Assessing high-risk human papillomavirus-based cervical precancer screening recommendations and implications among women aged 60/65 years and older in Ghana
Bibliographic record
Abstract
We aimed to assess the prevalence of high-risk HPV (hr-HPV) infection, cervical lesions observed through visual inspection, and abnormal cytology among women aged ≥ 60 years screened by the Cervical Cancer Prevention and Training Centre, Ghana. We further compared screening outcomes between women aged ≥ 60 and ≥ 65 years to assess the implications of applying these age cut-offs for screening cessation. Among 1,319 women screened, the overall mean ages were 66.7 and 71.2 years among ≥ 60- and ≥ 65-year-olds, respectively. The overall prevalence of hr-HPV infection was 27.9% (95% CI, 25.1 - 31.0), with a higher prevalence among ≥ 65-year-olds (30.8%; 95% CI, 26.6 - 35.2). Visual inspection 'positivity' rates were 1.9% (95% CI, 1.2 - 2.8) among ≥ 60-year-olds and 1.9% (95% CI, 1.0 - 3.2) among ≥ 65-year-olds. Cytology revealed ASCUS or worse lesions in 8.6% (95% CI, 1.8 - 23.1). Factors independently associated with hr-HPV infection among all women aged ≥ 60 included HIV co-infection (aOR, 4.12; 95% CI, 2.48 - 6.84), age (aOR, 1.03; 95% CI, 1.00 - 1.05), parity (aOR, 1.08; 95% CI, 1.02 - 1.14), and earning an income (aOR, 1.54; 95% CI, 1.10 - 2.15). In the ≥ 65-year-old subgroup, these associations were attenuated, except for HIV infection (aOR, 4.20; 95% CI, 2.07 - 8.49; p-value < 0.001). Among histopathologically-confirmed CC cases, 39.1% (95% CI, 31.7 - 46.8) were ≥ 60-year-olds, while 25.4% (95% CI, 19.1 - 32.7) were ≥ 65-year-olds. The study indicates a higher prevalence of hr-HPV infection among older women compared to community-dwelling younger women, with similar rates of cervical lesions on colposcopy. Given the increasing life expectancy in Ghana, the population of older women at risk for CC is expected to grow. Therefore, it is premature to recommend age-based cessation of cervical precancer screening in older women in Ghana. The context of limited access to screening and the opportunistic nature of screening, supports a more conservative approach to CC prevention among older women, particularly those living with HIV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".