Understanding cervical cancer screening among lesbians: a national survey

BMC Public Health

Deborah R Greenberg¹  Nicholas H Schluterman¹  J Kathleen Tracy¹ 

[1] Department of Epidemiology and Public Health, University of Maryland School of Medicine, 10 South Pine Street, MSTF 334-F, Baltimore, MD 21201, USA

关键词: Health behavior;    Reproductive health;    Papanicolaou test;    Female;    Homosexuality;   

Others  :  1162239
DOI  :  10.1186/1471-2458-13-442

 received in 2012-07-19, accepted in 2013-04-22,  发布年份 2013

【 摘 要 】

Background

Lesbians have low rates of cervical cancer screening, even though they are at risk of developing the disease. The aim of this study was to examine cervical cancer screening behaviors in a national sample of lesbians.

Methods

A standardized internet survey was sent to 3,000 self-identified lesbians to assess cervical cancer screening behaviors and barriers to screening. The sample consisted of 1,006 respondents.

Results

Sixty-two percent of the weighted sample of respondents were routine screeners. Lack of a physician referral (17.5%) and lack of a physician (17.3%) were the most commonly-cited top reasons for lack of screening. Adjusting for age, education, relationship status, employments status, and insurance status, women who had disclosed their sexual orientation to their primary care physician (adjusted odds ratio [OR] 2.84 [95% confidence interval 1.82-4.45]) or gynecologist (OR 2.30 [1.33-3.96]) had greater odds of routine screening than those who did not. Those who knew that lack of Pap testing is a risk factor for cervical cancer were also more likely to be routine screeners (OR 1.95 [1.30-2.91]), although no association with screening was apparent for women who had more knowledge of general cervical cancer risk factors. Physician recommendation appeared to be a potent determinant of regular screening behavior. Routine screeners perceived more benefits and fewer barriers to screening, as well as higher susceptibility to cervical cancer.

Conclusions

Some women who identify as lesbian are at a potentially elevated risk of cervical cancer because they are not routinely screened. Evidence-based interventions should be developed to address critical health beliefs that undermine participation in screening. Given the value placed on physician recommendation, patient-provider communication may serve as the optimal focus of effective intervention.

【 授权许可】

   
2013 Tracy et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S: Human papillomavirus and cervical cancer. Lancet 2007, 370(9590):890-907.
• [2]Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide. IARC CancerBase: IARC CancerBase No. 10; 2010:10.
• [3]Clifford GM, Gallus S, Herrero R, Muñoz N, Snijders PJ, Vaccarella S, Anh PT, Ferreccio C, Hieu NT, Matos E, Molano M, Rajkumar R, Ronco G, de Sanjosé S, Shin HR, Sukvirach S, Thomas JO, Tunsakul S, Meijer CJ, Franceschi S: IARC HPV Prevalence Surveys Study Group: Worldwide distribution of human papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: a pooled analysis. Lancet 2005, 366(9490):991-998.
• [4]American Cancer Society: Cervical Cancer Causes, Risk Factors, and Prevention. [http://www.cancer.org/acs/groups/cid/documents/webcontent/003094-pdf.pdf webcite]
• [5]Schiffman MH, Brinton LA, Devesa SS, Fraumeni JF Jr: Cancer epidemiology and prevention. In New York. Edited by Schottenfeld D, Fraumeni JF Jr. NY: Oxford University Press; 1996:1090-1116.
• [6]Cochran SD, Mays VM, Bowen D, Gage S, Bybee D, Roberts SJ, Goldstein RS, Robinson A, Rankow EJ, White J: Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. Am J Public Health 2001, 91(4):591-597.
• [7]Roberts SJ, Patsdaughter CA, Grindel CG, Tarmina MS: Health related behaviors and cancer screening of lesbians: results of the Boston Lesbian Health Project II. Women Health 2004, 39(4):41-55.
• [8]Tracy JK, Lydecker AD, Ireland L: Barriers to Cervical Cancer Screening Among Lesbians. J Womens Health (Larchmt) 2010, 19(2):229-37.
• [9]Brown JP, Tracy JK: Lesbians and cancer: an overlooked health disparity. Cancer Causes Control 2008, 19(10):1009-1020.
• [10]American Congress of Obstetricians and Gynecologists: New Cervical Cancer Screening Recommendations from the U.S. : Preventive Services Task Force and the American Cancer Society/American Society for Colposcopy and Cervical Pathology/American Society for Clinical Pathology; [http://www.acog.org/About_ACOG/Announcements/New_Cervical_Cancer_Screening_Recommendations webcite]
• [11]ACOG updates cervical cancer screening guidelines: ACOG updates cervical cancer screening guidelines. Cancer Connect News; [http://news.cancerconnect.com/acog-updates-cervical-cancer-screening-guidelines/ webcite]
• [12]US Preventive Services Task Force: Screening for cervical cancer. [http://www.ahrq.gov/clinic/uspstf/uspscerv.htm webcite]
• [13]Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System; [http://www.cdc.gov/brfss/ webcite]
• [14]National Center for Health Statistics: with special feature on medical technology. Health, United States: Hyattsville, MD; 2010.
• [15]Bradford J, Ryan C: The national Lesbian Health Care Survey Final Report. Wasington, DC: National Lesbian and Gay Health Foundation; 1987.
• [16]Diamant AL, Schuster MA, Lever J: Receipt of preventive health care services by lesbians. Am J Prev Med 2000, 19(3):141-148.
• [17]Diamant AL, Wold C, Spritzer K, Gelberg L: Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women. Arch Fam Med 2000, 9(10):1043-1051.
• [18]Rankow EJ, Tessaro I: Cervical cancer risk and Papanicolaou screening in a sample of lesbian and bisexual women. J Fam Pract 1998, 47(2):139-143.
• [19]Johnson SR, Smith EM, Guenther SM: Comparison of gynecologic health care problems between lesbians and bisexual women. A survey of 2,345 women. J Reprod Med 1987, 32(11):805-811.
• [20]Roberts SJ, Sorensen L: Health related behaviors and cancer screening of lesbians: results from the Boston Lesbian Health Project. Women Health 1999, 28(4):1-12.
• [21]Kottke TE, Trapp MA: Implementing nurse-based systems to provide American Indian women with breast and cervical cancer screening. Mayo Clin Proc 1998, 73(9):815-823.
• [22]Marrazzo JM, Koutsky LA, Stine KL, Kuypers JM, Grubert TA, Galloway DA, Kiviat NB, Handsfield HH: Genital human papillomavirus infection in women who have sex with women. J Infect Dis 1998, 178(6):1604-1609.
• [23]Marrazzo JM, Stine K, Koutsky LA: Genital human papillomavirus infection in women who have sex with women: a review. Am J Obstet Gyneco 2000, 183(3):770-774.
• [24]Marrazzo JM, Koutsky LA, Kiviat NB, Kuypers JM, Stine K: Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women. Am J Public Health 2001, 91(6):947-952.
• [25]Marrazzo JM, Koutsky LA, Handsfield HH: Characteristics of female sexually transmitted disease clinic clients who report same-sex behaviour. Int J STD AIDS 2001, 12(1):41-46.
• [26]Marrazzo JM: Genital human papillomavirus infection in women who have sex with women: a concern for patients and providers. AIDS Patient Care STDS 2000, 14(8):447-451.
• [27]Bruni L, Diaz M, Castellsague X, Ferrer E, Bosch FX, de Sanjose S: Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis 2010, 202(12):1789-1799.
• [28]Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R, Clifford GM: Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: A meta-analysis update. International Journal of Cancer. Journal International Du Cancer 2007, 121(3):621-632.
• [29]Price JH, Easton AN, Telljohann SK, Wallace PB: Perceptions of cervical cancer and Pap smear screening behavior by women's sexual orientation. J Community Health 1996, 21(2):89-105.
• [30]O'Hanlan KA, Crum CP: Human papillomavirus-associated cervical intraepithelial neoplasia following lesbian sex. Obstet Gynecol 1996, 88(4 Pt 2):702-703.
• [31]Roberts SJ: Health care recommendations for lesbian women. J Obstet Gynecol Neonatal Nurs 2006, 35(5):583-591.
• [32]Mravcak SA: Primary care for lesbians and bisexual women. Am Fam Physician 2006, 74(2):279-286.
• [33]Harvard School of Public Health: Your Disease Risk. Cervical Cancer; [http://www.diseaseriskindex.harvard.edu webcite]
• [34]American Cancer Society: Cervical cancer key statistics. [http://www.cancer.org/Cancer/CervicalCancer/DetailedGuide/cervical-cancer-key-statistics webcite]
• [35]Solarz A: Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: National Academies Press; 1999.
• [36]Castellsague X, Bosch FX, Munoz N: The male role in cervical cancer. Salud Publica Mex 2003, 45(Suppl 3):S345-53.
• [37]Williams DR, Yu Y, Jackson JS, Anderson NB: Racial differences in physical and mental health: Socioeconomic status, stress and discrimination. Journal of Health Psychology 1997, 2(3):335-351.
• [38]Mohr JJ, Fassinger RE: Measuring dimensions of lesbian and gay male experience. Measurement and Evaluation in Counseling and Development 2000, 33(2):66-90.
• [39]Grindel CG, McGehee LA, Patsdaughter CA, Roberts SJ: Cancer prevention and screening behaviors in lesbians. Women Health 2006, 44(2):15-39.
• [40]Sirovich BE, Welch G: The frequency of Pap smear screening in the United States. J GEN INTERN MED 2004, 19:243-250.
• [41]McPhee SJ, Nguyen TT, Shema SJ, Nguyen B, Somkin C, Vo P, Pasick R: Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Prev Med 2002, 35(5):463-473.
• [42]Caplan LS, McQueen DV, Qualters JR, Leff M, Garrett C, Calonge N: Validity of women's self-reports of cancer screening test utilization in a managed care population. Cancer Epidemiol Biomarkers Prev 2003, 12(11 Pt 1):1182-1187.