Stigma and cervical cancer prevention: A scoping review of the U.S. literature

Peterson, Caryn E.; Silva, Abigail; Goben, Abigail; Ongtengco, Natalia P.; Hu, Elise; Khanna, Deepika; Nussbaum, Elizabeth R.; Jasenof, Ian G.; Kim, Sage J.; Dykens, J. Andrew

doi:10.1016/j.ypmed.2021.106849

Cited by 37 publications

(31 citation statements)

References 58 publications

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“…Societal, community, and individual factors are associated with differential uptake of cervical cancer screening services and affect the ability to follow up after an abnormal test result . Stigma related to human papillomavirus infection or inability to receive screening can prevent further follow-up care, which can result in more advanced-stage cancer diagnoses. Also, human papillomavirus vaccination is an effective primary prevention intervention, and efforts should focus on ensuring that all eligible populations are vaccinated …”

Section: Discussionmentioning

confidence: 99%

Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status

et al. 2023

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ImportanceBlack and Hispanic or Latina women are more likely than White women to receive a diagnosis of and to die of cervical cancer. Health insurance coverage is associated with diagnosis at an earlier stage of cervical cancer.ObjectiveTo evaluate the extent to which racial and ethnic differences in the diagnosis of advanced-stage cervical cancer are mediated by insurance status.Design, Setting, and ParticipantsThis retrospective, cross-sectional population-based study used data from the Surveillance, Epidemiology, and End Results (SEER) program on an analytic cohort of 23 942 women aged 21 to 64 years who received a diagnosis of cervical cancer between January 1, 2007, and December 31, 2016. Statistical analysis was performed from February 24, 2022, to January 18, 2023.ExposuresHealth inusurance status (private or Medicare insurance vs Medicaid or uninsured).Main Outcomes and MeasuresThe primary outcome was a diagnosis of advanced-stage cervical cancer (regional or distant stage). Mediation analyses were performed to assess the proportion of observed racial and ethnic differences in the stage at diagnosis that were mediated by health insurance status.ResultsA total of 23 942 women (median age at diagnosis, 45 years [IQR, 37-54 years]; 12.9% were Black, 24.5% were Hispanic or Latina, and 52.9% were White) were included in the study. A total of 59.4% of the cohort had private or Medicare insurance. Compared with White women, patients of all other racial and ethnic groups had a lower proportion with a diagnosis of early-stage cervical cancer (localized) (American Indian or Alaska Native, 48.7%; Asian or Pacific Islander, 49.9%; Black, 41.7%; Hispanic or Latina, 51.6%; and White, 53.3%). A larger proportion of women with private or Medicare insurance compared with women with Medicaid or uninsured received a diagnosis of an early-stage cancer (57.8% [8082 of 13 964] vs 41.1% [3916 of 9528]). In models adjusting for age, year of diagnosis, histologic type, area-level socioeconomic status, and insurance status, Black women had higher odds of receiving a diagnosis of advanced-stage cervical cancer compared with White women (odds ratio, 1.18 [95% CI, 1.08-1.29]). Health insurance was associated with mediation of more than half (ranging from 51.3% [95% CI, 51.0%-51.6%] for Black women to 55.1% [95% CI, 53.9%-56.3%] for Hispanic or Latina women) the racial and ethnic inequities in the diagnosis of advanced-stage cervical cancer across all racial and ethnic minority groups compared with White women.Conclusions and RelevanceThis cross-sectional study of SEER data suggests that insurance status was a substantial mediator of racial and ethnic inequities in advanced-stage cervical cancer diagnoses. Expanding access to care and improving the quality of services rendered for uninsured patients and those covered by Medicaid may mitigate the known inequities in cervical cancer diagnosis and related outcomes.

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Section: Discussionmentioning

confidence: 99%

Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status

et al. 2023

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“…Cancer remains a stigmatised disease in many countries. Poor survival due to limited cancer control programmes and infrastructure in low‐income countries has led to a high sense of ‘fatalism’ related to a cancer diagnosis 6 and several studies have shown the impact of cancer stigma on screening rates 7,8 and reluctance to visit a health provider 9 . In addition, specific cancers linked to preventable risk factors or behavioural causes such as smoking, drinking or sexual interaction are stigmatised as ‘deserved’ or ‘self‐induced’ resulting in feelings of guilt, shame or the social isolation of patients 10 .…”

Section: Low‐middle Income Countriesmentioning

confidence: 99%

Invited Editorial: Why all countries should include psycho‐oncology in their cancer response

Johnson

Adams

2023

Psycho-Oncology

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“…In addition, the expression of attitudes related to stigma is moderated by social influence—that is by the ability of individuals to affect one another’s thoughts, ideas, and behaviors [ 12 , 13 ]. In these ways, stigma may directly and indirectly contribute to vaccine and screening hesitancy [ 14 ]. For example, stigmas around sexual behavior and HPV infection [ 15 ] may contribute to vaccine and screening hesitancy by causing individuals to avoid engagement with providers [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Social norms that provided motivation to receive HPV vaccination and screening served as positive facilitators. Gender and social norms were negative facilitators of stigma [ 14 ]. Understanding how these factors contribute to the acceptability and adoption of cervical cancer prevention strategies is critical to preventing cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

Assessing the interrelationship between stigma, social influence, and cervical cancer prevention in an urban underserved setting: An exploratory study

et al. 2022

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In the US, incidence and mortality from cervical cancer disproportionately affects racial/ethnic minorities and low-income women. Despite affordable access to primary and secondary prevention measures at Federally Qualified Health Centers (FQHCs), Human Papillomavirus (HPV) vaccination and screening rates are low, suggesting the presence of non-financial barriers to uptake in this population. This explanatory sequential mixed-methods study sought to explore factors that influence the acceptability of cervical cancer prevention services among parents and legal guardians of vaccine-eligible girls attending an urban FQHC and to assess social influences related to cervical cancer prevention. Participants included eight mothers, one father, and two grandparents/legal guardians. Nine participants self-identified as Black/Afro-Caribbean, or African American, two as Latinx, and one as Native American. The quantitative data suggested discordance between participants’ cervical cancer prevention knowledge and their practices. Most indicated that their daughters had received the HPV vaccine but were unsure about HPV transmission modes. Qualitative data revealed that participants were comfortable disclosing information on HPV infection and vaccination status, and most women were likely to share information related to cervical cancer testing and diagnosis. Few comments indicated personal stigma on the part of participants, but there was frequent expression of perceived public stigma (shaming and blaming women), gender differences (men are indifferent to risk), and distrust of the healthcare system. Findings highlight several concepts including the disharmony between knowledge and practice, prevalent perceived public stigma, cumbersome attitudes on the part of men regarding HPV and cervical cancer, and distrust of the healthcare system.

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Stigma and cervical cancer prevention: A scoping review of the U.S. literature

Cited by 37 publications

References 58 publications

Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status

Mediation of Racial and Ethnic Inequities in the Diagnosis of Advanced-Stage Cervical Cancer by Insurance Status

Invited Editorial: Why all countries should include psycho‐oncology in their cancer response

Assessing the interrelationship between stigma, social influence, and cervical cancer prevention in an urban underserved setting: An exploratory study

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