Racial and ethnic differences in cervical cancer screening barriers and intentions: The My Body My Test-3 HPV self-collection trial among under-screened, low-income women

Abstract

Under-screened women are more likely to be diagnosed with invasive cervical cancer at later stages and have worse survival outcomes. Under- or un-insured women, low-income women, and minoritized groups face barriers to screening. Intention to screen is an indicator of future screening behavior, yet is understudied among low-income, under-screened women. Participants were 710 low-income, uninsured or publicly insured women ages 25–64 years in North Carolina who were not up to date on cervical cancer screening according to national guidelines. Participants were asked about barriers to screening and intention to screen. We estimated reported barriers to cervical cancer screening stratified by race and ethnicity (categorized as White, Black, and Hispanic) and assessed predictors of intention to screen. Sixty-one percent of all participants reported 5 or more barriers to screening. The most commonly reported reasons for not getting screened were lack of insurance (White: 71%, Black: 62%, Hispanic/Latina: 63%) and cost (White: 55%, Black: 44%, Hispanic/Latina: 61%). Women were more likely to have an intention to screen if they reported “it was not hard to get screening” (OR: 1.47 (1.00, 2.15)). Older women reported being less likely to intend to screen. Black women reported being more likely to intend to screen than White women. Lack of health insurance and cost were frequently reported barriers to cervical cancer screening. Increasing knowledge of affordable clinics and expanding access to Medicaid may reduce barriers and increase cervical cancer screening uptake.

3D Topographical Scanning for the Detection of Osteoporosis

“…Lower socioeconomic status has been correlated with no show at follow-up appointments[ 31 ]. Driving forces behind the barriers to obtaining screening tests in general included lack of insurance, cost, having to take time off work, lack of childcare, and lack of transportation[ 32 ]. This highlights the value of creating adjunct screening tests that can be performed quickly, inexpensively, and without an additional appointment to optimize bone health outcomes for all patients when they may not be able to otherwise be screened for osteoporosis.…”

Cervical Cancer Prevention and Treatment Needs among Hispanic Women Living on the US-Mexico Border

“…The most common reason is lack of knowledge (Garg et al, 2020; Suk et al, 2022). In order to increase the number of people who get screened and the number of timely cervical cancer diagnoses, researchers suggest the expansion of surveillance systems; using reminder mechanisms; and developing community-based, culturally tailored intervention programs including health education campaigns and home visits (Bruni et al, 2022; Desai et al, 2022; Makadzange et al, 2022; Silvera et al, 2022; Suk et al, 2022; Zeno et al, 2022). They also recommend transitioning to using HPV-research-based screening (specifically DNA detection) rather than the Pap test because it is more cost-effective, can be self-collected, and allows high-grade persistent lesions to be identified earlier (ACS, 2023; Cascardi et al, 2022; Desai et al, 2022; Makadzange et al, 2022; Poniewierza & Panek, 2022; Ramos-Pibernus et al, 2021; Wood et al, 2018).…”

“…Research literature reveals a breadth of information regarding cervical cancer screening beliefs and behaviors (Calderón-Mora et al, 2020; Desai et al, 2022; Giuliano, 2023; Shokar et al, 2021; Silvera et al, 2023; Stenzel et al, 2022; Suk et al, 2022; Zeno et al, 2022). Many reasons why people do not get screened include lack of healthcare system literacy; lack of insurance; resource and logistic barriers including provider shortages and lack of capacity, communication, coordination, and facility access; fear of and a fatalistic attitude about cancer; linguistic, religious, and cultural barriers including perceived discrimination; feeling less susceptible; fearing that the test will be painful or uncomfortable; lack of confidence or knowledge about cervical cancer, HPV, and test availability; negative interactions with healthcare providers; and partner disapproval (Allahqoli et al, 2022; Desai et al, 2022; Makadzange et al, 2022; Ramos-Pibernus et al, 2021; Silvera et al, 2022; Stenzel et al, 2022; Suk et al, 2022; Zeno et al, 2022). The most common reason is lack of knowledge (Garg et al, 2020; Suk et al, 2022).…”

“…Some factors that improve screening rates in Hispanic women include being recommended by a primary care physician or having had a well-woman visit in the last year; community outreach programs that are socially reinforced by Hispanic, bilingual promotoras de salud (lay health workers); print material in Spanish; use of culturally specific media and educational interventions that utilize role models; greater acculturation; believing that many other Hispanic women also get Pap tests and hearing positive stories from them; being able to collect the test sample oneself; spousal encouragement; intention to screen; and having health insurance (Calderón-Mora et al, 2020; Desai et al, 2022; Garg et al, 2020; Makadzange et al, 2022; Shokar et al, 2021; Suk et al, 2022; Wood et al, 2018; Zeno et al, 2022). Increasing demand for screening involves using reminder and recall systems, incentives, and both one-on-one and group education (Community Preventive Services Task Force, 2022).…”

Lives Saved Through Increasing Adherence to Follow-Up After Abnormal Cervical Cancer Screening Results

“…The Health Belief Model focuses on the fear of cancer, embarrassment from the speculum examination, lack of knowledge, anxiety, time away from work, transportation costs, childcare costs, and lack of insurance. 3 Building on the lack of insurance, one potential and poorly studied factor is that many women with an abnormal initial cervical cancer screening test result (14–37%) do not receive clinically indicated follow-up diagnostic testing (20–75%) to determine the presence or absence of malignancy.…”