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Samman E, Mkuu R, Zhang X, Scummings S, Burdine J. Body Mass Index and Breast and Cervical Cancer Screening. WOMEN'S HEALTH REPORTS 2022; 3:508-514. [PMID: 35651991 PMCID: PMC9148662 DOI: 10.1089/whr.2021.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
Background: Breast and cervical cancer screening are responsible for dramatically reducing cancer deaths. Overweight and obesity are associated with deleterious health outcomes, including increased risk of developing cancer. This study adds to the existing literature examining the association of having overweight and obesity and receipt of breast or cervical cancer screening. Methods: Using the 2013 Brazos Valley Community Health Needs Assessment, we examined the association between body mass index (BMI) and receipt of breast or cervical cancer screening among women meeting age recommendations for breast cancer and cervical cancer screening (n = 1979 and n = 2040), respectively. We used SPSS 22 statistical software for descriptive and logistic regression analysis. Results: Overall, 26.6% of women missed the breast cancer screening guidelines, and 13.3% missed the cervical cancer screening guidelines. BMI had a weak association with missing cervical cancer screenings (odds ratio [OR] = 1.02; confidence interval [CI] = 1.01–1.04), but no association with missing breast cancer screenings (OR = 1.01; CI = 0.99–1.03). Higher age, race (non-White), rural area, no health insurance, smoking, and delayed health care were associated with missing breast cancer screenings. Higher age, marital status (single), lower education, no health insurance, smoking, and delayed health care were associated with missing cervical cancer screening. Further research is needed to better understand the association using larger, more diverse samples.
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Affiliation(s)
- Elfreda Samman
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Rahma Mkuu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida Gainesville, Florida, USA
| | - Xiaoying Zhang
- Department of Health and Kinesiology, College of Education & Human Development, Texas A&M University, USA
| | - Shelby Scummings
- Department of Statistics, College of Science, Texas A&M University, USA
| | - James Burdine
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, Texas, USA
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Steele EM, Robertson SE, Holmes JA. The effect of distance from cancer facility on advanced clinical stage at diagnosis in patients with cervical cancer. Cancer Treat Res Commun 2020; 25:100226. [PMID: 33120317 DOI: 10.1016/j.ctarc.2020.100226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE/OBJECTIVES In the United States, cervical cancer remains a significant cause of morbidity and mortality. The effect of distance has a complicated relationship with disease characteristics and outcomes in other cancers. The purpose of this study is to investigate the relationship between distance from cancer facility on clinical stage at diagnosis in women with cervical cancer. MATERIALS/METHODS Data were obtained from the National Cancer Database which include patient demographics, disease characteristics, and treatment details. Persons diagnosed with cervical cancer from 2004 to 2015 were included. Subjects were excluded if they had missing information, variant histology, or lived >1,000 miles from their facility resulting in 51,413 persons. Disease was classified as localized (stage 1a-2a) or advanced (stage 2b-4b). Univariate comparisons were performed using analysis of variance and chi-square test. Multivariable logistic regression was used to investigate the effect of distance quartiles on advanced stage while adjusting for other significant variables. RESULTS Mean age was 51.0 years, 16.9% of women were black, 14.7% were Hispanic, 45.0% had private insurance, and 10.7% were uninsured. Overall, 50.9% of women presented with advanced disease. In multivariable analysis, greater distance demonstrated a stepwise risk reduction of advanced disease where those in the farthest quartile had odds ratio of 0.73 (p<0.001) relative to the closest. Additionally, age, race, income, and insurance status significantly affected risk of advanced disease. CONCLUSIONS Distance from cancer facility resulted in lower risk of advanced stage disease at diagnosis. Additional research could elucidate the nuanced relationship between distance, disease characteristics and outcomes in cervical cancer.
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Affiliation(s)
- Ethan M Steele
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sharon E Robertson
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Gynecologic Oncology, Indiana University Simon Cancer Center, Indianapolis, IN, United States
| | - Jordan A Holmes
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Radiation Oncology, Indiana University Simon Cancer Center, Indianapolis, IN, United States.
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Silvera SAN, Bandera EV, Jones BA, Kaplan AM, Demisse K. Knowledge of, and beliefs about, access to screening facilities and cervical cancer screening behaviors among low-income women in New Jersey. Cancer Causes Control 2019; 31:43-49. [DOI: 10.1007/s10552-019-01244-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/16/2019] [Indexed: 01/02/2023]
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Miles-Richardson S, Allen S, Claridy MD, Booker EA, Gerbi G. Factors Associated with Self-Reported Cervical Cancer Screening Among Women Aged 18 Years and Older in the United States. J Community Health 2018; 42:72-77. [PMID: 27496176 DOI: 10.1007/s10900-016-0231-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In 2016, an estimated 4120 women will die as a result of cervical cancer. The objective of this study was to examine the factors associated with cervical cancer screening among women 18 years of age and older in the United States (U.S.). Using the 2012 Behavioral Risk Factor Surveillance System survey, women over the age of 18 in the U.S. were examined to assess factors associated with cervical cancer screening. Analyses were conducted using SAS 9.2. Of the 272,692 study participants, 258,496 (95 %) had obtained cervical cancer screening. After adjusting for demographic and socioeconomic factors, being non-Hispanic White, Hispanic or Latino, Asian, Native Hawaiian or Other Pacific Islander, in the age group 18-44 years and 75 years and above, having less than a high school education and an annual household income of less than a $25,000, having never married, and residing in the West region of the U.S. reduced the likelihood of participation in cervical cancer screening. Also, after adjusting for demographic and socioeconomic factors, being between the ages of 45-74 years of age, having more than a high school education, having a higher income, and residing in the South region of the U.S. increased the likelihood of participation in cervical cancer screening. The results of this study suggest that socio-demographic factors and region of residence are predictors of cervical cancer screening. These findings highlight the need to identify potential prevention strategies to promote cervical cancer screening among at-risk populations and groups.
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Affiliation(s)
- Stephanie Miles-Richardson
- Department of Community Health and Preventative Medicine, Morehouse School of Medicine, 720 Westview Dr. SW, National Center for Primary Care (NCPC) Suite 346, Atlanta, GA, 30310-1495, USA.
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA.
| | - Shari Allen
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA
| | - Mechelle D Claridy
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elaine Archie Booker
- Department of Community Health and Preventative Medicine, Morehouse School of Medicine, 720 Westview Dr. SW, National Center for Primary Care (NCPC) Suite 346, Atlanta, GA, 30310-1495, USA
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA
| | - Gemechu Gerbi
- Department of Community Health and Preventative Medicine, Morehouse School of Medicine, 720 Westview Dr. SW, National Center for Primary Care (NCPC) Suite 346, Atlanta, GA, 30310-1495, USA
- Master of Public Health Program, Morehouse School of Medicine, Atlanta, GA, USA
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Lee JA, Pausé CJ. Stigma in Practice: Barriers to Health for Fat Women. Front Psychol 2016; 7:2063. [PMID: 28090202 PMCID: PMC5201160 DOI: 10.3389/fpsyg.2016.02063] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023] Open
Abstract
In this paper, we explore barriers to health for fat people. By shifting the focus from what fat people do or do not do, neoliberal principles are replaced by a focus instead on structural and institutional policies, attitudes, and practices. This includes the impact of stigma on the health treatment and health-seeking behavior of fat people. For example, we consider the role that provider anti-fat attitudes and confirmation bias play in the failure to provide evidenced-based healthcare to fat patients. This is an autoethnographic paper, which provides the opportunity to read research from the perspective of fat scholars, framed by questions such as: can fat people have health? Is health itself a state of being, a set of behaviors, a commodity, a performance; perhaps the new social contract? As a co-written autoethnographic paper, one aspect of the evidence provided is the recorded experiences of the two fat authors. This includes writing from notes, journals, compiled and repeated experiences with medical professionals, family, and the community. Framed by feminist standpoint and supported by literature drawn from Fat Studies, Public Health, Obesity Research, and other interdisciplinary fields, this is a valuable opportunity to present an extended account of fat discrimination and the impact of the stigma fat people face through the medical profession and other sectors of the community, written by fat individuals. The paper concludes by considering the health pathways available to fat people. Special attention is paid to whether Bacon and Aphramor's Health at Every Size paradigm provides a path to health for fat individuals.
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Affiliation(s)
- Jennifer A. Lee
- College of Arts, Victoria UniversityMelbourne, VIC, Australia
| | - Cat J. Pausé
- College of Humanities and Social Sciences, Institute of Education, Massey UniversityPalmerston North, New Zealand
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Fletcher FE, Vidrine DJ, Tami-Maury I, Danysh HE, King RM, Buchberg M, Arduino RC, Gritz ER. Cervical cancer screening adherence among HIV-positive female smokers from a comprehensive HIV clinic. AIDS Behav 2014; 18:544-54. [PMID: 23605155 DOI: 10.1007/s10461-013-0480-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV-positive women are at elevated risk for developing cervical cancer. While emerging research suggests that gynecologic health care is underutilized by HIV-positive women, factors associated with adherence to Pap testing, especially among HIV-positive female smokers are not well known. We utilized baseline data from a smoking cessation trial and electronic medical records to assess Pap smear screening prevalence and the associated characteristics among the HIV-positive female participants (n = 138). 46 % of the women had at least 1 Pap test in the year following study enrollment. Multiple logistic regression analysis indicated that younger age, African American race, hazardous drinking, increased number of cigarettes smoked per day, and smoking risk perception were associated with non-adherence to Pap smear screening. Cervical cancer screening was severely underutilized by women in this study. Findings underscore the importance of identifying predictors of non-adherence and addressing multiple risk factors and behavioral patterns among HIV-positive women who smoke.
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Affiliation(s)
- Faith E Fletcher
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, PO Box 301439, Unit 1330, Houston, TX, 77030-1439, USA,
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Translating access into utilization: lessons from the design and evaluation of a health insurance Web site to promote reproductive health care for young women in Massachusetts. Contraception 2013; 88:684-90. [DOI: 10.1016/j.contraception.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/03/2013] [Accepted: 09/07/2013] [Indexed: 11/21/2022]
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Abstract
Mobile mammography services are typically offered as a means to increase access and adherence to mammography screenings. As mobile mammography becomes a viable strategy to increase screening, a 3 year study of such a state-wide program in WV found surprisingly high rates of obesity within the study population. Thus, the objectives were to: (1) describe the demographic characteristics and comorbidities of women who utilized the WV program, and (2) determine the association between body mass index (BMI) and personal health and screening history, preventive care and wellness behaviors, nutrition and exercise behaviors, and demographics. Data collected from 1,099 women, age 40 and above, were analyzed using descriptive statistics, bivariate analyses, and a multivariate regression model. The majority (60.4 %) were married, had an income <$25,000 (59.2 %), and had health insurance (53.5 %). Major comorbidities were hypertension (49 %) and high cholesterol (43.9 %). Based on BMI scores, 884 participants were either overweight (26.6 %), mildly obese (27.7 %), moderately obese (15.1 %), or severely obese (11.1 %). Bivariate analyses indicated that increasing BMI was significantly associated with factors such as having hypertension or diabetes, limited daily activities, perceived health, and not smoking or drinking. The regression model was significant (p < 0.001; R2 = 0.425) indicating that women who engaged in preventive care behaviors were less likely to be obese than those who did not. The WV mobile mammography program appeared to attract women who were disproportionately obese and had multiple comorbidities, thus providing a great opportunity for targeted interventions related to improving preventive care and screening behaviors.
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Tracy JK, Lydecker AD, Ireland L. Barriers to cervical cancer screening among lesbians. J Womens Health (Larchmt) 2012; 19:229-37. [PMID: 20095905 DOI: 10.1089/jwh.2009.1393] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate cervical cancer screening practices and barriers to screening in a sample of lesbians. METHODS Cross-sectional survey data were collected from 225 self-identified lesbians who completed an online questionnaire. RESULTS Of the respondents, 71% reported receiving a Pap screening test in the past 24 months (routine screeners), and 29% reported receiving a Pap screening test >24 months ago or never (nonroutine screeners). Routine screeners were more likely to be older (p < 0.01), white (p = 0.04), and college graduates (p < 0.01) than nonroutine screeners. Nonroutine screeners were more likely to delay seeking healthcare because of fear of discrimination (p < 0.01) and were less likely than routine screeners to disclose orientation to their primary care physician (p < 0.01). After adjusting for age, race, and education, nonroutine screeners perceived fewer benefits from (p < 0.01) and more barriers (p < 0.01) to Pap screening tests and were less knowledgeable about screening guidelines (p < 0.01) than routine screeners, but there was no difference in perceived susceptibility (p = 0.68), perceived seriousness (p = 0.68), or risk factor knowledge (p = 0.35) of cervical cancer. CONCLUSIONS Many lesbians do not screen for cervical cancer at recommended rates. Nonroutine screeners perceive fewer benefits, more barriers, and more discrimination and are less knowledgeable about screening guidelines than routine screeners.
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Affiliation(s)
- J Kathleen Tracy
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Lofters AK, Moineddin R, Hwang SW, Glazier RH. Predictors of low cervical cancer screening among immigrant women in Ontario, Canada. BMC WOMENS HEALTH 2011; 11:20. [PMID: 21619609 PMCID: PMC3121675 DOI: 10.1186/1472-6874-11-20] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/27/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Disparities in cervical cancer screening are known to exist in Ontario, Canada for foreign-born women. The relative importance of various barriers to screening may vary across ethnic groups. This study aimed to determine how predictors of low cervical cancer screening, reflective of sociodemographics, the health care system, and migration, varied by region of origin for Ontario's immigrant women. METHODS Using a validated billing code algorithm, we determined the proportion of women who were not screened during the three-year period of 2006-2008 among 455,864 identified immigrant women living in Ontario's urban centres. We created eight identical multivariate Poisson models, stratified by eight regions of origin for immigrant women. In these models, we adjusted for various sociodemographic, health care-related and migration-related variables. We then used the resulting adjusted relative risks to calculate population-attributable fractions for each variable by region of origin. RESULTS Region of origin was not a significant source of effect modification for lack of recent cervical cancer screening. Certain variables were significantly associated with lack of screening across all or nearly all world regions. These consisted of not being in the 35-49 year age group, residence in the lowest-income neighbourhoods, not being in a primary care patient enrolment model, a provider from the same region, and not having a female provider. For all women, the highest population-attributable risk was seen for not having a female provider, with values ranging from 16.8% [95% CI 14.6-19.1%] among women from the Middle East and North Africa to 27.4% [95% CI 26.2-28.6%] for women from East Asia and the Pacific. CONCLUSIONS To increase screening rates across immigrant groups, efforts should be made to ensure that women have access to a regular source of primary care, and ideally access to a female health professional. Efforts should also be made to increase the enrolment of immigrant women in new primary care patient enrolment models.
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Affiliation(s)
- Aisha K Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.
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Fagan HB, Wender R, Myers RE, Petrelli N. Obesity and Cancer Screening according to Race and Gender. J Obes 2011; 2011:218250. [PMID: 22220270 PMCID: PMC3246761 DOI: 10.1155/2011/218250] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/24/2011] [Indexed: 12/21/2022] Open
Abstract
The relationship between obesity and cancer screening varies by screening test, race, and gender. Most studies on cervical cancer screening found a negative association between increasing weight and screening, and this negative association was most consistent in white women. Recent literature on mammography reports no association with weight. However, some studies show a negative association in white, but not black, women. In contrast, obese/overweight men reported higher rates of prostate-specific antigen (PSA) testing. Comparison of prostate cancer screening, mammography, and Pap smears implies a gender difference in the relationship between screening behavior and weight. In colorectal cancer (CRC) screening, the relationship between weight and screening in men is inconsistent, while there is a trend towards lower CRC screening in higher weight women.
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Affiliation(s)
- Heather Bittner Fagan
- Department of Family and Community Medicine, Christiana Care Health System, 1400 North Washington Street, Room 328, Wilmington, DE 19801, USA
- *Heather Bittner Fagan:
| | - Richard Wender
- Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ronald E. Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Nicholas Petrelli
- Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE 19713, USA
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Abstract
RATIONALE Compliance with preventive care recommendations differs between countries. Directly comparable data are often not available. The recent release of the Joint Canada/United States Survey of Health makes available data for both Canadians and Americans. OBJECTIVES The health care systems in the United States and Canada differ quite dramatically. Canadians are covered by a universal health care system while residents of the United States, if they are insured, obtain their insurance from various private or public sources. This paper examines how the use of the Papanicolaou test (Pap smear) by women differs in the United States and Canada. METHODOLOGY American women are more likely than Canadians to receive a pap smear. A Blinder/Oaxaca type decomposition is used to determine influence of observed population characteristics and unobserved differences between the 2 countries on this gap. RESULTS The decomposition shows that the gap in Pap smears between Canada and the United States is not influenced by observed demographic differences. Most of the difference is attributable to unobserved heterogeneity or how women are treated in the 2 systems. CONCLUSIONS Although Canada has universal health coverage, the use of Pap smears is lower than that of all US women and equal to that of uninsured US women. Most of the differences in use of Pap smears is the result of differences in unobserved heterogeneity or the way that the systems treat women which may be a function of differences between the 2 health care systems in marketing, delivering, and reimbursing care.
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Aldrich T, Hackley B. The impact of obesity on gynecologic cancer screening: an integrative literature review. J Midwifery Womens Health 2010; 55:344-56. [PMID: 20630361 DOI: 10.1016/j.jmwh.2009.10.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 10/08/2009] [Accepted: 10/08/2009] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Evidence indicates lower rates of breast and cervical cancer screening among obese compared to nonobese women. This integrative review examines the association between gynecologic cancer screening and body weight, as well as potential barriers to screening. METHODS A literature search of standard computerized databases was conducted for peer-reviewed articles published between 1950 and January 2009. RESULTS Twenty-three studies met the criteria for review. Of the 17 studies that evaluated rates of cervical cancer screening, 13 found obese women significantly less likely than their nonobese counterparts to have had a recent Papanicolaou test, a trend that was stronger in white women when compared to African American women. Eight of the 15 studies examining routine mammography found an inverse association between increasing body weight and recent screening, although findings generally pertained only to women who were white and/or severely obese. Possible barriers to care included embarrassment and perceived weight stigma in the clinical setting, lack of appropriately sized examination equipment, and poor patient-provider communication. DISCUSSION Further research is needed to clarify the challenges that obese women face in accessing care and to evaluate strategies such as ensuring the availability of appropriate equipment and supplies, the use of alternative screening methodologies, and more culturally sensitive counseling approaches that may improve screening rates in obese women.
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Lee DJ, Cheetham P, Badani KK. Penile rehabilitation protocol after robot-assisted radical prostatectomy: assessment of compliance with phosphodiesterase type 5 inhibitor therapy and effect on early potency. BJU Int 2010; 105:382-8. [DOI: 10.1111/j.1464-410x.2009.08820.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Psychosocial predictors of adherence to risk-appropriate cervical cancer screening guidelines: a cross sectional study of women in Ohio Appalachia participating in the Community Awareness Resources and Education (CARE) project. Prev Med 2010; 50:74-80. [PMID: 19744509 PMCID: PMC2813897 DOI: 10.1016/j.ypmed.2009.09.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 08/27/2009] [Accepted: 09/01/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We describe factors, in the context of the Social Determinants of Health model, associated with receiving Pap smears within risk-appropriate guidelines (i.e., guidelines that specify screening intervals based upon a woman's individual risk of developing cervical cancer). METHODS Completed in June 2006, we conducted a cross-sectional survey of women from 14 health clinics in Ohio Appalachia pertaining to psychosocial, demographic, biological, and health-related factors. A logistic regression model was constructed to predict whether or not a woman was within risk-appropriate cervical cancer screening guidelines. RESULTS Of 562 women with a date of last Pap smear, 380 (68%) were within risk-appropriate guidelines. Logistic regression showed that, compared to women with low-level SES, women with middle- and high-level SES had 3.39 [1.85, 6.21] and 3.86 [2.03, 7.34] times the odds, respectively, of being within risk-appropriate guidelines. Odds of being within guidelines increased 1.09 [1.04, 1.15] fold for each decrease of one major life event. Additionally, women that were financially better off or financially worse off than their parents at the same age had lower odds (0.41 [0.23, 0.73] and 0.49 [0.24, 0.98], respectively) of being within guidelines than women who reported their finances were the same as their parents. Results also showed an interaction between marital status and age at first intercourse (p=0.001). CONCLUSION The results suggest an impact of psychosocial factors on Pap smear testing behaviors, and illustrate the need to examine risk-appropriate interventions to improve screening.
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Williams KP, Reiter P, Mabiso A, Maurer J, Paskett E. Family history of cancer predicts Papanicolaou screening behavior for African American and white women. Cancer 2009; 115:179-89. [PMID: 19025974 DOI: 10.1002/cncr.23994] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Understanding women's motivations for getting Papanicolaou (Pap) screening has the potential to impact cancer disparities. This study examined whether having a family history of cancer was a predictor for Pap screening. METHODS By using the National Health Interview Survey 2000 Cancer Control and Family modules, we identified a subsample (n=15,509) of African American (n=2774) and white women (n=12,735) unaffected by cancer, with and without a family history of cancer. Data were analyzed using logistic regression models. RESULTS African American and white women with a positive family history of cancer were 42% (P<.0001) more likely to have had a recent Papanicolaou (Pap) test than their counterparts without a family history of cancer. Among African American women, those with a positive family history of cancer were 53% more likely to have had a recent Pap test, whereas among white women those with a positive family history of cancer were 41% more likely to have received a Pap test. African American women with a family history of cancer were more likely to have had a recent Pap test than white women with or without a family history of cancer. CONCLUSIONS This study presents a unique perspective on Pap screening behavior. Having an immediate family member with any cancer statistically predicted having a recent Pap test for both African American and white women. Because these results demonstrated that regardless of the cancer type, having an immediate affected family member is a motivator for cervical cancer screening behavior, healthcare providers managing cancer treatment patients have a teachable opportunity that extends beyond the patient.
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Affiliation(s)
- Karen Patricia Williams
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan 48824, USA.
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Maruthur NM, Bolen SD, Brancati FL, Clark JM. The association of obesity and cervical cancer screening: a systematic review and meta-analysis. Obesity (Silver Spring) 2009; 17:375-81. [PMID: 18997682 PMCID: PMC3008358 DOI: 10.1038/oby.2008.480] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Obese women are at an increased risk of death from cervical cancer, but the explanation for this is unknown. Through our systematic review, we sought to determine whether obesity is associated with cervical cancer screening and whether this association differs by race. We identified original articles evaluating the relationship between body weight and Papanicolaou (Pap) testing in the United States through electronic (PubMed, CINAHL, and the Cochrane Library) and manual searching. We excluded studies in special populations or those not written in English. Two reviewers sequentially extracted study data and independently extracted quality using standardized forms. A total of 4,132 citations yielded 11 relevant studies. Ten studies suggested an inverse association between obesity and cervical cancer screening. Compared to women with a normal BMI, the combined odds ratios (95% CI) for Pap testing were 0.91 (0.80-1.03), 0.81 (0.70-0.93), 0.75 (0.64-0.88), and 0.62 (0.55-0.69) for the overweight and class I, class II, and class III obesity categories, respectively. Three out of four studies that presented the results by race found this held true for white women, but no study found this for black women. In conclusion, obese women are less likely to report being screened for cervical cancer than their lean counterparts, and this does not hold true for black women. Less screening may partly explain the higher cervical cancer mortality seen in obese white women.
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Affiliation(s)
- Nisa M Maruthur
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Cohen SS, Palmieri RT, Nyante SJ, Koralek DO, Kim S, Bradshaw P, Olshan AF. Obesity and screening for breast, cervical, and colorectal cancer in women: a review. Cancer 2008; 112:1892-904. [PMID: 18361400 DOI: 10.1002/cncr.23408] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The literature examining obesity as a barrier to screening for breast, cervical, and colorectal cancer has not been evaluated systematically. With the increasing prevalence of obesity and its impact on cancer incidence and mortality, it is important to determine whether obesity is a barrier to screening so that cancers among women at increased risk because of their body size can be detected early or prevented entirely. On the basis of 32 relevant published studies (10 breast cancer studies, 14 cervical cancer studies, and 8 colorectal cancer studies), the authors reviewed the literature regarding associations between obesity and recommended screening tests for these cancer sites among women in the U.S. The most consistent associations between obesity and screening behavior were observed for cervical cancer. Most studies reported an inverse relation between decreased cervical cancer screening and increasing body size, and several studies reported that the association was more consistent among white women than among black women. For breast cancer, obesity was associated with decreased screening behavior among white women but not among black women. The literature regarding obesity and colorectal cancer screening adherence was mixed, with some studies reporting an inverse effect of body size on screening behavior and others reporting no effect. Overall, the results indicated that obesity most likely is a barrier to screening for breast and cervical cancers, particularly among white women; the evidence for colorectal cancer screening was inconclusive. Thus, efforts to identify barriers and increase screening for breast and cervical cancers may be targeted toward obese women, whereas outreach to all women should remain the objective for colorectal cancer screening programs.
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Affiliation(s)
- Sarah S Cohen
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA.
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Goyal V, Levison S, Bavendam T, Gillen D, Stehman-Breen C. Preventive Care in African American Women with End-Stage Renal Disease. ACTA ACUST UNITED AC 2008. [DOI: 10.1002/dat.20206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Martin JT. Do women comply with recommendations for Papanicolaou smears following colposcopy? A retrospective study. J Midwifery Womens Health 2008; 53:138-42. [PMID: 18308263 DOI: 10.1016/j.jmwh.2007.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to determine compliance with follow-up serial Papanicolaou smears after the completion of colposcopic examination and treatment as required in women with abnormal Papanicolaou smears. Following a retrospective chart review, data were selected from 103 charts of women who had undergone colposcopy. Patient compliance with the treatment plan was tracked for 18 months. Compliance was defined as having at least two cervical cancer screenings performed in the year and a half following colposcopy. Thirty-two percent of the study population complied with the plan of care. Eighty-six percent of those patients who had at least one Papanicolaou smear in the 18 months following colposcopy had no progression of dysplasia. Less than one-third of the patients in this study population followed the recommendations given to them after their colposcopic examination and treatment. Health care providers will be aware of the low percentage of patient follow-up as well as the importance of educating patients about prevention of cervical cancer and reducing risk of cervical dysplasia.
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Blackwell DL, Martinez ME, Gentleman JF. Women’s Compliance with Public Health Guidelines for Mammograms and Pap tests in Canada and the United States. Womens Health Issues 2008; 18:85-99. [DOI: 10.1016/j.whi.2007.10.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 09/17/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
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Katz ML, Tatum CM, Degraffinreid CR, Dickinson S, Paskett ED. Do cervical cancer screening rates increase in association with an intervention designed to increase mammography usage? J Womens Health (Larchmt) 2007; 16:24-35. [PMID: 17324094 PMCID: PMC4465268 DOI: 10.1089/jwh.2006.0071] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess cervical cancer screening behaviors among underserved women participating in an intervention designed to increase mammography use. METHODS This was a randomized trial of 897 women from three racial groups (white, African American, Native American) living in a rural county in North Carolina. Baseline and followup surveys were completed by 815 women; 775 women provided data to be included in these analyses. The intervention group received an educational program focused on mammography delivered by a lay health advisor, and the control group received a physician letter/brochure focusing on Pap tests. RESULTS Women in both the intervention (OR 1.70; 1.31, 2.21, p < 0.001) and control groups (OR 1.38; 1.04, 1.82, p = 0.025) significantly increased cervical cancer screening rates within risk appropriate guidelines. No differences by racial group were documented. Women categorized in the high-risk group for developing cervical cancer (>2 sexual partners, age <18 years at first sexual intercourse, smoker; treated for sexually transmitted disease [STD] or partner with treated STD) significantly (OR 1.88; 1.54, 2.28, p < 0.001) increased Pap test completion. However, a nonsignificant increase (OR 1.25; 0.87, 1.79, p = 0.221) in Pap test completion was demonstrated in women categorized as low risk for cervical cancer. CONCLUSIONS This study suggests that women in an intensive behavioral intervention designed to increase mammography use may also increase Pap test completion, similar to a minimal intervention focused only on increasing Pap test completion. These results have implications for the design and evaluation of behavioral intervention studies.
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Affiliation(s)
- Mira L Katz
- The School of Public Health, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA.
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Barber MD, Neubauer NL, Klein-Olarte V. Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies? Am J Obstet Gynecol 2006; 195:942-8. [PMID: 16681989 DOI: 10.1016/j.ajog.2006.02.050] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 02/21/2006] [Accepted: 02/28/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Large population-based epidemiologic studies of pelvic organ prolapse are rare. One barrier is the need for physical examination in order to confirm disease status. The objectives of this study were to develop a simple screening question for pelvic organ prolapse (POP) and to evaluate its test characteristics in high and low prevalence populations. STUDY DESIGN Data from 100 women enrolled in the validation study of the Pelvic Floor Distress Inventory (PFDI) were used to identify the question or questions that most accurately identified women with advanced pelvic organ prolapse. After identifying an accurate and reliable screening question from this original group, its test characteristics were evaluated prospectively in 2 additional distinct populations: a group of 120 women presenting to a tertiary care urogynecology clinic (High prior probability of POP) and 448 women presenting to a nurse practitioner for annual gynecologic examination (Low prior probability of POP). Subjects in these 2 groups each completed the screening question and underwent a POPQ examination by a blinded examiner. RESULTS A single question was identified from the original study population that most accurately and reliably identified those women with POP "Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?" An affirmative answer to this question was 96% sensitive (95%CI 92-100) and 79% specific (95%CI 77-92) for prolapse beyond the hymen. The 1-week test-retest reliability was good (kappa .84). The prevalence of POP in this group was 29%. No other single question or group of questions had better test characteristics. When prospectively evaluated in the second High probability population (prevalence 39%), similar test characteristics were noted: sensitivity 85% (95%CI 71-93), specificity 86% (95%CI 75-92). However, when evaluated in the Low prior probability group (POP prevalence 3.8%) the specificity improved to 99% (95%CI 98-99), while the sensitivity decreased dramatically to 35% (95%CI 15-61). CONCLUSION Screening for POP without a physical examination is subject to spectrum bias. Spectrum bias occurs when a diagnostic test performs differently in different groups of patients. In groups with a high prior probability of POP, a simple screening question can accurately screen for advanced POP without a physical exam. However, in groups with a low prior probability of POP such as might be seen in a population-based epidemiologic study, this question has poor sensitivity.
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Affiliation(s)
- Matthew D Barber
- Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, Cleveland, OH, USA
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del Carmen MG, Findley M, Muzikansky A, Roche M, Verrill CL, Horowitz N, Seiden MV. Demographic, risk factor, and knowledge differences between Latinas and non-Latinas referred to colposcopy. Gynecol Oncol 2006; 104:70-6. [PMID: 16949138 DOI: 10.1016/j.ygyno.2006.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Revised: 06/28/2006] [Accepted: 07/07/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Disparities occur in the incidence and mortality of cervical cancer among minority women in the US. Screening lowers cervical cancer incidence. Screening rates are lower for minority women than for White women in the US. This study sought to identify demographic, risk factor, and perception of the role of Pap smears between Latinas and non-Latinas. METHODS A written survey was administered to 150 Latinas and 150 non-Latinas attending a colposcopy unit. Data on demographics, risk factors, screening rates, knowledge about cervical cancer screening, and perceived barriers to participation in screening programs were collected. RESULTS A total of 140 Latinas and 146 non-Latinas completed the survey. Marital status and health insurance status were similar in the two groups. 30% of Latinas and 73.3% of non-Latinas reported completing college (p<0.0001). Only 55.7% of Latinas were employed, compared to 82.2% of non-Latinas (p<0.0001). 21% of Latinas and 53.4% of non-Latinas reported an annual income greater than 35,000 dollars (p<0.0001). Among Latinas, women with 1-5 lifetime Pap smears were less likely to have completed college than those with more than 5 lifetime Pap smears (OR=2.11; 95% CI 1.05-4.22) and to have an annual income of less than 35,000 dollars (OR=3.81; 95% CI 1.64-8.87). Latinas were less likely to have > or =6 lifetime sexual partners, use tobacco, and have a history of sexually transmitted infections. Latinas more commonly reported fear of test results (OR, 0.04; 95% CI 0.02-0.09) and inability to communicate with their provider in Spanish (p<0.0001) as barriers to screening than the non-Latina respondents. CONCLUSIONS Several of the barriers limiting access to cervical cancer screening programs are also present among screened Latinas undergoing further evaluation for abnormal Pap smears.
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Affiliation(s)
- Marcela G del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA 02114, USA.
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Datta GD, Colditz GA, Kawachi I, Subramanian SV, Palmer JR, Rosenberg L. Individual-, neighborhood-, and state-level socioeconomic predictors of cervical carcinoma screening among U.S. black women: a multilevel analysis. Cancer 2006; 106:664-9. [PMID: 16378349 DOI: 10.1002/cncr.21660] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cervical carcinoma is the fifth most common cancer among African American women in the U.S. Although the Papanicolaou (Pap) smear is an efficacious screening tool in the early detection of the disease, disparities are known to persist in the utilization of this procedure across socioeconomic groups. METHODS Data regarding cervical carcinoma screening and covariates were obtained from the 59,090 Black Women's Health Study participants across the U.S. via a mailed questionnaire in 1995. Logistic regression and multilevel techniques were used to assess the independent effects of the covariates on nonrecent cervical carcinoma screening. RESULTS In all, 8.3% of the 40,009 women in the present analysis had not undergone a Pap smear examination within the previous 2 years (nonrecent screening). Lower educational attainment, older age, obesity, smoking, and neighborhood poverty were found to be independently related to increased risk of nonrecent screening. The adjusted odds ratio for nonrecent screening was 1.2 (95% confidence interval [95% CI], 1.1-1.4) for women residing in neighborhoods with 20% or more poverty compared with those in neighborhoods with less than 5% poverty. State of residence was also associated with nonrecent cervical carcinoma screening. CONCLUSION These results suggest that among black women, residence in high-poverty (20%) neighborhoods is associated with an increased risk of nonrecent cervical carcinoma screening, independent of individual level risk factors.
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Affiliation(s)
- Geetanjali D Datta
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Modesitt SC, van Nagell JR. The impact of obesity on the incidence and treatment of gynecologic cancers: a review. Obstet Gynecol Surv 2006; 60:683-92. [PMID: 16186785 DOI: 10.1097/01.ogx.0000180866.62409.01] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Sixty-five percent of the adult population in the United States is overweight and 30% of the population is obese. There is mounting evidence that obesity is a risk factor for gynecologic cancers and may also adversely impact survival. The objectives of this review were to systematically evaluate and discuss the impact of overweight and obesity on endometrial, ovarian, and cervical cancer incidence and to review the data on the impact of obesity on treatment of these same gynecologic cancers. A PUBMED literature search was performed to identify articles in the English language that focused on the impact of obesity on cancer incidence and treatment. References of identified articles were also used to find additional related articles. Obesity profoundly increases the incidence of endometrial cancer, predominantly through the effects of unopposed estrogen. Although the data are less compelling in ovarian and cervical cancer, obesity may modestly increase the incidence of premenopausal ovarian cancer and might potentially increase cervical cancer incidence, perhaps as a result of the impact on glandular cancers or decreased screening compliance. Obese women with cancer have decreased survival; this may be disease-specific, the result of comorbid illnesses, or response to treatment. Obese women have increased surgical complications, may also have increased radiation complications, and there is no current consensus regarding appropriate chemotherapy dosing in the obese patient. Obesity is a serious health problem with significant effects on the incidence and treatment of the gynecologic malignancies. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to summarize the clear evidence that obesity is a risk factor for many cancers, including gynecologic malignancies; describe the role of unopposed estrogen in gynecologic cancers; and explain that obese women overall have a poorer survival rate when afflicted with cancer.
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Affiliation(s)
- Susan C Modesitt
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center, Lucille Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0298, USA.
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Sabates R, Feinstein L. The role of education in the uptake of preventative health care: the case of cervical screening in Britain. Soc Sci Med 2006; 62:2998-3010. [PMID: 16403597 DOI: 10.1016/j.socscimed.2005.11.032] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Accepted: 11/18/2005] [Indexed: 11/30/2022]
Abstract
This paper reports findings on the relationship between education and the take-up of screening for cervical cancer, as an example of preventative health-care activity. Theoretically, education can enhance the demand for preventative health services by raising awareness of the importance of undertaking regular health check-ups and may also improve the ways in which individuals understand information regarding periodical tests, communicate with the health practitioner, and interpret results. Furthermore, education enhances the inclusion of individuals in society, improving self-efficacy and confidence. All these factors may increase service uptake. The empirical analysis uses data from the British Household Panel Survey (BHPS) and applies techniques for discrete panel data to estimate the parameters of the model. Results show that adult learning leading to qualifications is statistically associated with an increase in the uptake of screening. The marginal effect indicates that participation in courses leading to qualifications increases the probability of having a smear test between 4.3 and 4.4 percentage points. This estimate is strongly robust to time-invariant selectivity bias in education and the inclusion of income, class, occupation, and parental socio-economic status. These findings enrich existing evidence on the socio-economic determinants of screening for cervical cancer and enable policy makers to better understand barriers to service uptake.
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Affiliation(s)
- Ricardo Sabates
- Institute of Education, University of London, 20 Bedford Way, London WC1H 0AL, UK.
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Women's perceptions and social barriers determine compliance to cervical screening: Results from a population based study in India. ACTA ACUST UNITED AC 2006; 30:369-74. [DOI: 10.1016/j.cdp.2006.07.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2006] [Indexed: 11/19/2022]
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Press N, Reynolds S, Pinsky L, Murthy V, Leo M, Burke W. ‘That's like chopping off a finger because you’re afraid it might get broken’: Disease and illness in women's views of prophylactic mastectomy. Soc Sci Med 2005; 61:1106-17. [PMID: 15955410 DOI: 10.1016/j.socscimed.2005.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Accepted: 01/25/2005] [Indexed: 10/25/2022]
Abstract
While data are accumulating on the efficacy of prophylactic mastectomy as a means to reduce breast cancer risk in high risk women, the effectiveness of the procedure depends on women's interest in undergoing the procedure. We report on women's responses to this surgical option as a prevention tool. Data derive from a multi-method study of women's interest in and understandings about genetic testing for breast cancer susceptibility. The sample comprises 246 women of varying ethnicities and familial breast cancer risk from Seattle, USA. In this paper, quantitative data are presented on the sociodemographic and risk perception correlates of degree of interest in taking a genetic test for breast cancer if prophylactic mastectomy were the only treatment option. In addition, we report results of a content analysis of women's open-ended responses to the question of whether and why they could imagine undergoing prophylactic mastectomy. Our analysis of these data benefits from a central distinction in medical anthropology between the concepts of illness and disease. We suggest that while prophylactic mastectomy may prevent the "disease" of breast cancer, it may be of little interest to women who see this surgery as itself mimicking the "illness" of breast cancer.
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Affiliation(s)
- Nancy Press
- Schools of Nursing & Medicine, Oregon Health & Science University, 3455 SW US Veterans Hospital Road, SN-5S, Portland, OR 97239-2941, USA.
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Hoyo C, Yarnall KSH, Skinner CS, Moorman PG, Sellers D, Reid L. Pain predicts non-adherence to pap smear screening among middle-aged African American women. Prev Med 2005; 41:439-45. [PMID: 15917039 DOI: 10.1016/j.ypmed.2004.11.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Revised: 06/22/2004] [Accepted: 11/23/2004] [Indexed: 12/22/2022]
Abstract
BACKGROUND Middle-aged African American women have the highest incidence and mortality of invasive cervical cancer in the United States and the lowest adherence to pap smear screening. METHODS In 2001, we identified factors associated with non-adherence to screening recommendations using three focus group interviews and subsequently developed a questionnaire administered to 144 African American women aged 45 to 65 years. RESULTS The perception that the Pap test was painful was associated with non-adherence to screening recommendations (OR = 4.78; 95%CI: 1.67-13.7). Difficulty to pay for the office visit coupled with perceived pain was associated with a nearly sixfold increase in risk of non-adherence (OR = 5.8; 95%CI: 2.8-15.5). Previously identified barriers to screening including lower education and socioeconomic status, poor access to care, knowledge of and exposure to known risk factors of invasive cervical cancer, cancer fatalism, and perceived racism were not independently associated with non-adherence. CONCLUSIONS These data suggest that, among middle-aged African American women, future interventions addressing pain during a Pap test will likely increase acceptability of and adherence to cervical cancer screening. Pain could be addressed either by providing information during the pap test and/or using smaller lubricated speculums.
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Affiliation(s)
- Cathrine Hoyo
- Department of Community and Family Medicine, Duke University Medical Center, Box 2914, Durham, NC 27710, USA.
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Behbakht K, Lynch A, Teal S, Degeest K, Massad S. Social and cultural barriers to Papanicolaou test screening in an urban population. Obstet Gynecol 2005; 104:1355-61. [PMID: 15572502 DOI: 10.1097/01.aog.0000143881.53058.81] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To define screening behaviors, attitudes, and beliefs regarding cancer and its treatment among women with cervical cancer. METHODS Between August 2000 and July 2002, 148 consecutive women with invasive cervical cancer were queried about barriers to screening. Women presented to outpatient clinics, emergency departments, or inpatient units of 3 urban hospitals. Two groups of women were identified: those who denied having had a Papanicolaou (Pap) test and those who had recalled having Pap test in the past. Responses were compared using t tests, chi(2) tests, and binary logistic regression. RESULTS The 146 (99%) respondents were predominantly African Americans (50%) or Hispanic (27%). Thirty-six (25%) women reported no prior screening. Women never screened were significantly more likely to be Hispanic (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.4-6.7), recent immigrants (OR 5.7, 95% CI 2.0-16), less educated (OR 3.6, 95% CI 1.6-8.0), and uninsured (OR 3.9, 95% CI 1.6-9.7). They were more likely to lack family support (adjusted OR 3.5, 95% CI 1.1-11) and lack knowledge about their risk for cervical cancer (adjusted OR 2.6, 95% CI 1.1-6.4). Unscreened women displayed fatalistic attitudes, believing cancer is bad luck (adjusted OR 2.6, 95% CI 1.0-6.9) and not wanting to know they had cancer (adjusted OR 3.0, 95% CI 1.0-9.4).. CONCLUSION We have identified factors and beliefs that are barriers to Pap test screening in urban cervical cancer patients. Further studies should evaluate effects of addressing cultural, cognitive, and financial barriers on Pap test compliance.
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Affiliation(s)
- Kian Behbakht
- Divisions of Gynecologic Oncology and Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado, USA.
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Insinga RP, Dasbach EJ, Elbasha EH. Assessing the annual economic burden of preventing and treating anogenital human papillomavirus-related disease in the US: analytic framework and review of the literature. PHARMACOECONOMICS 2005; 23:1107-22. [PMID: 16277547 DOI: 10.2165/00019053-200523110-00004] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The anogenital human papillomavirus (HPV) is estimated to be the most commonly occurring sexually transmitted infection in the US. Comprehensive estimates of the annual economic burden associated with the prevention and treatment of anogenital HPV-related disease in the US population are currently unavailable. The purpose of this paper is to (i) outline an analytic framework from which to estimate the annual economic burden of preventing and treating anogenital HPV-related disease in the US; (ii) review available US literature concerning the annual economic burden of HPV; and (iii) highlight gaps in current knowledge where further study is particularly warranted. Among eight US studies identified that describe the annual economic burden pertaining to one or more aspects of anogenital HPV-related disease, three met the review eligibility criteria (published between 1990 and 2004, examined multiple facets of annual anogenital HPV-related economic burden, and clearly articulated the data and methods used in the estimation process). All costs were adjusted to 2004 US dollars. Estimates of the annual direct medical costs associated with cervical cancer were comparable across studies (range 300-400 million US dollars). In contrast, there was a wide range across studies for estimates of the annual direct medical costs associated with cervical intraepithelial neoplasia (range 700 million US dollars-2.3 billion US dollars). Only one study reported direct medical costs for anogenital warts (200 million US dollars) and routine cervical cancer screening (2.3 billion US dollars). No studies examined direct medical costs attributable to HPV-related anal, penile, vaginal or vulvar cancers, or the work and productivity losses resulting from time spent receiving medical care, morbidity or mortality. Current economic burden estimates would suggest annual direct medical costs associated with the prevention and treatment of anogenital warts and cervical HPV-related disease of at least 4 billion US dollars. This figure would likely rise to at least 5 billion US dollars per year if direct medical costs associated with other disease entities caused by the sexual transmission of HPV were included, with further additions to the economic burden totalling in the billions of dollars if work and productivity losses were incorporated, a research priority for future studies.
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Affiliation(s)
- Ralph P Insinga
- Department of Health Economic Statistics, Merck Research Laboratories, Blue Bell, PA 19422, USA.
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Abstract
Although Papanicolaou test screening rates are reportedly high, a significant proportion of women remain unscreened. With recent revision of Papanicolaou test guidelines, it is critical that interventions and programs for cervical cancer directed toward low participating groups or individuals be developed. The purpose of the study was to examine factors that influence participation in cervical cancer screening by quantifying characteristics of women who engage in Papanicolaou test screening in a 12-month period. Using the 2000 National Health Interview Survey and Cancer Topical Module, the sample (N = 18,388) consisted of women who were older than 18 years. The dependent variable was nominally identified as whether a woman had had a Papanicolaou test in the last 12 months. Independent variables examined were insurance, level of education, place for care, age, race, employment, place of residence, and income level. Using logistic regression, all variables except race and income level were found to be significant for participation in cervical cancer screening (P < .000). Each variable is discussed within the framework of the Institute of Medicine model of access to personal healthcare services. Study findings provide insight and guidance for the development and implementation of methods for accessing women who have lower participation rates.
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Thomas BC, Pandey M, Ramdas K, Sebastian P, Nair MK. FACT-G: reliability and validity of the Malayalam translation. Qual Life Res 2004; 13:263-9. [PMID: 15058807 DOI: 10.1023/b:qure.0000015303.68562.3f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Emphasis is currently being placed on the need for quality of life in cancer survivors. There is a great need to identify an appropriate tool for quality of life estimation in these linguistically and culturally different settings. PATIENTS AND METHOD The Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire was translated into the Malayalam language complying with the standard cross-cultural translation methodology. The tool was validated and used for estimating quality of life (QOL) of 214 cancer patients undergoing treatment with curative intent. RESULTS Cronbach's alpha for the Malayalam version of the FACT-G was 0.8, and for the subscales it ranged from 0.64 to 0.83, compared to source tool alpha of 0.89, with the subscale's ranging from 0.63 to 0.89. The mean overall FACT-G score was 79.8 (standard deviation [SD] = 18.7). Socio-economic factors such as education, education of the spouse, occupation of the spouse, and family income were found to influence FACT-G scores. CONCLUSION Despite cultural variations, the local Malayalam language version of the FACT-G scale was found to be reliable like the source scale and sensitive cross-culturally. The instrument makes it possible to identify domains influencing QOL and thereby may help direct interventions to them.
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Affiliation(s)
- B C Thomas
- Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, India
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Abstract
Public health agencies often require data that address the needs of special populations, such as minority groups. Sources of surveillance data often contain insufficient numbers of subjects to fully inform health agencies. In this review, we address the problems of and potential approaches for situations with insufficient surveillance data. We use the examples of race and ethnic minority groups throughout our discussion. However, many of the broad issues are applicable to other special groups with low frequency or who are especially hard to reach. Our recommendations are based, in part, on a symposium held in Missouri with the collaboration of state health agency, community, and academic research participants. We review problems in using existing data and collecting new data, especially from nonprobability samples. We also describe fieldwork issues for reaching and collecting information from special populations. Decisions among methods and solutions may require seeking additional resources for surveillance.
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Affiliation(s)
- Elena M Andresen
- School of Public Health, Saint Louis University, St. Louis, Missouri 63104-1314, USA.
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Remington PL, Simoes E, Brownson RC, Siegel PZ. The role of epidemiology in chronic disease prevention and health promotion programs. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2003; 9:258-65. [PMID: 12836507 DOI: 10.1097/00124784-200307000-00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the role for epidemiology is widely accepted in public health programs in general, its role in chronic disease programs is not as widely recognized. One possible barrier to improving epidemiologic capacity in chronic disease prevention and health promotion programs is that chronic disease program managers and public health decision makers may have a limited understanding of basic chronic disease epidemiology functions. We describe the assessment process of data collection, analysis, interpretation, and dissemination, and, using examples from two states, illustrate how this approach can be used to support program and policy development in three areas: by defining the problem, finding programs that work, and evaluating the effects of the program over time. Given the significant burden of chronic diseases in the United States, the scientific guidance provided by epidemiology is essential to help public health leaders identify priorities and intervene with evidence-based and effective prevention and control programs.
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Affiliation(s)
- Patrick L Remington
- Department of Population Health Sciences, University of Wisconsin School of Medicine, 610 North Walnut St, Madison, Wisconsin 53705, USA.
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Pinho ADA, França-Junior I. Prevenção do câncer de colo do útero: um modelo teórico para analisar o acesso e a utilização do teste de Papanicolaou. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2003. [DOI: 10.1590/s1519-38292003000100012] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vários estudos têm apontado que a permanência das altas taxas de incidência e mortalidade por câncer cérvico-uterino deve-se à baixa qualidade e cobertura do teste de Papanicolaou, principalmente em países em desenvolvimento. Pretende-se neste artigo analizar alguns pontos relacionados às medidas de prevenção e controle do câncer cervical quanto à efetividade do teste de Papanicolaou, a lógica operacional e científica por detrás das políticas públicas de prevenção ao câncer cervical e a cobertura do teste em países norte-americanos, europeus e na América Latina. Consideram-se, ainda, os modelos explicativos que estão sendo propostos para avaliar o acesso e a utilização deste serviço, a partir da análise dos fatores associados à realização do teste de Papanicolaou descritos pela literatura. Propõe-se uma nova abordagem na investigação destes fatores, buscando a integração e interlocução de outros aspectos de cunho social, cultural e organizacional na análise do acesso e da utilização deste exame, visando um planejamento mais coerente das ações de prevenção e promoção à saúde com as necessidades e direitos das mulheres.
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Pinho ADA, França Junior I, Schraiber LB, D'Oliveira AFPL. Cobertura e motivos para a realização ou não do teste de Papanicolaou no Município de São Paulo. CAD SAUDE PUBLICA 2003; 19 Suppl 2:S303-13. [PMID: 15029350 DOI: 10.1590/s0102-311x2003000800012] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Investigou-se a prevalência da realização do teste de Papanicolaou alguma vez na vida e nos últimos três anos entre mulheres de 15 a 49 anos, o recebimento do resultado do último teste realizado e os motivos relatados para a realização ou não do exame. Um inquérito domiciliar foi realizado no Município de São Paulo em 2000, com uma amostra representativa de 1.172 mulheres selecionadas aleatoriamente em seus domicílios. Das mulheres que já tinham iniciado a vida sexual (n = 1.050), 86,1% (932) realizaram o teste alguma vez na vida e 77,3 % (839) nos últimos três anos. Das que já realizaram o teste, 806 (87,0%) receberam o resultado do último exame. Os principais motivos para a realização do último teste foram: demanda espontânea (55,5%), recomendação médica (25%) e presença de queixas ginecológicas (18,2%). As principais razões para a não realização do exame foram: ausência de problemas ginecológicos, vergonha ou medo e dificuldades de acesso. A despeito do relativo aumento na cobertura do teste de Papanicolaou e de mais da metade das mulheres demandarem espontaneamente pelo exame, sua realização foi menor entre aquelas com as piores condições sócio-econômicas e, portanto, de maior risco para o câncer cervical.
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Affiliation(s)
- Adriana de Araujo Pinho
- Departamento de Saúde Materno-infantil, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, 01246-904, Brasil
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Franks P, Fiscella K. Effect of patient socioeconomic status on physician profiles for prevention, disease management, and diagnostic testing costs. Med Care 2002; 40:717-24. [PMID: 12187185 DOI: 10.1097/00005650-200208000-00011] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous research shows patient socioeconomic status (SES) affects physician profiles for health status and satisfaction, but effects on other aspects of care are not known. OBJECTIVE To examine the effect of patient SES on physician profiles for preventive care, disease management, and diagnostic testing costs. RESEARCH DESIGN Cross-sectional analysis of a managed care claims data. SUBJECTS Five hundred sixty-eight physicians and 600,618 patients. MEASURES Patient age, gender, case-mix, and SES based on zip code, likelihood of having a Papanicolaou smear, mammogram, for diabetics having had a glycosylated hemoglobin, diabetic eye exam, and diagnostic testing costs. RESULTS For each performance indicator, except glycosylated hemoglobin, there was a statistically significant effect of adjusting for patient SES. For diabetic eye checks, mammograms and Papanicolaou tests respectively, 5%, 16%, and 21% of physicians who were outliers (in the top or bottom 5% of rankings) were no longer outliers after socioeconomic adjustment. For all performance measures the change in physician ranking was strongly correlated with the mean practice SES. CONCLUSIONS Patient SES, as measured by zip code, appreciably affects physician profiles for preventive care and diabetes management. Monitoring patient SES using patient zip codes could be used to target resources to improve outcomes for higher risk patients.
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Affiliation(s)
- Peter Franks
- Department of Family and Community Medicine, University of California School of Medicine, Davis, CA, USA
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Cantor SB, Volk RJ, Cass AR, Gilani J, Spann SJ. Psychological benefits of prostate cancer screening: the role of reassurance. Health Expect 2002; 5:104-13. [PMID: 12031051 PMCID: PMC5060134 DOI: 10.1046/j.1369-6513.2002.00166.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The role of reassurance in decision-making about screening for health problems is largely unknown. We examined the reassurance value of prostate cancer screening in primary care patients. SETTING AND PARTICIPANTS One hundred and sixty eight men, aged 45-70 years, who had no history of prostate cancer, from three family medicine practices in southeast Texas. METHODS A hypothetical scenario was developed where men were asked to assume they did not have prostate cancer, and then to rank three predefined screening states with regard to reassurance value: (A) unknown (no screening), (B) normal by screening [a prostate-specific antigen (PSA) test and a digital rectal examination (DRE)] and (C) normal by biopsy (abnormal PSA test and DRE results but a negative ultrasound-guided prostate biopsy). RESULTS Most of the men (96.8%) associated some reassurance value with screening, considering health state A to be the worst possible health state. Results from a multivariate analysis showed that preference for screening state C was associated with a family history of prostate cancer and perceived greater risk for prostate cancer compared with other men. CONCLUSION These findings suggest that prostate cancer screening may have some reassurance value for men, and that increased risk status may explain why some men prefer the added reassurance afforded by screening.
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Affiliation(s)
- Scott B Cantor
- Section of Health Services Research, Department of Biostatistics, M. D. Anderson Cancer Center, The University of Texas, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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Vradenburg JA, Simoes EJ, Jackson-Thompson J, Murayi T. The prevalence of arthritis and activity limitation and their predictors in Missouri. J Community Health 2002; 27:91-107. [PMID: 11936760 DOI: 10.1023/a:1014557016281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Arthritis and other rheumatic conditions comprise the leading cause of disability in the United States. In 1990, an estimated 16.7% of Missourians had arthritis. By 2020, an estimated 20% of Missourians will have this condition. We examined Missouri's prevalence of self-reported physician-diagnosed arthritis, chronic joint symptoms, and activity limitation due to joint symptoms and their associations with selected predictors (i.e., socio-demographic, access to health care, risk factor, and comorbidity indicators) from Missouri's 1996 Behavioral Risk Factor Surveillance System. We conducted logistic regression analysis to generate Odds Ratios and 95% Confidence Intervals of arthritis and activity limitation across levels of predictors. Analysis indicates arthritis is under-diagnosed in younger individuals and that arthritis and activity limitation due to joint symptoms are significant contributors to functional limitation, enhancing dependency while decreasing the quality of life. As the population ages, arthritis, chronic joint symptoms, and activity limitation will become a larger public health problem.
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Affiliation(s)
- Joseph A Vradenburg
- Division of Chronic Disease Prevention and Health Promotion, Missouri Department of Health, Jefferson City 65102-0570, USA
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Tao G, Zhang P, Li Q. Services provided to nonpregnant women during general medical and gynecologic examinations in the United States. Am J Prev Med 2001; 21:291-7. [PMID: 11701300 DOI: 10.1016/s0749-3797(01)00366-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To estimate the number of visits coded as general medical or gynecologic examinations (GMGEs) per 100 nonpregnant women aged > or = 18 years per year, to examine the content of the services provided during those examinations, to examine the degree of agreement between the patient's stated reason for visits and the diagnosis coded by physicians for GMGEs, and to examine the extent of preventive services delivered during GMGE visits and non-GMGE visits. METHODS We analyzed data from two national surveys: the 1997 National Ambulatory Medical Care Survey and 1997 National Hospital Ambulatory Medical Care Survey. In addition, we obtained the number of women aged > or = 18 years in the United States from the Bureau of Census and the number of women who were pregnant from the National Center for Health Statistics. RESULTS The number of visits coded as GMGEs by physicians was estimated to be < 21 visits per 100 nonpregnant women aged > or = 18 years per year. The leading four services provided during a GMGE were blood pressure check, breast examination, pelvic examination, and Papanicolaou (Pap) test. Of the visits coded as GMGEs by physicians, 82% of patients stated that their reason for visit was a GMGE. Only 35% of the visits that were initially considered to be GMGEs by patients were classified as such by physicians. For the visits initially considered to be GMGEs by patients, women were more likely to receive preventive services if the visits were also classified as GMGEs by physicians. Of Pap tests provided to nonpregnant women aged > or = 18 years, 44% were provided during these visits that were classified as non-GMGE visits by both physicians and by patients. CONCLUSIONS GMGEs were important means of delivering preventive services to nonpregnant women, but not many women had GMGE visits. Evaluation of the acceptability and cost effectiveness of GMGEs to deliver preventive services to different populations is needed.
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Affiliation(s)
- G Tao
- Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Maxwell CJ, Bancej CM, Snider J, Vik SA. Factors important in promoting cervical cancer screening among Canadian women: findings from the 1996-97 National Population Health Survey (NPHS). Canadian Journal of Public Health 2001. [PMID: 11338151 DOI: 10.1007/bf03404946] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although routine Pap screening represents an effective tool in the early detection of cervical cancer, it remains underused by some Canadian women. This study examines selected sociodemographic, health, lifestyle, and system barriers to Pap test participation among 33,817 women aged 18+ years in the cross-sectional 1996-97 National Population Health Survey (NPHS). Among women 18 years and over, 87% reported ever having had a Pap test while 72% reported a recent (< 3 years) test. A report of ever and recent use was most common among women 25-34 (92% and 86.9%, respectively). Only 0.6% of recently screened women reported access problems. Among those without a recent test, most (53%) reported that they did not think it was necessary. Pap test use varied little across provinces and was less common among older and single women, those with lower education, a spoken language other than English, a birth place outside Canada and negative health and lifestyle characteristics.
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Affiliation(s)
- C J Maxwell
- Departments of Community Health Sciences and Medicine, University of Calgary, AB.
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Press NA, Yasui Y, Reynolds S, Durfy SJ, Burke W. Women's interest in genetic testing for breast cancer susceptibility may be based on unrealistic expectations. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 99:99-110. [PMID: 11241466 DOI: 10.1002/1096-8628(2000)9999:999<00::aid-ajmg1142>3.0.co;2-i] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report on results of an interview study assessing women's attitudes toward and hypothetical interest in genetic susceptibility testing for breast cancer. Data are from 246 interviews with women of varying ethnicity (African American, European American, Native American, and Ashkenazi Jewish), family history of breast cancer (negative, positive, and borderline), and educational level. Semistructured interviews included questions on general health beliefs; attitudes, experiences, and concerns about breast cancer; and hypothetical interest in genetic testing. Influence of specific test characteristics was assessed with 14 Likert scales varying negative and positive predictive value, timing of disease, possible medical interventions following a positive result. Results reported include both statistical and qualitative analysis. We found that women had a high level of interest in testing which, in general, did not vary by ethnicity, level of education, or family history. Interest in testing appeared to be shaped by an exaggerated sense of vulnerability to breast cancer, limited knowledge about genetic susceptibility testing, and generally positive views about information provided through medical screening. However, study participants were most interested in a test that didn't exist (high positive predictive value followed by effective, noninvasive, preventive therapy) and least interested in the test that does exist (less than certain positive predictive value, low negative predictive value, and limited, invasive, and objectionable therapeutic options). Our data suggest that without a careful counseling process, women could easily be motivated toward interest in a test which will not lead to the disease prevention they are seeking.
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Affiliation(s)
- N A Press
- Department of Public Health and Preventive Medicine, Oregon Health Sciences University, Portland, Oregon 97201, USA.
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Jennings-Dozier K, Lawrence D. Sociodemographic predictors of adherence to annual cervical cancer screening in minority women. Cancer Nurs 2000; 23:350-6; quiz 357-8. [PMID: 11037955 DOI: 10.1097/00002820-200010000-00004] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Papanicolaou (Pap) test is an effective screening mechanism for reducing morbidity and mortality from cervical cancer. Nevertheless, Pennsylvania ranks fifth in national cervical cancer incidence and fourth in national cervical cancer mortality, with a significant number of cases contributed by Philadelphia. Substantial subgroups of American women, specifically ethnic minorities, the elderly, the uninsured, and the poor, have not been screened or are not screened at regular intervals. A secondary data analysis was conducted to test whether age, income, insurance coverage, marital status, level of education, and number of persons living at home could predict whether a woman among convenience sample of 204 black and Hispanic women adhered to annual Pap testing. A woman was considered adherent to annual Pap testing if she reported undergoing a Pap smear in the 14 months preceding her enrollment in the study. African American woman who were high school graduates and had insurance coverage were more likely to be adherent to annual Pap testing. Hispanic women older than 50 years and born outside the mainland United States were less likely to be adherent to annual Pap testing. Findings suggest that cancer nurses working to promote cervical cancer screening in Philadelphia should continue to target at-risk populations, specifically uninsured and less-educated black and Hispanic women older than 50 years who were born outside the mainland United States.
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Affiliation(s)
- K Jennings-Dozier
- College of Nursing and Health Professions, MCP Hahnemann University, Philadelphia, Pennsylvania 19102, USA
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