Facilitators and Barriers to Cervical Cancer Screening, Diagnosis, and Enrollment in Medicaid: Experiences of Georgia’s Women’s Health Medicaid Program Enrollees

Abstract

Although cervical cancer incidence and mortality rates have declined in the USA, African American women have a higher incidence rate of cervical cancer and a higher percentage of late-stage diagnosis than white women. Previous analyses by the authors showed that, even after adjusting for age, provider location, and availability, African American women were almost half as likely as white women to be diagnosed or enter Medicaid while at an early stage of their cervical cancer. To understand why these differences exist, we undertook a qualitative examination of the cervical cancer experiences of women enrolled in Georgia's Women's Health Medicaid Program (WHMP). Life history interviews were conducted with 24 WHMP enrollees to understand what factors shaped their cervical cancer experiences, from screening through enrollment in Medicaid. We also examined whether these factors differed by race in order to identify opportunities for increasing awareness of cervical cancer screening among underserved women. Results suggest that many women, especially African Americans, lacked understanding and recognition of early symptoms of cervical cancer, which prevented them from receiving a timely diagnosis. Additionally, participants responded positively to provider support and good communication but wished that their doctors explained their diagnosis more clearly. Finally, women were able to enroll in Medicaid without difficulty due largely to the assistance of clinical staff. These findings support the need to strengthen provider education and public health efforts to reach low-income and minority communities for screening and early detection of cervical cancer.

Variation in Women's Understanding of Prenatal Testing

“…On balance, racial and–ethnic minorities and women of lower socioeconomic status were less likely to have a good understanding of prenatal testing options and of their own experience. These data parallel reports documenting disparities in various screening domains 15-19 . While the American College of Obstetricians and Gynecologists recommends that “...screening and invasive diagnostic testing for aneuploidy should be available to all women...regardless of maternal age” 20 , it appears that this information is not being effectively provided to all women, and that many do not understand the messages conveyed.…”

University Students’ Awareness of Breast and Cervical Cancers: A Comparison of Two Countries and Two Different Cultures

“…Of the Turkish students, 78.9% knew about early diagnosis of cervical cancer, 66.3% knew about the recommendation of the Pap smear test, 14.2% knew about the HPV vaccine, and 25.3% knew about safe sexual practice. Of the Polish students, 68.8% knew about early diagnosis of cervical cancer, 41.9% knew about the Pap smear test, 20% knew about the HPV vaccine, and 15.6% knew about safe sexual practice.…”

“…The Papanicolaou test (Pap smear), which is systematically used in the fight against cervical cancer, is an effective, low-cost, and highly sensitive early diagnostic method which is easy to apply and reduces the burden of the treatment, morbidity and mortality (2,11,12). Cervical cancer shows the benefit of early diagnosis best; developed countries report that invasive cervical cancer rates have been reduced with the use of routine Pap smear screening tests over the last 40-50 years (7,(13)(14)(15).…”

The awareness levels of women for gynecologic cancer in Turkey: A cross‐sectional study

“…Early diagnosis and treatment need to raise awareness about the risk factors, symptoms, prevention, and screening of gynecologic cancers 5,6,21,35 . Cooper et al 36 reported that a majority of women had heard of cervical, ovarian, and endometrial cancers, but not vaginal and vulval cancers.…”