Pain predicts non-adherence to pap smear screening among middle-aged African American women

Personal influences that affect motivation in pap smear testing among African American women

OBJECTIVE

To explore personal influencing factors that contribute to Papanicolaou (Pap smear) testing in African American women who do (routine-use group) and do not (non-routine-use group) obtain routine testing.

DESIGN

Qualitative using the interaction model of client health behavior.

SETTING

Community programs, homes, and churches.

PARTICIPANTS

Twenty four African American women aged 19 to 60.

METHODS

Face-to-face interviews. Data were analyzed using a constant comparison approach.

RESULTS

Routine-use group was socially influenced to value preventive health care while the non-routine-use group was not. Previous health care experiences with having a Pap smear and pelvic exam were positive for routine-use group and negative for non-routine-use group. Cognitively, both groups believed Pap smears tested for cancer and sexually transmitted diseases. Vulnerability to cervical cancer was thought to run in families; participants believed they were either safe from risk or hoped that the odds were in their favor. In addition, there was a link between avoiding routine preventive care and a trauma history (sexual, physical, medical), eliciting negative perceptions towards Pap smears and pelvic exams.

CONCLUSION

Differences and similarities in personal influencing factors associated with cervical cancer screening were found in the two groups. Further research is needed to explore these differences and similarities because they may contribute to the reason that African American women have a greater mortality rate from cervical cancer than White women.

Impact of perceived racial discrimination on health screening in black women

Perceived discrimination has been shown to be related to health screening behavior. The present study examines the effect of discrimination on cancer screening among women in the Black Women's Health Study. Five self-report items measured discrimination in everyday life and three items measured experiences of major discrimination. Logistic regression was used to test associations of discrimination with Pap smear, mammography, or colonoscopy utilization. At the start of follow-up, 88.8% had a Pap smear in the previous year, 52.7% had a mammogram, and 20.0% had received a colonoscopy. Both everyday and major discrimination were associated with not having received a Pap smear, even after adjusting for other variables. Discrimination was not associated with mammography or colonoscopy utilization. In conclusion, perceived everyday and major discrimination is associated with poorer utilization of Pap smears for cervical cancer screening among Black women.

After-effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial

OBJECTIVE

Few studies have investigated physical after-effects of colposcopy. We compared post-colposcopy self-reported pain, bleeding, discharge and menstrual changes in women who underwent: colposcopic examination only; cervical punch biopsies; and large loop excision of the transformation zone (LLETZ).

DESIGN

Observational study nested within a randomised controlled trial.

SETTING

Grampian, Tayside and Nottingham.

POPULATION

Nine hundred-and-twenty-nine women, aged 20-59, with low-grade cytology, who had completed their initial colposcopic management.

METHODS

Women completed questionnaires on after-effects at approximately 6-weeks, and on menstruation at 4-months, post-colposcopy.

MAIN OUTCOME MEASURES

Frequency of pain, bleeding, discharge; changes to first menstrual period post-colposcopy.

RESULTS

Seven hundred-and-fifty-one women (80%) completed the 6-week questionnaire. Of women who had only a colposcopic examination, 14-18% reported pain, bleeding or discharge. Around half of women who had biopsies only and two-thirds treated by LLETZ reported pain or discharge (biopsies: 53% pain, 46% discharge; LLETZ: 67% pain, 63% discharge). The frequency of bleeding was similar in the biopsy (79%) and LLETZ groups (87%). Women treated by LLETZ reported bleeding and discharge of significantly longer duration than other women. The duration of pain was similar across management groups. Forty-three percent of women managed by biopsies and 71% managed by LLETZ reported some change to their first period post-colposcopy, as did 29% who only had a colposcopic examination.

CONCLUSIONS

Cervical punch biopsies and, especially, LLETZ carry a substantial risk of after-effects. After-effects are also reported by women managed solely by colposcopic examination. Ensuring that women are fully informed about after-effects may help to alleviate anxiety and provide reassurance, thereby minimising the harms of screening.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

Discrimination and racial disparities in health: evidence and needed research

This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

Cervical cancer screening among immigrants and ethnic minorities: a systematic review using the Health Belief Model

OBJECTIVE

To systematically review all studies examining sociocultural factors influencing cervical cancer screening among immigrant and ethnic minorities in the United States along the theoretical framework of the Health Belief Model.

MATERIALS AND METHODS

MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane database searches were conducted searching for English language, US-based studies to examine minority and immigrant populations within the theoretical framework of the Health Belief Model. Fifty-five of more than 3,381 potentially relevant articles were included in the final analysis.

RESULTS

Commonly held beliefs across several cultural groups emerged including the following: fatalistic attitudes, a lack of knowledge about cervical cancer, fear of Pap smears threatening one's virginity, as well as beliefs that a Pap smear is unnecessary unless one is ill. Beliefs unique to specific cultural groups included: body-focused notions among Hispanics, as childbirth, menses, sex, and stress were considered to play a role in one's susceptibility to cancer. African Americans identified administrative processes in establishing health care as barriers to screening, whereas Asian immigrants held a variety of misconceptions concerning one's susceptibility to cancer as well as stigmatization imposed by their own community and providers.

CONCLUSION

Health care providers and policy makers must be cognizant of the various sociocultural factors influencing health-related beliefs and health care utilization among immigrant and ethnic minorities in the United States. Culturally relevant screening strategies and programs that address these sociocultural factors must be developed to address the growing disparity in cervical cancer burden among underserved, resource-poor populations in the United States.

Personal influencing factors associated with pap smear testing and cervical cancer

Pap smear is a screening test that detects abnormal cells before they advance to cancer. Unfortunately, not all women obtain routine screening. The method used was a qualitative study exploring personal influences regarding Pap smears. Face-to-face interviews with 7 low-income African American women who do and do not obtain Pap smears (between 21 and 37 years of age) were conducted at a health department about their social influence, previous health care experience, and cognitive appraisal regarding Pap smears and cervical cancer. Women were found to be socially influenced by their family and their physician. Previous health care experience with the Pap and pelvic was perceived as negative. Cognitively, Pap smears were believed to test for sexually transmitted diseases, including HIV, and the women also felt that if one took good care of oneself it reduced the risk for cervical cancer. It was concluded that exploring beliefs associated with Pap smears and perceptions of vulnerability to cervical cancer and giving correct information and counseling may increase Pap smear screening in women.

Factors influencing cancer screening practices of underserved women

PURPOSE

This integrated review was conducted to evaluate the factors that inhibit or promote decisions by African American and Hispanic women to obtain cervical cancer screening.

DATA SOURCES

Research articles were identified using MEDLINE, PubMed, and Cumulative Index to Nursing and Allied Health literature, published between 1999 and 2005.

CONCLUSIONS

Cervical cancer screening practices of African American and Hispanic women were influenced by extrinsic motivators including lack of insurance, no usual source of health care, acculturation, and socioeconomic factors. Intrinsic motivators were related to beliefs and perceptions of vulnerability, such as ignoring cervical cancer screening when no symptoms were present; believing that not knowing if one had cervical cancer was better; and thinking that only women who engage in sexual risk-taking behaviors need to obtain Papanicolaou (Pap) smear testing.

IMPLICATIONS FOR PRACTICE

Nurse practitioners (NPs) have an opportunity to impact the incidence and mortality of cervical cancer by improving screening practices of minority women. They can emphasize the importance of obtaining Pap smears regularly, teach patients the risks for and signs and symptoms of cervical cancer, and provide recommendations for obtaining screening at low cost or no cost to the patient. To improve cancer screening practices, NPs need to address minority women's beliefs about cervical cancer and provide information and services in a culturally sensitive manner at an appropriate level of learning.

Advances in primary and secondary interventions for cervical cancer: human papillomavirus prophylactic vaccines and testing

Cytologic screening has greatly reduced the incidence of invasive cervical cancer in many industrialized nations. State-of-the-art cervical cancer prevention is costly, however, and includes cytologic screening at repeat intervals, confirmation of abnormalities by colposcopic biopsy, and treatment of precancerous lesions. In resource-limited settings, accessibility to prevention programs for cervical cancer is often poor, or such programs are simply unavailable or inadequately supported. This disease, therefore, remains a leading form of cancer among women living in low-resource regions, and over 250,000 women worldwide die from cervical cancer each year. Persistent cervical infection with one of approximately 15 carcinogenic human papillomavirus (HPV) types causes virtually all invasive cervical cancer and its precursor abnormalities, which can be detected by cytologic screening. Genital HPV infections are primarily transmitted via sexual intercourse. One promising prophylactic HPV vaccine is available and others continue in development as primary cervical cancer prevention strategies in younger women. As secondary interventions, HPV tests are simultaneously evolving for use in cervical cancer screening programs, including routine screening of older women. HPV testing is more sensitive and reproducible than cytology with colposcopy for the detection of cervical precancer and cancer. This article presents current advances and perspectives on HPV vaccines and HPV testing.

Cervical cancer prevention in the era of prophylactic vaccines: A preview for gynecologic oncologists

OBJECTIVE

The recent approval of a vaccine to prevent HPV infection is an important advance in cervical cancer prevention. This article is intended to provide gynecologic oncologists with a comprehensive background in modern cervical cancer prevention strategies.

METHODS

We describe and contrast the quadrivalent and bivalent vaccines. More established cervical cancer prevention strategies are reviewed, with comments on the impact of HPV vaccination. Clinical guidance is provided for use of the approved quadrivalent vaccine. Safety and side effects of both vaccines are reviewed and future questions and challenges are explored.

RESULTS

It is vitally important that both vaccinated and unvaccinated women continue to fully engage in cervical cancer prevention, including cervical cancer screening, follow-up of abnormal screens, and treatment of premalignant lesions. A quadrivalent virus-like particle vaccine has now been approved for use in girls and women ages 9 to 26. A bivalent vaccine may be available soon. Vaccine efficacy in clinical trials has been outstanding, with 100% protection against HPV-type-specific cervical intraepithelial neoplasia (CIN) II and III.

CONCLUSIONS

Comprehensive cervical cancer protection now includes prophylactic vaccination for girls and young women in addition to screening and treatment of premalignant changes. Gynecologic oncologists will continue to play an important role in promoting optimal prevention practices.

Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial

OBJECTIVES

To determine if a standardised method of leg positioning without stirrups reduces the physical discomfort and sense of vulnerability and increases the sense of control among women undergoing speculum examination as part of a routine gynaecological examination.

DESIGN

Randomised clinical trial.

SETTING

Family medicine outpatient clinic.

PATIENTS

197 adult women undergoing routine gynaecological examination and cervical smear.

INTERVENTION

Examination with or without stirrups.

MAIN OUTCOME MEASURES

Women's perceived levels of physical discomfort, sense of vulnerability, and sense of control during the examination, measured on 100 mm visual analogue scales.

RESULTS

Women undergoing examination without stirrups had a reduction in mean sense of vulnerability from 23.6 to 13.1 (95% confidence interval of the difference - 16.6 to - 4.4). Mean physical discomfort was reduced from 30.4 to 17.2 (- 19.7 to - 6.8). There was no significant reduction in sense of loss of control.

CONCLUSION

Women should be able to have gynaecological examinations without using stirrups to reduce the stress associated with speculum examinations.

TRIAL REGISTRATION

US Army Central Investigation Regulatory Office. Trial No DDEAMC 05-11.