Intimate Partner Violence and Cancer Screening among Urban Minority Women

Abstract

Purpose: To evaluate the association of intimate partner violence (IPV) with breast and cervical cancer screening rates.Methods: We conducted retrospective chart audits of 382 adult women at 4 urban family medicine practices. Inclusion criteria were not being pregnant, no cancer history, and having a partner. Victims were defined as those who screened positive on at least one of 2 brief IPV screening tools: the HITS (Hurt, Insult, Threat, Scream) tool or Women Abuse Screening Tool (short). Logistic regression models were used to examine whether nonvictims, victims of emotional abuse, and victims of physical and/or sexual abuse were up to date for mammograms and Papanicolaou smears. Intimate partner violence (IPV) is an important social concern. It is estimated that 7.7 million IPV victimizations occur each year and that the lifetime prevalence of IPV victimization is 25% among women and 8% among men in the general population.1 Women are particularly vulnerable to the harmful effects of IPV; they are 7 to 14 times more likely than men to suffer severe physical injury from an assault by an intimate partner.2 A history of being the target of violence puts women at increased risk of physical injury, chronic pain syndromes, irritable bowel syndrome, gastrointestinal disorders, sexually transmitted diseases, 3-5 depression, suicide attempts, psychosomatic disorders, reproductive health consequences, and other comorbidities. 6Victims also reported more risky behaviors, including smoking, heavy drinking, and drug use. 1,[7][8][9][10] More recently, research has explored the association between IPV and health issues related to breast and cervical cancer. Studies have found that exposure to IPV increases the risk of cervical cancer, 11,12 possibly through its effect on risk factors such as stress, smoking, and drinking. 11 Alternatively, IPV may be related to decreased adherence to cancer screening. Findings from the few studies about the association between IPV and cancer screening have been inconsistent. A recent Australian study of 7312 middle-aged women (aged 45 to 50) found that those who have experienced IPV

Association Between Intimate Partner Violence and Preventive Screening Among Women

“…One study has shown that women who were victims of sexual and/or physical violence were less likely to be up-to-date with their mammograms and Pap smear screenings. 44 It is likely that the Behavioral Model of Vulnerable Populations applies to preventive healthcare utilization of HIV testing and breast examinations among female victims of IPV. Because women who are abused in relationships are vulnerable, their experience may influence their risk perception and may affect how they use healthcare compared to women who are not exposed to IPV.…”

Intimate partner violence and women’s cancer quality of life

“…IPV may influence cancer survivorship through delays in diagnosis or cancer treatment, reducing QOL [3] during treatment or recovery, and ultimately affect survival. While IPV may [15–17] or may not [18–19] be associated with receiving cancer screening at recommended intervals, IPV has been associated with not receiving follow-up care for pre-invasive disease [20] and with delays in receipt of care for invasive cancer [21]. IPV may impact women’s ability to obtain cancer treatment because those currently experiencing IPV are less likely to have health insurance, are more likely to live in poverty, and fewer transportation options [13, 22].…”

Prospective Association of Intimate Partner Violence with Receipt of Clinical Preventive Services in Women of Reproductive Age

“…Moreover, current literature inadequately describes preventive healthcare utilization among women exposed to IPV. Prior work examining IPV and prevention is limited by cross-sectional (Cronholm & Bowman, 2009; Lemon, Verhoek-Oftedahl, & Donnelly, 2002) or retrospective (Gandhi et al, 2010) study designs, examination of relatively few preventive services (Gandhi et al, 2010; Lemon et al, 2002; Loxton, Powers, Schofield, Hussain, & Hosking, 2009), or focus on women beyond reproductive age (Loxton et al, 2009) for whom IPV is less prevalent (McCauley et al, 1995). A few studies suggest that women exposed to IPV are less likely to receive clinical preventive services than the general population; for example, women with self-reported safety concerns in their relationships were less likely to report receiving cervical cancer screening within the past 12 months (Cronholm & Bowman, 2009).…”