Livmoderhalskræftscreening: Selvtest som et middel til forandring i forebyggelse af livmoderhalskræft

Tybjerg, Anne Julie ; Riisberg, Maja

4. semester

Folkesundhedsvidenskab, Kandidat

2016

2016-05-31

100 pages

Baggrund: Livmoderhalskræft er en af de mest udbredte kræftformer verden over, og i Danmark dør cirka 100 kvinder af sygdommen hvert år. Efter indførelsen af det nationale screeningsprogram i Danmark og andre vestlige lande samt indførelsen af HPV-vaccinen, er antallet af kvinder med livmoderhalskræft væsentligt reduceret. Der er dog endnu ikke opnået et landsdækkende mål om 75 % screeningsdeltagelse, og der er mange kvinder, der ikke deltager i den regulære screening af forskellige årsager. Dette projekt har til formål at afdække, hvilke barrierer kvinder oplever i forbindelse med livmoderhalskræftscreening - samt hvilken betydning en indførelse af en HPV-selvtest kan have på deltagelsen i livmoderhalskræftscreening, samt på at identificere kvinder med celleforandringer. Metode: Projektet tager udgangspunkt i en systematisk litteratursøgning med efterfølgende analyse og diskussion for at finde svar på projektets problemformuleringer med udgangspunkt i en MTV inspireret tilgang med teknologi, patient og økonomiaspekterne. Der er blevet foretaget en online spørgeskemaundersøgelse med henblik på at belyse patientperspektivet og barrierer i en dansk kontekst. Resultaterne relateret til patientperspektivet bliver yderligere diskuteret i relation til teorien omkring Health Belief Model for at undersøge, hvilke forandringer der potentielt kan give kvinderne incitament til at deltage i livmoderhalskræftscreening. For at undersøge det økonomiske perspektiv bliver der udarbejdet en mindre økonomisk analyse i TreeAge baseret på data fra litteraturen, samt data fra et dansk pilotstudie der har anvendt selvtest. Resultater: Teknologiresultaterne peger på, at HPV-selvtesten ikke matcher specificiteten og sensitiviteten, som den prøve der bliver foretaget ved egen læge, men det vil være et hensigtsmæssigt supplement eller alternativ for kvinder, som ellers ikke ville deltage i livmoderhalskræftscreening. Resultaterne viser, at screeningsdeltagelsen ville øges, hvis der blev indført en selvtest som supplement til den ordinære screening. Patientresultaterne indikerer, at der er forskellige barrierer for kvinderne i forhold til at deltage i den regulære screening, herunder fysiske og psykiske gener såsom smerter eller forlegenhed, eller praktiske aspekter såsom tidsforbrug. Den økonomiske analyse indikerer, at det er mest omkostningseffektivt, at den ønskede målgruppe selv skal rekvirere selvtesten frem for at sende selvtesten direkte ud til dem. Konklusion: De fremfundne resultater viser, at der skal tages højde for flere barrierer, hvis der ønskes en forandring i forhold til kvinders deltagelse i screening for livmoderhalskræft. Mere information til de danske kvinder er én tilgang til dette, der potentielt kan styrke deltagelsen i screening generelt. Implementering af selvtest, som et supplement til det nationale screeningstilbud, kan bidrage til en højere deltagelsesprocent ved at eliminere de barrierer, kvinder møder i forhold til at skulle have foretaget en celleprøve hos lægen. En øget deltagelse i screening kan medføre, at flere kvinder med uopdagede celleforandringer vil blive opdaget og vil kunne få den passende behandling. Dette vil i sidste instans betyde, at færre kvinder vil udvikle livmoderhalskræft, og dermed vil dødeligheden kunne nedbringes. Nøgleord: Livmoderhalskræft, screening, selvtest, sundhedsøkonomisk evaluering, Health Belief Model

Background: Cervical cancer is one of the most common cancers worldwide and in Denmark approximately a hundred women die from the disease every year. After the introduction of the national screening program in Denmark and other Western countries and the introduction of the HPV vaccine, the number of women with cervical cancer had been reduced significantly. However, the national goal of a participation rate of 75 % has not yet been reached, and there are still a number of women who do not participate in the regular screening for various reasons. This project aims to identify the barriers women meet in relation to screening for cervical cancer, as well as the impact an implementation of HPV self-test would have on the participation rate in cervical cancer screening and on the number of women being identified with early stages of cancer. Methods: The project is based on a systematic literature search with a subsequent analysis and discussion to find answers using a MTV-inspired approach with technology, patient and economy aspects. A questionnaire has been conducted to further illuminate the patient perspective and barriers in a Danish context. The results regarding the patient perspective has been discussed in relation to the theory of Health Belief Model to examine the changes that potentially can provide an incentive for women to participate in cervical cancer screening. In order to examine the economic perspective, a minor economic analysis has been conducted in TreeAge based on data from the literature as well as data from a Danish pilot study that has used the self-test. Results: The technology results indicate that HPV self-test does not match the specificity and sensitivity of the sample made by a physician, however, it is a useful supplement or alternative for women who would not otherwise participate in cervical cancer screening. The results states that screening participation would increase if a self-test was introduced in addition to the regular screening program. The patient-related results indicate that there are various barriers for women to participate in the regular screening, barriers which include physical and mental symptoms e.g. pain and embarrassment, as well as practical aspects e.g. time consumption. The economic analyses indicate that self-tests on request is a more cost-effective approach than mailing the self-test kit directly to the women. Conclusion: The results obtained show that several barriers need to be considered if changes are to be made in women's participation in cervical cancer screening. More information for the Danish women is one approach that can potentially increase participation in screening in general. Implementation of a self-test as a supplement to the national screening can contribute to an increase in participation by eliminating the barriers that women face in relation to a Pap-smear sampling at the doctor. An increase in screening participation can lead to the discovery of more women with undiagnosed early stages of cancer and these women will be able to receive the appropriate treatment. This will ultimately mean that fewer women will develop cervical cancer and the mortality rate will be reduced. Keywords: Cervical cancer, screening, self-test, economic evaluation, Health Belief Model.

livmoderhalskræft ; screening ; health belief model ; sundhedsøkonomi

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