Cervical cancer screening among homeless women in the Greater Paris Area (France): results of the ENFAMS survey

Abstract

Little is known about the prevalence of cervical cancer screening (CCS) and its correlates among homeless women in France. The objectives of this study were to determine the prevalence of women who had never been screened for cervical cancer and to identify the associated factors. This cross-sectional study was based on data collected in the ENFAMS survey, which was conducted in 2013 among 764 sheltered homeless mothers in the Greater Paris Area. Robust Poisson regression models were used to estimate the association between no lifetime CCS and certain sociodemographic and health-related factors (selected from the behavioral model of vulnerable populations). Analyses were carried out separately for women with and without a regular gynaecological follow-up (RGF). The proportion of never-screeners was 33% among the women with an RGF versus 64% among those without an RGF (P<0.001). Among the latter, never having been screened for CCS was associated mainly with socioeconomic conditions, the length of time lived in France, a history of delivery in France and the duration of homelessness. In those with an RGF, the factors were mainly poor health service utilization and language difficulties. This first quantitative study of CCS among homeless women in the Greater Paris Area points to the need for it to be proposed and performed more systematically in primary care. Every contact between this hard-to-reach population and health services should be an opportunity to check their screening status and to ensure that those in need actually undergo a Pap test.

Do vulnerable groups access prevention services? Cervical cancer screening and HIV testing among homeless migrant women in the Paris metropolitan area

“…rate of no lifetime screening in our results. In a sample of homeless women housed in emergency shelters in the Paris metropolitan area in 2013, researchers found no lifetime CCS rates similar to our own [29].…”

Unmet healthcare needs in homeless women with children in the Greater Paris area in France

“…The sampling process has been detailed elsewhere [ 27 , 28 ]. The sampling design included three levels of random sampling: shelters (which were randomly selected among an exhaustive list of all services in the Paris region), families (which were randomly selected in each selected service; either the single parent or one of the two parents was interviewed: in 95.4% of the cases this was the mother), and one child from every family.…”

Cancer and the Politics of Care

“…In 2003, France identified cancer as a national priority. A finegrained analysis of the incidence of heath inequalities indicates that differential cancer mortality rates continue to merit attention (Vuillermoz et al 2016). In addition, during this same period, the French social security system was globally renowned for its egalitarian model, with specific benefits reserved for the most vulnerable populations.…”

“…A notable reason for this lack of attention is the state's resistance to collecting data measuring features of identity, such as the health status of immigrants or disease prevalence. Disease and death registries may only obtain state authorisation to collect statistics on ethnicity by petitioning the CNIL (Commission Nationale de l'Informatique et des libertés, and/or the Comité National d'Ethique), providing assurance of full anonymity and providing evidence that the data on race or ethnicity would supersede the potential harm of disclosing such data (Simon, Beauchemin and Hamel 2015;Vuillermoz et al 2016;Wittwer et al 2019).…”