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Intimate Partner Violence and Barriers to Cervical Cancer Screening: A Gynecologic Oncology Fellow Research Network Study

Levinson, Kimberly L. MD, MPH1; Jernigan, Amelia M. MD2; Flocke, Susan A. PhD3; Tergas, Ana I. MD, MPH4; Gunderson, Camille C. MD5; Huh, Warner K. MD6; Wilkinson-Ryan, Ivy MD7; Lawson, Peter J. MPH, MBA3; Fader, Amanda N. MD1; Belinson, Jerome L. MD2,8

Journal of Lower Genital Tract Disease: January 2016 - Volume 20 - Issue 1 - p 47–51
doi: 10.1097/LGT.0000000000000153
Original Research Articles: Cervix and HPV

Objectives The aims of the study were to examine barriers to cervical cancer screening among women who have experienced intimate partner violence (IPV) and accessed domestic violence shelters, to compare barriers among those up-to-date (UTD) and not UTD on screening, and to evaluate acceptability of human papillomavirus self-sampling.

Materials and Methods This is a cross-sectional survey in which domestic violence shelters in Ohio were identified and women completed an anonymous survey assessing UTD screening status, barriers related to screening, history of IPV, intention to follow up on abnormal screening, and acceptability of self-sampling. Characteristics of UTD and not UTD women were compared using Mann-Whitney U tests.

Results A total of 142 women from 11 shelters completed the survey. Twenty-three percent of women were not UTD. Women who were not UTD reported more access-related barriers (mean = 2.2 vs 1.8; p = .006). There was no difference in reported IPV-related barriers between women who were not UTD and those who are UTD (mean = 2.51 in not UTD vs 2.24 in UTD; p = .13). Regarding future screening, of the women who expressed a preference, more women not UTD preferred self-sampling than UTD women (32% vs 14%; p = .05).

Conclusions In this study, access-related barriers were more commonly reported among women not UTD with screening. Addressing these barriers at domestic violence shelters may improve screening among not UTD women. Self-sampling may also be one feasible approach to support screening in this population.

In this population, access-related barriers are more commonly reported among women not up-to-date on screening; self-sampling may be 1 intervention to help address these barriers.Supplemental digital content is available in the text.

1The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD; 2Divsion of Gynecologic Oncology, Women's Health Institute, The Cleveland Clinic, Cleveland, OH; 3Department of Family Medicine and Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH; 4Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Medical Center, New York, NY; 5Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Oklahoma, Oklahoma City, OK; 6Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL; 7Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University, St. Louis, MO; and 8Preventive Oncology International, Cleveland, OH.

Reprint requests to: Kimberly Levinson, MD, MPH, Johns Hopkins Hospital, 600 N, Wolfe St, Phipps 281, Baltimore, MD 21287. E-mail:

The authors have declared they have no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The study was supported by a grant through the Foundation for Gynecologic Oncology from the Gynecologic Oncology Group entitled Improving Outcomes in Gynecologic Oncology Patients Research and Education Award and the Behavioral Measurement Core Facility of the Case Comprehensive Cancer Center (P30 CA43703).

The study was approved by The Institutional Review Board of The Cleveland Clinic.

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology