Learning From Cervical Cancer Survivors: An Examination of Barriers and Facilitators to Cervical Cancer Screening Among Women in the United States

Abstract

Background: Screening and timely follow-up have lowered cervical cancer incidence in the US; however, screening coverage, incidence, and death rates have remained fairly stable in recent years. Studies suggest that half of women diagnosed with cervical cancer don’t receive appropriate screening prior to diagnosis; cervical cancer survivors can provide crucial insight into barriers and facilitators to screening. Methods: Participants were cervical cancer survivors ≥21 years, identified through population-based central cancer registries (CR) in 3 US states or a social network (SN), Cervivor. CR participants completed a mailed survey on screening history, barriers, and facilitators to screening and sociodemographic data. SN participants completed the same survey online. Results: CR participants (N = 480) were older, with a lower proportion of non-Hispanic white, married, and insured women compared to SN participants (N = 148). Fifty percent of CR and 79% of SN participants were screened 5 years prior to their diagnoses. Of those screened, 28% in both groups reported not following-up on abnormal results. For both groups, the most frequently identified screening barrier was that participants never imagined they would develop cervical cancer (percent agree CR = 76%; SN = 86%), and the facilitator was wanting to take care of their bodies (CR = 95%; SN = 94%). Conclusion: Addressing key barriers to obtaining screening and timely follow-up related to lack of knowledge of cervical cancer risk and screening tests and addressing insurance coverage in the design or modification of interventions may increase cervical cancer screening and lower cervical cancer incidence in the US.

Colorectal cancer screening utilization among breast, cervical, prostate, skin, and lung cancer survivors

“…Additionally, we observed that cervical cancer survivors had slightly lower screening use (65%) compared to other types of cancer survivorships. Compared to a prior study, using cancer registries, 78% of cervical cancer survivors received CRC screening [ 32 ]. Higher screening use from this study may be due to using registry-based data, which usually have more accurate information compared to self-reported data.…”

“…Higher screening use from this study may be due to using registry-based data, which usually have more accurate information compared to self-reported data. Variations of CRC screening utilization across different cancer types may be influenced by doctor’s recommendations on screening tests [ 23 ] and CRC risk perceptions [ 33 , 34 ] as well as insurance coverage to access preventive care [ 32 , 35 ]. Finally, more research on examining CRC screening behaviors in skin and lung cancer survivors are needed due to lack of existing literature.…”

Cervical cancer screening barriers and facilitators from the perspectives of women with a history of criminal-legal system involvement and substance use

“…But whereas these approaches were recommended to increase equity in colorectal and breast cancer screenings, the recommendation was withheld for cervical cancer since evidence of effects on cervical cancer screening rates was lacking. Along similar lines, Senkomago et al’s ( 2021 ) comparison of screening barriers in women in a cancer registry and in a cancer survivors’ social network ( Cervivor ) found the barrier “Clinic hours were inconvenient” to be among the least common responses—though more common among the study’s racially diverse and socioeconomically disadvantaged social network cohort. Interestingly, in the same study, one of two most common facilitators of screening in the social network group was “Having screening tests with their annual exams,” suggesting that clinic hours might only partially capture the scheduling construct (Senkomago et al, 2021 ).…”

“…Along similar lines, Senkomago et al’s ( 2021 ) comparison of screening barriers in women in a cancer registry and in a cancer survivors’ social network ( Cervivor ) found the barrier “Clinic hours were inconvenient” to be among the least common responses—though more common among the study’s racially diverse and socioeconomically disadvantaged social network cohort. Interestingly, in the same study, one of two most common facilitators of screening in the social network group was “Having screening tests with their annual exams,” suggesting that clinic hours might only partially capture the scheduling construct (Senkomago et al, 2021 ). Mkuu et al’s ( 2022 ) study of clinicians’ views of cervical care barriers for women with behavioral health conditions (i.e., mental health and substance use) adds another perspective: in the clinicians’ view, the salient scheduling barrier was women’s “forgetting” to schedule appointments, not the availability or lack of ease in making appointments.…”

“…Payment mechanisms can also play a role. Senkomago et al’s ( 2021 ) study of barriers and facilitators of cervical care identified full or partial insurance coverage among the most commonly noted enablers of cervical cancer screening. We know from previous research on barriers to follow-up after an abnormal Pap exam that women with past CLS involvement, in a state without Medicaid expansion, expressed hesitancy to schedule due to fears about cost (Kelly et al, 2017 ).…”