Correlates of cervical cancer screening among underserved Hispanic and African-American women

BACKGROUND: Substantial subgroups of American women, specifically those of ethnic minorities, have not been screened for cervical cancer or are not screened at regular intervals. The rates for receipt of female-related cancer screening tests remain far below the goals set forth in Healthy People 2010. OBJECTIVE: This study applied a well-known, recently revised theoretical model of health care access and utilization, the Behavioral Model for Vulnerable Populations, to examine the correlates of the adherence to cervical cancer screening guidelines among publicly housed Hispanic and African-American women, two of the most vulnerable segments of our population. METHODS: This study conducted a cross-sectional survey of a community-based random sample of 230 African-American and Latino female heads of household, from a geographically defined area, the three urban public housing communities in Los Angeles County, CA. RESULTS: Only 62% of our sample had received a screening for cervical cancer within the past year. Yet, 29% of the sample claimed that no health care provider had ever told them that they needed a screening test for cervical cancer. Hispanic and older women are by far less likely to adhere to screening guidelines; in this study, 51% of Hispanics and 22% of African-Americans reported no screening within the last year. Multivariate analysis shows that affordability, continuity of care, and receiving advice from health care providers regarding a Papanicolaou (Pap) smear were significant predictors of up-to-date to cervical cancer screening. CONCLUSION: This study documents a significant disparity in screening for cervical cancer among underserved minorities, particularly Hispanic, uninsured, and older women. The continuity of obtaining medical services and receiving recommendations from physicians remain the core factors that are significantly associated with obtaining cervical cancer screening. These results underscore the need for continued efforts to ensure that medically underserved minority women have access to cancer screening services.     

Cultural and emotional determinants of cervical cancer screening among older Hispanic women

Older adults are at highest risk of cancer and yet have the lowest rates of cancer screening participation. Older minority adults bear the burden of cancer screening disparities leading to late stage cancer diagnoses. This investigation, utilization data from the 2008 wave of the Health and Retirement study examined the cultural and emotional factors thought to influence cervical cancer screening among older Hispanic women. We utilized logistic regression models to conduct the analyses. Findings indicate that the emotional factors were not significant but the cultural factor, time orientation was a significant predictor for older Hispanics' cervical cancer screening behaviors.     

Use of Pap test among Hispanics and non-Hispanic whites in a rural setting

BACKGROUND: Hispanic women in the United States have a higher incidence of invasive cervical cancer than non-Hispanic whites. A key factor related to the relatively high incidence is the underutilization of cancer-screening services. Several previous investigations have reported that Hispanic women are less likely to comply with screening recommendations for Pap testing; some have identified factors that are associated with non-compliance with screening recommendations. METHODS: Using baseline personal interview data from a randomized community trial on cancer prevention in a rural area, we assessed the association between health barriers and non-compliance with cervical screening recommendations. RESULTS: Among Hispanic women (n = 382), those with a lower level of acculturation were more likely than highly acculturated Hispanic and non-Hispanic white women (n = 385) to report personal barriers as reasons for not getting an initial or subsequent screening exam. Such barriers include fear of finding cancer, fear of finding diseases other than cancer, and embarrassment about receiving a physical exam. Certain structural barriers, such as cost of care, no time off work, and lack of transportation, were reported to be associated with non-compliance with routine cervical cancer screening, especially among non-Hispanic white women. CONCLUSIONS: Future research should examine barriers related to initial and subsequent screening among Hispanics with varying levels of acculturation.     

Cervical cancer among Hispanic women: assessing the impact on farmworkers

The purpose of this paper was to review the literature on Hispanic populations to outline: 1) demographics; 2) general health status; 3) cervical cancer incidence and mortality; 4) Pap smear screening rates; and 5) barriers to preventive care services. The methods: MEDLINE, Med66, Med75, and Med85 files, from 1966 to 1999, were searched for key words Hispanic health, cervical cancer and Hispanics, cervical cancer and Mexico, migrants and health, agricultural occupational health, farmworkers and cancer, and farmworker health. AGRICOLA (1982–98) was searched for key words farmworker health, agricultural workers and health, and agriculture and cancer. The results show that Hispanic immigrant women may have cervical cancer incidence rates ranging between the California rates for 1991–93 (19.8/100,000) and for Mexico in 1990 (115–220 per 100,000). Mortality rates for the same periods were 3.9/100,000 and 16.11/100,000 respectively. While survey results report Hispanic Pap smear rates above 70%, these surveys count urban women who do not share the barriers to care experienced by poor rural Hispanics. Since validated self-reports of survey responses are 20–50% lower than reported lower rates and Pap smear screening persist in Hispanic Pap evaluations and are reflected in higher morbidity and mortality from cervical cancer. That targeted community interventions have been successful in raising Pap smear rates among poor Spanish-speaking women. Such interventions should be a priority for preventive health care policy and practice.     

Invasive cervical cancer among Hispanic and non-Hispanic women--United States, 1992-1999

During 1973-1999, both the incidence of and death rates for cervical cancer decreased approximately 50% in the United States. For 2002, approximately 13,000 new cases of invasive cervical cancer are expected, and approximately 4,100 women will die of the disease. Although invasive cervical cancer can be prevented by regular screening, the prevalence of Papanicolaou (Pap) testing remains relatively low among minority populations such as Hispanic women. To characterize the incidence of invasive cervical cancer, CDC analyzed incidence data for Hispanic and non-Hispanic women during 1992-1999 in 11 geographic areas with population-based registries. This report summarizes the results of this analysis, which indicate that the incidence of invasive cervical cancer decreased for Hispanic and non-Hispanic women. However, among women aged > or = 30 years, cervical cancer incidence for Hispanic women was approximately twice that for non-Hispanic women. To lower the incidence of invasive cervical cancer, local health organizations should provide culturally appropriate public health interventions that encourage participation in readily accessible cervical cancer-screening programs.     

Pap smear use in California: are we closing the racial/ethnic gap?

BACKGROUND: Minority women continue to be disproportionately affected by cervical cancer. Minority population groups at high risk for cervical cancer may be failing to fully comply with screening recommendations. The use of Pap smears among women in California was evaluated to identify ethnic groups at higher risk for noncompliance with cervical cancer screening. METHODS: Cross-sectional analysis of 2001 California Health Interview Survey data. Logistic regression was used to assess the independent contribution of race/ethnicity to the use of Pap smears. RESULTS: Hispanic (aPR = 1.03, 95% CI 1.02-1.05) and Black (aPR = 1.03, 95% CI 1.001-1.06) women are more likely to report a Pap smear in the past 3 years as compared to White women. Asians were the least likely to report cervical cancer screening despite a more favorable sociodemographic profile. Screening rates varied among Hispanic or Asian subgroups; Mexicans, Vietnamese, Chinese, and South Asians are particularly underserved. CONCLUSIONS: In contrast to the country as a whole, Hispanic women in California are more likely to report a recent Pap smear as compared to White women. However, racial/ethnic disparities in Pap smear use persist; Asian women are the least likely to report cervical cancer screening as compared to any other group.     

Cervical cancer screening beliefs among young Hispanic women

OBJECTIVES: This study examined beliefs, attitudes, and personal characteristics that correlated with self-reported cervical cancer screening history among Hispanic women aged 18 to 25 years old in El Paso, TX, a large metropolitan area on the U.S.-Mexico border. METHODS: Data were collected through a cross-sectional, face-to-face survey. The study questionnaire was based primarily on the Health Belief Model, and included scales that measured perceived susceptibility and seriousness of cervical cancer, and perceived benefits and barriers to Pap test screening. The study questionnaire also included measures of acculturation, Pap test history, pregnancy and sexual history, use of birth control, type of medical insurance, and educational attainment. RESULTS: Sixty-nine percent reported ever having had a Pap test and 56% reported having had a test in the past year. Eighty percent reported that they were sexually active, and of these, 63% reported using birth control. Respondents understood the seriousness of cervical cancer, their susceptibility to cervical cancer, and the benefits of Pap testing; however, only 61% agreed that most young women whom they know have Pap tests. Greater acculturation and the belief that most young unmarried women have Pap tests were positively associated with ever having screening. The perception that the test would be painful and not knowing where to go for the test were negatively associated with ever having a Pap test. CONCLUSIONS: This study found suboptimal rates of screening for cervical cancer in a sample of young Hispanic women residing along the U.S.-Mexico border. Although women may understand the seriousness of cervical cancer and the benefits of screening, perceptions about Pap tests may pose barriers to undergoing screening. Efforts to increase screening also may need to focus specifically on women who are least acculturated, as they also were least likely to have had prior Pap tests.     

Factors Associated with Self-Reported Cervical Cancer Screening Among Women Aged 18 Years and Older in the United States

In 2016, an estimated 4120 women will die as a result of cervical cancer. The objective of this study was to examine the factors associated with cervical cancer screening among women 18 years of age and older in the United States (U.S.). Using the 2012 Behavioral Risk Factor Surveillance System survey, women over the age of 18 in the U.S. were examined to assess factors associated with cervical cancer screening. Analyses were conducted using SAS 9.2. Of the 272,692 study participants, 258,496 (95 %) had obtained cervical cancer screening. After adjusting for demographic and socioeconomic factors, being non-Hispanic White, Hispanic or Latino, Asian, Native Hawaiian or Other Pacific Islander, in the age group 18–44 years and 75 years and above, having less than a high school education and an annual household income of less than a $25,000, having never married, and residing in the West region of the U.S. reduced the likelihood of participation in cervical cancer screening. Also, after adjusting for demographic and socioeconomic factors, being between the ages of 45–74 years of age, having more than a high school education, having a higher income, and residing in the South region of the U.S. increased the likelihood of participation in cervical cancer screening. The results of this study suggest that socio-demographic factors and region of residence are predictors of cervical cancer screening. These findings highlight the need to identify potential prevention strategies to promote cervical cancer screening among at-risk populations and groups.     

Non-utilization of the Pap Test Among Women with Frequent Health System Contact

Despite improvements in health access, many underserved women abstain from cervical cancer screening. A self-administered questionnaire was used to identify factors determining whether medically underserved women attending a safety net health system regularly are screened for cervical cancer. Approximately 11 % of study subjects had never received a Pap test despite an average of nearly four clinic visits in the preceding 12 months. Never screeners were significantly younger, more likely to be Hispanic, non-U.S. born and less likely to have healthcare continuity. In multivariable analysis, odds for never screening were independently lower among women with male partner support (aOR 0.29) and physician’s recommendation for screening (aOR 0.34) and higher among women who believed screening visits are too long (aOR 2.53). Educating male partners of Hispanic and immigrant women in addition to addressing recognized situational barriers may help to improve cervical cancer screening rates.     

Demographic predictors of mammography and Pap smear screening in US women.

OBJECTIVES. Proven screening technologies exist for both breast and cervical cancer, but they are underused by many women. We sought to evaluate the effect of demographic characteristics on the underuse of mammography and Pap smear screening. METHODS. We analyzed responses from 12,252 women who participated in the 1987 National Health Interview Survey Cancer Control Supplement. Demographic profiles were produced to target severely underserved groups of women. RESULTS. Low income was a strong predictor of mammography underuse, as was Hispanic ethnicity and other race, low educational attainment, age greater than 65, and residence in a rural area. A strong predictor of never having had a Pap smear was never having been married; however, the importance of this characteristic is difficult to interpret in the absence of data on sexual activity. Hispanic women and women of other races of all ages and all income levels underused Pap smear screening, as did older women, particularly older Black women. CONCLUSIONS. The tendency of women to underuse screening technologies varies greatly across levels of basic demographic characteristics. The importance of these characteristics differs for mammography screening versus Pap smear screening.     

Hispanic acculturation and utilization of cervical cancer screening in the US

BACKGROUND: Hispanic women have an incidence rate of invasive cervical cancer that is twice as high as that of non-Hispanic White women. Previous investigations have reported that Hispanics are less likely to utilize cancer screening services. Using data from the 2000 National Health Interview Survey, this study examined whether acculturation of Hispanic women was associated with cervical cancer screening. METHODS: The subjects included 2307 Hispanic women aged 21-70 who did not have a history of cervical cancer or a hysterectomy. Women were analyzed by acculturation level according to whether or not they ever had a Pap smear and had one in the previous year and previous 3 years. RESULTS: Acculturation levels tended to be inversely correlated with no Pap smear. Compared to lower acculturated women, women who were more acculturated were less likely to never had a Pap smear (OR = 0.86; 95% CI = 0.58-1.27 for moderate acculturated women and OR = 0.51; 95% CI = 0.29-0.89 for higher acculturated women). Similar results were found for having no Pap smear within the past 3 years (OR = 0.83; 95% CI = 0.61-1.13 for moderate acculturated women and OR = 0.73; 95% CI = 0.49-1.08 for higher acculturated women). CONCLUSION: The findings show that lower acculturation was associated with the under use of cervical cancer screening and suggest that these women might have barriers in accessing and utilizing Pap smears.     

Breast and cervical cancer screening practices among Hispanic women in the United States and Puerto Rico, 1998-1999

BACKGROUND: Results from recent studies suggest that Hispanic women in the United States may underuse cancer screening tests and face important barriers to screening. METHODS: We examined the breast and cervical cancer screening practices of Hispanic women in 50 states, the District of Columbia, and Puerto Rico from 1998 through 1999 by using data from the Behavioral Risk Factor Surveillance System. RESULTS: About 68.2% (95% confidence interval [CI] = 66.3 to 70.1%) of 7,253 women in this sample aged 40 years or older had received a mammogram in the past 2 years. About 81.4% (95% CI = 80.3 to 82.5%) of 12,350 women aged 18 years or older who had not undergone a hysterectomy had received a Papanicolaou test in the past 3 years. Women with lower incomes and those with less education were less likely to be screened. Women who had seen a physician in the past year and those with health insurance coverage were much more likely to have been screened. For example, among those Hispanic women aged 40 years or older who had any health insurance coverage (n = 6,063), 72.7% (95% CI 70.7-74.6%) had had a mammogram in the past 2 years compared with only 54.8% (95% CI 48.7-61.0%) of women without health insurance coverage (n = 1,184). CONCLUSIONS: These results underscore the need for continued efforts to ensure that Hispanic women who are medically underserved have access to cancer screening services.     

HPV and cervical cancer testing and prevention: knowledge, beliefs, and attitudes among Hispanic women

Cervical cancer is a preventable disease resulting from infection with high-risk types of sexually transmitted human papillomaviruses (HPVs). Public knowledge of HPVs and their link to cervical cancer is limited. Participation in cervical cancer prevention programs, including Pap and HPV screening and HPV vaccine acceptance, is crucial for limiting the incidence of cervical cancer. Hispanic women suffer the highest cervical cancer incidence rates in the United States. In this study, we conducted community-based focus groups with Hispanic women to explore knowledge and attitudes relating to cervical cancer, HPV, HPV testing, and HPV vaccination. Study findings suggest a need to increase public health literacy in relation to HPV, the link between HPV and cervical cancer, and HPV primary and secondary prevention options. Health care providers should be prepared to share information with patients that supports and promotes informed decision making about HPV testing and vaccines and their complementary roles in cervical cancer screening and prevention.     

Knowledge, Attitudes, and Patterns of Cancer Screening: A Self-report Among Foreign Born Hispanic Women Utilizing Rural Migrant Health Clinics

Hispanics are the fastest growing minority in the United States and are currently Washington state's largest minority, with the highest growth rates found in the rural agricultural areas of eastern Washington state. Because breast and cervical cancer mortality rates are higher in Hispanics than other U.S. women, subgroups of Hispanic women with the lowest cancer screening utilization rates need to be identified and targeted for cancer control intervention to most effectively reduce late-stage cancer diagnoses and mortality. A study was conducted at six migrant health clinics located throughout eastern Washington state to discern age-specific proportions for utilization of mammography, breast self-examination, and Pap smears among Hispanic migrants to the United States. Knowledge and attitudes regarding these procedures also were assessed and face-to-face interviews were completed with 512 women. Among women 20 years or older, 15 percent had never heard of a Pap smear, only 78 percent had ever received a Pap smear, and only 44 percent had received a Pap smear within the prior year. In all, 73 percent of the women had been taught breast self-examination, 62 percent performed breast self-examination, and 41 percent had performed a breast self-examination in the prior month. Among women 40 years or older, only 38 percent had never heard of a mammogram, 38 percent had ever received a mammogram, and only 30 percent had received a mammogram in the prior two years. Cost was reported as a major barrier for screening in this population. Additionally, a substantial proportion of the women perceived Pap smears and mammography as unnecessary or diagnostic procedures, rather than preventive health measures.     

Family and cultural influences on cervical cancer screening among immigrant Latinas in Miami-Dade County,USA

Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA, with disparities greatest among Latino immigrants. We examined barriers and facilitators to cervical cancer screening practices among a group of immigrant Latino women in Florida, USA. Between January and May 2013, six focus group discussions, involving 35 participants, were conducted among Hispanic women in Miami to explore their knowledge, beliefs about cervical cancer and facilitators and barriers to cervical cancer screening using a theoretical framework. The data showed that family support, especially from female relatives, was an important facilitator of screening and treatment. Women, however, reported prioritising family health over their own, and some expressed fatalistic beliefs about cancer. Major obstacles to receiving a Pap smear included fear that it might result in removal of the uterus, discomfort about being seen by a male doctor and concern that testing might stigmatise them as being sexually promiscuous or having a sexually transmitted disease. Targeted education on cancer and prevention is critically needed in this population. Efforts should focus on women of all ages since younger women often turn to older female relatives for advice.     

Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model.

The aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.     

Mammograms and healthcare access among US Hispanic and non-Hispanic women 40 years and older

Compared to non-Hispanic women, Hispanic women have disproportional mortality rates due to breast cancer. Mammographic screening detects breast cancer in its early stages and reduces mortality. We examined data obtained from the 2002 Behavioral Risk Factor Surveillance System questionnare using logistic regression analyses to study the relationships between demographic and healthcare factors and mammography use among Hispanic and non-Hispanic White women 40 years and older. Overall, the odds of ever having had a mammogram were similar among Hispanic and non-Hispanic White women (odds ratio = 1.2; 95% confidence interval = 0.9, 1.6), when adjusted for age, employment status, and other demographic variables. Having a personal physician and the type of healthcare facility typically used were associated with mammography use, regardless of Hispanic ethnicity. Although associations between mammography use and demographic factors were similar between ethnic groups, larger proportions of Hispanics had demographic characteristics that were negatively associated with mammography use. Establishing policies and mechanisms to provide all women with regular access to a personal physician or healthcare professional for their preventive and nonemergency healthcare needs may improve mammography use among both Hispanic and non-Hispanic White women. Similarly, reaching out to women who are uninsured and who use facilities other than physicians' offices for their healthcare needs may increase the use of mammography among both ethnic groups.     

Prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and factors associated with non-participation in screening

The objective of the study was to determine the self-reported prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and to analyze factors associated with non-participation in screening. A population-based cross-sectional study with a sample of 772 women 18 to 69 years of age and living in Rio Branco was conducted in 2007 and 2008. Data were analyzed with Stata 10.0, and prevalence rates were estimated with Poisson multivariate regression (95%CI). 85.3% of women reported at least one cervical cancer screening test in the previous three years. The majority of women (72.8%) were screened in the Brazilian Unified National Health System. After adjusting for selected variables, statistically significant prevalence rates for absence of screening were found in women 18-24 and 60-69 years of age, single, and with low income and low schooling. The prevalence rates were consistent with findings from other studies, highlighting the need for greater intervention in the group of women most vulnerable to cervical cancer incidence and mortality.