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Obstetrics & Gynecology 2006;107:1330-1336
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Adverse Impact of a History of Violence for Women With Breast, Cervical, Endometrial, or Ovarian Cancer

Susan C. Modesitt, MD1,2, Alisa C. Gambrell, MD2, Hope M. Cottrill, MD2, Lon R. Hays, MD3, Robert Walker, LCSW, MSW4, Brent J. Shelton, PhD5, Carol E. Jordan, MS6 and James E. Ferguson, II, MD2

From the 1Division of Gynecologic Oncology, 2Department of Obstetrics and Gynecology, 3Department of Psychiatry, 4Center on Drug and Alcohol Research, 5Kentucky Cancer Registry, Lucille P. Markey Cancer Center, and 6Center for Research on Violence Against Women, University of Kentucky, Lexington, Kentucky.

OBJECTIVE: The experience of physical and sexual violence (victimization) is common among U.S. women and is associated with adverse health consequences. The study objectives were to estimate the prevalence of victimization in women with cancer and to examine associations with demographics, cancer screening, and cancer stage.

METHODS: From 2004 to 2005, 101 women with breast, cervical, endometrial, or ovarian cancer were interviewed to collect demographics, cancer screening history, health care access/use, and violence history. Chi-square and Fisher exact tests were used test risk-factor associations. A multinomial logistic regression model was used for multivariable analysis.

RESULTS: The prevalence of a history of violence was 48.5% (49/101 women), and within that group, 46.9% (23/49) had a positive childhood violence screen, 75.5% (37/49) had a positive adult screen, and 55% (27/49) reported sexual violence at any age. Women with a positive violence screen differed significantly from women with a negative screen in that they were younger (P = .031), more often divorced (P = .012), more likely to smoke (P = .010), more often lacked commercial insurance (P = .036), and had more advanced stage of disease (P = .013), but they did not differ with regard to race, cancer type, education level, alcohol or drug use, or cancer screening compliance. Multivariable analysis revealed that only stage remained significant; women with a history of violence had a 2.6-fold increased chance of diagnosis in later stages (odds ratio 2.61, 95% confidence interval 1.03–6.59).

CONCLUSION: A history of violence in breast, ovarian, endometrial, and ovarian cancer patients was extremely common and correlated with advanced stage at diagnosis.

LEVEL OF EVIDENCE: II-2






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