Cervical Cancer Screening Preferences among African American Women in the Mississippi Delta

Abstract

Although cervical cancer screening rates have increased in the United States, there are still geographic areas that experience a high cervical cancer burden, including the Mississippi Delta. Human papillomavirus (HPV) self-collection may be a feasible alternative to traditional clinician-collection for cervical cancer screening for under-screened women. This study examined women's preferences for cervical cancer screening methods. Interviewer-administered questionnaires regarding cervical cancer screening preferences were completed by 524 African American women in the Mississippi Delta. Statistically significant differences were observed for age, employment status, and number of children across recruitment groups. Regardless of how women were recruited, the majority preferred self-sampling for HPV testing method to clinician-collection. Among women who preferred self-collected sampling for HPV testing, the most frequent reasons given were convenience, privacy, and comfort. Alternative strategies must be considered when targeting the under-screened to reduce the burden of cervical cancer.

Assessing Acceptability of Self-Sampling Kits, Prevalence, and Risk Factors for Human Papillomavirus Infection in American Indian Women

“…This result demonstrates the feasibility of self-collection among Hopi women. As in other studies, most women reported positive attitudes toward self-sampling [6, 8, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40], with almost all reporting that the test was easy to use, and that they would recommend it to a friend or relative. A minority reported discomfort.…”

“…Most previous studies have also reported that a majority of participating women preferred self-sampling [6, 8, 24, 25, 27, 29, 30, 31, 35, 36, 37, 38], although some have returned the opposite finding [26, 28, 34, 39]. In our study, a higher proportion of women who were not adherent to Pap screening, relative to adherent women, preferred self-testing over clinician testing.…”

“…As in other study populations, common reasons cited for preferring HPV self-testing over Pap testing were enhanced privacy and reduced embarrassment [6, 8, 27, 29, 30, 33, 34, 35, 37] and ease and convenience (including not having to travel to a clinic or take time off work) [6, 8, 24, 25, 30, 31, 32, 35, 37, 39]. Nevertheless, almost two-thirds of participants in our study chose to visit the HCSS office either to perform self-sampling on site (21%) or to hand-deliver a sample collected at home (42%).…”

Perceptions of Mailed HPV Self-testing Among Women at Higher Risk for Cervical Cancer

“…These findings lend support to an emerging literature that suggests the acceptability of HPV self-testing is high among under-screened women in the United States. Prior studies have found, for example, that a sizeable minority of under-screened women prefer HPV self-testing to provider-based HPV or Pap testing and that women value the convenience and privacy self-testing affords [10, 11, 15]. Given persistent racial- and income-based disparities in cervical cancer incidence and mortality, the absence of variation in trust across demographic subgroups in our sample is encouraging and suggests that programs for self-testing would not exacerbate existing disparities by being less trustworthy to those women who could most benefit from screening.…”

“…Of special importance, the test must be acceptable to higher-risk women who do not regularly participate in cervical cancer screening programs [12]. Although research to date has found that low-income and under-screened women in the U.S. are generally amenable to self-testing [10–12], no studies have evaluated the acceptability of programs that offer HPV testing by mail. Because such programs could increase access to care, we sought to evaluate perceptions of a novel, mail-based approach to HPV self-testing in a diverse sample of low-income, under-screened women in North Carolina.…”