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Screening Behaviors and Cultural Barriers in Women with Newly Diagnosed Cervical Cancer

Erickson, Britt K. MD1; Zhang, Bin PhD2; Straughn, J. Michael Jr MD1

Journal of Lower Genital Tract Disease: October 2013 - Volume 17 - Issue 4 - p 425–429
doi: 10.1097/LGT.0b013e3182818e31
Original Articles

Objective: This study aimed to evaluate the screening histories and compare barriers to screening between women with newly diagnosed early-stage cervical cancer versus advanced stage cervical cancer.

Materials and Methods: Between August 2010 and August 2011, women with invasive cervical cancer were identified at a single urban academic referral center and surveyed regarding access to health care, screening history, and barriers to screening services. The following 2 groups were identified: women with early-stage disease (ESD) (stages 1A1–1B2) and women with advanced-stage disease (ASD) (stages IIA–IV).

Results: A total of 65 women were enrolled. Thirty-eight women (58%) had ESD, and 27 (42%) had ASD. Patients with ESD had an average time since last Pap smear of 5.4 years compared with 10.7 years in patients with ASD (p = .014). Ten patients (26%) with ESD had screening histories compliant with recommendations compared with 0 patients (0%) with ASD (p = .004). Seventeen (45%) of 38 patients with ESD and 8 (30%) of 27 patients with ASD reported no barriers to accessing screening (p = nonsignificant [NS]). Financial difficulties were the most common barrier in 12 women with ESD (32%) and 7 women with ASD (41%) (p = NS). High levels of family support were noted in both groups (74% and 70%, p = NS).

Conclusions: Time since last Pap smear varied significantly in women with early versus advanced cervical cancer. Women with compliant screening histories still developed invasive cervical cancer, but none presented at an advanced stage. There were no significant differences in specific barriers to accessing health care and screening services between women with ESD compared with ASD. More than one third of patients reported no barriers to care, suggesting a need for improved awareness of screening recommendations.

Compliance with screening differs in women with early versus advanced cervical cancer, and the primary barriers to screening include financial and transportation difficulties.

1Division of Gynecologic Oncology, University at Alabama at Birmingham, Birmingham AL; and 2Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Reprint requests to: Britt K. Erickson, MD, University of Alabama at Birmingham, 176F Room 5329, 619 19th St South, Birmingham AL, 35294. E-mail: britte@uab.edu

This study was presented at the American Society for Colposcopy and Cervical Pathology Biennial Meeting, March 2012, San Francisco, CA.

The authors have declared they have no conflicts of interest.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology