Variation in Cervical Cancer Screening Preferences among Medically Underserved Individuals in the United States: A Systematic Review

Abstract

Underutilization of effective screening is one driver of disparities in cervical cancer incidence and mortality. Consideration of patient preferences could help to improve screening rates in populations facing substantial barriers to preventive care. We conducted a systematic review of the literature on cervical cancer screening preferences among medically underserved patients in the United States. We searched six electronic databases (PubMed, Web of Science, EMBASE, Scopus, CINAHL, and PsycINFO) for articles published through February 2019 (Prospero ID: CRD42019125431). Among the 43 articles included, 23 reported screening modality preferences, 11 reported preferences related to provider demographics and attributes, six reported screening scheduling and results delivery preferences, and nine reported preferences related to health education and communication. This review demonstrates the wide variety of medically underserved patient preferences related to cervical cancer screening. It also draws attention to two key preference trends that emerged despite heterogeneity in study design, populations, and preference assessment. Consistent preferences for human papillomavirus self-testing over traditional Pap testing highlight a key potential mechanism for increasing cervical cancer screening uptake among medically underserved populations. In addition, preferences for gender-and language-concordant providers underscore the need for continued efforts toward expanding diversity among medical professionals.

Self-Sampling Devices for HPV Testing

“…In the US, lower screening rates have been documented in a number of groups including Hispanic, Asian, and American Indian/Alaskan Native people. 42 New immigrants and people without a usual source of health care are also often underscreened. 42 In non-focus group studies included in a systematic review, percentages of people who preferred self-testing to Pap testing ranged from 10% to more than 90%.…”

“…42 New immigrants and people without a usual source of health care are also often underscreened. 42 In non-focus group studies included in a systematic review, percentages of people who preferred self-testing to Pap testing ranged from 10% to more than 90%. 42 People in low-income populations and those staying in domestic violence shelters preferred the HPV self-test less than other groups.…”

“…42 In non-focus group studies included in a systematic review, percentages of people who preferred self-testing to Pap testing ranged from 10% to more than 90%. 42 People in low-income populations and those staying in domestic violence shelters preferred the HPV self-test less than other groups. 42 The majority of rural residents preferred the self-test option.…”

“…42 People in low-income populations and those staying in domestic violence shelters preferred the HPV self-test less than other groups. 42 The majority of rural residents preferred the self-test option. 42 In focus group studies with low-income participants who belonged to ethnic minority groups, there was a preference for the health care provider to collect the HPV sample because of a fear of not doing it correctly themselves.…”

“…42 The majority of rural residents preferred the self-test option. 42 In focus group studies with low-income participants who belonged to ethnic minority groups, there was a preference for the health care provider to collect the HPV sample because of a fear of not doing it correctly themselves. 42 The majority of low-income and minority participants cited privacy and convenience as factors that contributed to their preference for self-collection.…”