Outcomes of a Multicomponent Culturally Tailored Cervical Cancer Screening Intervention Among Underserved Hispanic Women (De Casa en Casa)

Abstract

Hispanic women have almost double the cervical cancer incidence and are twice as likely to die from cervical cancer compared with non-Hispanic White women. Cervical cancer is preventable with screening, and based on available data, multiple component screening interventions have been proposed as a strategy to maximize screening, but such studies are lacking. We sought to test the effectiveness of a multicomponent screening intervention for primary prevention and early detection of cervical cancer among underserved Hispanic women. We conducted a prospective community-based cervical cancer screening intervention utilizing a quasi-experimental design. The intervention was theory based, delivered by bilingual community health workers, combined education and reduction of noneconomic barriers, and addressed economic barriers. Components included outreach, education, provision of no-cost Papanicolaou and human papillomavirus screening, on-site diagnostic and treatment colposcopy, and patient navigation with tracking to facilitate screening, diagnosis, and treatment. The main outcome was self-reported screening. We recruited 300 intervention group and 299 control group participants. Mean age of the sample was 44.7 years. The majority were Hispanic (98%), born in Mexico (79%), and had a Spanish-language preference (86%). In intention-to-treat analyses, the intervention group had a relative risk of screening of 14.58 (95% confidence interval = 8.57-24.80, p < .001) compared with the control group. A multilevel, multiple component culturally tailored bilingual cervical cancer screening intervention combining education, navigation, and no-cost screening can significantly increase cervical cancer screening uptake in a high-risk, underscreened population and has the potential to affect cervical cancer health disparities.

Qualitative assessment of knowledge and attitudes towards cervical cancer screening among male Latino immigrants in Houston, Texas

“…Participants in the intensive group had significantly higher screening rates than women in usual care and low-intensity outreach (video education) groups. Shokar et al [3] performed a community-wide, multidisciplinary intervention in El Paso County and the neighboring Hudspeth County to improve cervical cancer screening rates, including an educational and outreach component. After providing bilingual and culturally-directed education, they found that patients who received the intervention were 14 times more likely to participate successfully in screening.…”

“…After providing bilingual and culturally-directed education, they found that patients who received the intervention were 14 times more likely to participate successfully in screening. These studies have also documented that, given the language and cultural barriers that exist within immigrant Hispanic communities, strategies to increase screening found to be most effective are those that use a promotora, or a lay health person who is familiar with the languages and cultural nuances within the community [3,16]. At present, it is not yet known whether use of promotoras or patient navigators would improve knowledge of HPV-related infections among male partners of women presenting for gynecologic care.…”

“…Of note, the incidence of cervical cancer in the U.S. is significantly higher among Hispanic, American Indian, and non-Hispanic African American patients than their non-Hispanic White and Asian counterparts [2]. Hispanic women, particularly those who born outside the U.S., are generally diagnosed with cervical cancer at later stages, and experience greater mortality from this disease than others [3,4]. Multiple factors potentially account for this health disparity, including lower rates of cervical cancer screening among recent immigrants, difficulty accessing appropriate care, language barriers and rates of acculturation [5,6].…”

Blood cancer health disparities in the United States Hispanic population

“…Cancer health disparities describe the differences in cancer outcomes among various population groups, and are measured in terms of cancer incidence, prevalence, stage at diagnosis, morbidity, and mortality, as well as variations in screening, survivorship, and quality of life (Patel et al, 2020). Despite the "Hispanic paradox," health disparities have been reported in the Hispanic population for several different cancers, including gastric cancer (Florea et al, 2019;Rajabi et al, 2012), ovarian cancer (Shokar et al, 2019), cervical cancer (Carrillo et al, 2021), and several types of blood cancers (ACS, 2020a;…”

“…Bencomo-Alvarez et al, 2020). Additionally, minority groups tend to have lower rates of preventive screening measures (Florea et al, 2019;Shokar et al, 2019), higher numbers of comorbidities (de Heer et al, 2013), and higher rates of complications associated with therapy (Yanez et al, 2016). Here, we summarize the burden of cancers in the U.S. Hispanic population, with a focus on chronic and acute leukemia.…”