Cervical Cancer Screening Barriers and Risk Factor Knowledge Among Uninsured Women

Abstract

A steady decline in cervical cancer incidence and mortality in the United States has been attributed to increased uptake of cervical cancer screening tests such as Papanicolau (Pap) tests. However, disparities in Pap test compliance exist, and may be due in part to perceived barriers or lack of knowledge about risk factors for cervical cancer. This study aimed to assess correlates of cervical cancer risk factor knowledge and examine socio-demographic predictors of self-reported barriers to screening among a group of low-income uninsured women. Survey and procedure data from 433 women, who received grant-funded cervical cancer screenings over a span of 33 months, were examined for this project. Data included demographics, knowledge of risk factors, and agreement on potential barriers to screening. Descriptive analysis showed significant correlation between educational attainment and knowledge of risk factors (r = 0.1381, P < 0.01). Multivariate analyses revealed that compared to Whites, Hispanics had increased odds of identifying fear of finding cancer (OR 1.56, 95% CI 1.00–2.43), language barriers (OR 4.72, 95% CI 2.62–8.50), and male physicians (OR 2.16, 95% CI 1.32–3.55) as barriers. Hispanics (OR 1.99, 95% CI 1.16–3.44) and Blacks (OR 2.06, 95% CI 1.15–3.68) had a two-fold increase in odds of agreeing that lack of knowledge was a barrier. Identified barriers varied with age, marital status and previous screening. Programs aimed at conducting free or subsidized screenings for medically underserved women should include culturally relevant education and patient care in order to reduce barriers and improve screening compliance for safety-net populations.

Overview of Centers for Disease Control and Prevention's Case Investigation of Cervical Cancer Study

“…Previous studies examining factors affecting cervical cancer screening have been conducted in select populations, mainly immigrants and uninsured women in the United States. 30,31 This study provides data on a general population of cervical cancer survivors in three states that could be used to guide interventions to increase cervical cancer screening.…”

Pap Testing in a High-Income Country with Suboptimal Compliance Levels: A Survey on Acceptance Factors among Sicilian Women

“…Recent studies showed that, in countries with established screening programs, lower socioeconomic groups or people with particular cultural factors have a much lower screening uptake than the national average, even when screening is provided free of charge. Such groups include ethnic minorities, those living in rural areas, and women on low incomes [ 8 , 15 ].…”

“…However, this public health practice is uncommon, especially in low-income countries, with the lowest adhesion reported in Bhutan (6%) [ 7 ]. In high-income countries with established and free of charge screening programs, there is an increased level of Pap test adherence although people from lower socioeconomic backgrounds have a much lower screening uptake than the national average [ 8 , 9 ]. In Italy, Pap testing was performed free of charge with a coverage in 2017 of at least 80% among resident people [ 10 ].…”

The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities

“…Patients with low socioeconomic status (SES) or identify as minority, including racial and ethnic underserved minorities such as Hispanics and African Americans, and the LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) sexual and gender minorities. It is important to recognize that there is a huge overlap between patients with low SES and those with minority status—rather than face the double impact of being poor and disenfranchised (eg, heightened risks for cancer) [ 84 , 86 - 88 ], as a result of COVID-19, they now face the additional impact of the need to pay extra attention and allocate already limited resources to protect themselves against the coronavirus while also tackling unemployment or hazardous working conditions [ 89 - 91 ].…”