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Social and Cultural Barriers to Papanicolaou Test Screening in an Urban Population

Kian Behbakht, MD^*, Anne Lynch, MD, MSPH, Stephanie Teal, MD, MPH, Koen Degeest, MD and Stewart Massad, MD

From the Divisions of *Gynecologic Oncology and Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado; Division of Gynecologic Oncology, University of Iowa Medical Center, Iowa City, Iowa; and Division of Gynecologic Oncology, Southern Illinois University School of Medicine, Springfield, Illinois.

Address reprint requests to: Kian Behbakht, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, 4200 East 9th Avenue, B-198, Denver, CO 80262; e-mail: Kian.Behbakht{at}uchsc.edu.

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, 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.

LEVEL OF EVIDENCE: III

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