for patients’ outcome and the knowledge of these histologic characteristics may influence clinical decision making. However, studies evaluating the diagnostic value of various biopsy techniques regarding these parameters of cervical cancer are scarce. We reviewed 318 cases of cervical carcinoma with available pathology reports from preoperative core needle biopsy (CNB) assessment and from final postoperative evaluation of the hysterectomy specimen. Setting the postoperative comprehensive pathological evaluation as reference, we analysed CNB assessment of histological tumor characteristics. In addition, we performed multivariable logistic regression to identify factors influencing the accuracy in identifying LVSI and tumor grade. CNB was highly accurate in discriminating histological subtype. Sensitivity and specificity were 98.8% and 89% for squamous cell carcinoma, 92.9% and 96.6% for adenocarcinoma, 33.3% and 100% in adenosquamous carcinoma respectively. Neuroendocrine carcinoma was always recognized correctly. The accuracy of the prediction of LVSI was 61.9% and was positively influenced by tumor size in preoperative magnetic resonance imaging and negatively influenced by strong peritumoral inflammation. High tumor grade (G3) was diagnosed accurately in 73.9% of cases and was influenced by histological tumor type. In conclusion, CNB is an accurate sampling technique for histological classification of cervical cancer and represents a reasonable alternative to other biopsy techniques.

Bakgrund: Cervixcancer orsakas av human papillomavirus. WHO:s mål är utrotning av cervixcancer, för att nå målet krävs högt deltagande i vaccination- och screeningprogrammet för cervixcancer. Kvinnor som sällan deltar i screening hade störst risk för cervixcancer, därför planeras HPV-självtest att erbjudas. Studier om kvinnors attityd till HPV-självtest saknas. Syftet var att undersöka kvinnors attityd till HPV-självtest. Metod: En kvantitativ tvärsnittsstudie genomfördes med webbenkät. Resultatet analyserades med deskriptiv och passande analytisk statistik. Resultat: 408 kvinnor deltog i studien varav 89,7% tänka att sig HPV-självtest som screeningmetod för cervixcancer De som kunde tänka sig testet tyckte i större utsträckning att screeningen var viktigt (p=0,02). Majoriteten skulle föredra screening hos barnmorska (57,8%) framför HPV-självtest (42,2%) (p=<0,001). Oro för obehag (p=0,001), genans (p=0,001), svårt att använda testet (p=0,001), bristande tillförlitlighet till utförandet (p=0,001) och rädsla för smärta (p=0.01) framkom i högre utsträckning hos kvinnor som ej kunde tänka sig HPV-självtest. Majoriteten litade på hälso- och sjukvården (97,3%), främst de kvinnor som kunde tänka sig HPV-självtest (p=<0,001).  Slutsats: Kvinnor har positiv attityd till HPV-självtest. Majoriteten kunde tänka sig testet men föredrar screening hos barnmorska framför HPV-självtest. Otillräcklig tillförlitlighet och osäkerhet om genomförandet är barriärer för att välja HPV-självtest. Upplysning om HPV-självtest och tillförlitligheten krävs innan implementering i för att kvinnorna ska acceptera screeningmetoden. / Background: Cervical cancer is caused by human papillomavirus. WHO's goal is to eliminate cervical cancer, to accomplish that, a large number of women must participate in vaccination- and screening-programs. Women who rarely participate in screening have greatest risk of cervical cancer, therefore self-sampling is planned to be offered. There is paucity of studies on attitudes towards HPV self-sampling. Aim: Investigate women's attitudes towards HPV self-sampling. Method: Quantitative cross-sectional studie, web survey. Results were analysed with descriptive statistic and appropriate analytic statistic. Results: 408 women participated in the study and 89,7% could consider self-sampling as screening-method. Women who could consider self-sampling thought cervical cancer screening is important (p=0.02). Women preferred midwifery screening (57.8%) before self-sampling (42.2%) (p=<0.001). Anxiety about discomfort, embarrassment, difficulty, not taking the test correctly (p=0.001) and fear of pain (p=0.01) was higher among women who could not consider self-sampling. Majority of all women trusted the healthcare (97.3%) and was seen among women who could consider self-sampling (p=<0.001). Conclusion: Women have positive attitude towards HPV self-sampling. Majority could consider self-sampling but preferred midwife screening. Reliability and uncertainty about whether the test been used correctly seems to be barriers against choosing self-sampling as screening-method. Information about reliability of the method is needed before implementation so women accept the screening-method.

Background: Parametrial tumor involvement is an important prognostic factor in cervical cancer and is used to guide management. Here, we investigate the diagnostic value of clinical examination under general anesthesia (EUA) and magnetic resonance imaging (MRI) in determining parametrial tumor spread. Methods: Post-operative pathological findings of 400 patients with primary cervical cancer were compared to the respective MRI data and the results from EUA. The gynecological oncologist had access to the MR images during clinical assessment (augmented EUA, aEUA). Results: Pathologically proven parametrial tumor invasion was present in 165 (41%) patients. aEUA exhibited a higher accuracy than MRI alone (83% vs. 76%; McNemar’s odds ratio [OR] = 2.0, 95%CI 1.25–3.27, p = 0.003). Although accuracy was not affected by tumor size in aEUA, MRI was associated with a lower accuracy in tumors ≥2.5 cm (OR for a correct diagnosis compared to smaller tumors 0.22, p < 0.001). There was also a decrease in specificity when evaluating parametrial invasion by MRI in tumors ≥2.5 cm in diameter (p < 0.0001) compared to smaller tumors (< 2.5 cm). Body mass index had no influence on performance of either method. Conclusions: aEUA has the potential to increase the diagnostic accuracy of MRI in determining parametrial tumor involvement in cervical cancer patients.

Le cancer du col de l’utérus, le quatrième cancer le plus répandu chez la femme, affecte principalement les régions à faible et moyen revenu. Alors que les taux d’incidence et de mortalité sont les plus élevés dans les pays en développement, l’accessibilité aux systèmes de dépistage et traitement y est limitée. La curiethérapie (BT) à haut débit de dose (HDR) fait partie du traitement standard recommandé pour les cancers du col de l’utérus en stade localement avancé IIIB-IVA. Les applicateurs commerciaux pour les traitements de BT combinés intracavitaire et interstitiel (IC/IS) sont très chers et n’offrent que des positions et orientations fixes pour les aiguilles IS. L’applicateur à demi anneaux Montréal (MSR) propose la modification d’un applicateur IC commercial par l’ajout de capuchons Adaptiiv, imprimés 3D à faible coût avec la technologie de photopolymérisation (SLA) en résine stérilisable et biocompatible, permettant l’intégration et l’optimisation d’un maximum de 10 trajectoires IS. Dans cette étude, une nouvelle génération de capuchons réduit le diamètre de l’applicateur MSR d’au plus 8.4 mm et introduit quatre positions d’aiguilles IS additionnelles à l’intérieur du demi anneau (SR), deux positions par SR. Ces capuchons sont imprimés avec la résine BioMed Clear sur l’imprimante SLA Form3B (Formlabs Inc., Massachusetts, États-Unis) et accommodent des angles d’aiguilles IS allant jusqu’à 45°. Les erreurs sur les trajectoires des aiguilles IS de l’applicateur MSR avec les nouveaux capuchons sont évaluées dans un fantôme gynécologique (GYN), développé dans le cadre de ce projet, et comparées dans une analyse statistique aux performances de l’applicateur Venezia (Elekta, Stockholm, Suède). Le fantôme GYN développé comprend une masse implantable en silicone, dont la texture est optimisée avec l’expérience clinique de deux radio-oncologistes spécialisées en BT GYN pour simuler l’insertion d’implants cliniques, pouvant supporter un grand nombre d’aiguilles IS. L’étude sur ce fantôme a démontré que la performance de l’un des capuchons de la nouvelle génération ne présente pas de différence statistiquement et cliniquement significative avec l’applicateur Venezia. Les performances de ce capuchon sont reproductibles dans les différents milieux en silicone et en utilisant différents types d’aiguilles IS. / Cervical cancer, the fourth most common cancer in women, mainly affects low- and middleincome regions. While incidence and mortality rates are highest in developing countries, the accessibility to screening and treatments is limited in those regions. High dose rate (HDR) brachytherapy (BT) is part of the standard of care recommended for locally advanced cervical cancer. Commercial applicators for combined intracavitary-interstitial (IC/IS) BT treatments are very expensive and only offer fixed IS needle positions and orientations. The Montreal split ring (MSR) applicator modifies the CT/MR split-ring IC applicator by the addition of Adaptiiv caps, 3D printed at low cost with stereolithography apparatus (SLA) technology in biocompatible and sterilizable resin in order to allow integration and optimization of up to 10 IS trajectories. In this study, a new generation of caps reduces the diameter of the MSR applicator by at most 8.4 mm and introduces four additional IS needle positions inside the split ring (SR), two positions per SR. These caps are 3D printed using BioMed Clear resin on the Form3B (Formlabs Inc., Massachusetts, USA) SLA printer and accommodate up to 45° IS needle angles. The errors on the IS needle trajectories of the MSR applicator with the new caps are evaluated in a gynecological (GYN) phantom, developed within the framework of this project, and compared in a statistical analysis to the performance of the Venezia applicator (Elekta, Stockholm, Sweden). The developed GYN phantom includes an implantable silicone structure, optimized according to the feedback of two radiation oncologists specialized in GYN BT to simulate clinical implants insertion, which can support a large number of IS needles. The study on this phantom showed that the performance of one of the caps from the new generation does not present a statistically and clinically significant difference with the Venezia applicator. The performance of this cap is reproducible in different silicone media and using different IS needle types.