Intimate Partner Violence and Cancer Screening among Urban Minority Women

The Journal of the American Board of Family Medicine

Sue Rovi¹  Jeanne Ferrante¹  Sheetal Gandhi¹  Mark S. Johnson¹  Ping-Hsin Chen¹  Marielos Vega¹ 

[1] Department of Family Medicine, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark (SG, SR, MV, MSJ, JF, P-HC)

关键词: Domestic Violence;    Cancer Screening;    Intimate Partner Violence;   

DOI  :  10.3122/jabfm.2010.03.090124

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: To evaluate the association of intimate partner violence (IPV) with breast and cervical cancer screening rates.

Methods: We conducted retrospective chart audits of 382 adult women at 4 urban family medicine practices. Inclusion criteria were not being pregnant, no cancer history, and having a partner. Victims were defined as those who screened positive on at least one of 2 brief IPV screening tools: the HITS (Hurt, Insult, Threat, Scream) tool or Women Abuse Screening Tool (short). Logistic regression models were used to examine whether nonvictims, victims of emotional abuse, and victims of physical and/or sexual abuse were up to date for mammograms and Papanicolaou smears.

Results: Prevalence of IPV was 16.5%. Compared with victims of emotional abuse only, victims of physical and/or sexual abuse aged 40 to 74 were associated with 87% decreased odds of being up to date on Papanicolaou smears (odds ratio, 0.13; 95% CI, 0.02–0.86) and 84% decreased odds of being up to date in mammography (odds ratio, 0.16; 95% CI, 0.03–0.99). There was no difference in Papanicolaou smear rates among female victims and nonvictims younger than 40.

Conclusions: Because of the high prevalence of IPV, screening is essential among all women. Clinicians should ensure that victims of physical and/or sexual abuse are screened for cervical cancer and breast cancer, particularly women aged 40 or older. Cancer screening promotion programs are needed for victims of abuse.

• Domestic Violence
• Cancer Screening
• Intimate Partner Violence

Intimate partner violence (IPV) is an important social concern. It is estimated that 7.7 million IPV victimizations occur each year and that the lifetime prevalence of IPV victimization is 25% among women and 8% among men in the general population.¹ Women are particularly vulnerable to the harmful effects of IPV; they are 7 to 14 times more likely than men to suffer severe physical injury from an assault by an intimate partner.² A history of being the target of violence puts women at increased risk of physical injury, chronic pain syndromes, irritable bowel syndrome, gastrointestinal disorders, sexually transmitted diseases,^3–5 depression, suicide attempts, psychosomatic disorders, reproductive health consequences, and other comorbidities.⁶ Victims also reported more risky behaviors, including smoking, heavy drinking, and drug use.^1,7–10

More recently, research has explored the association between IPV and health issues related to breast and cervical cancer. Studies have found that exposure to IPV increases the risk of cervical cancer,^11,12 possibly through its effect on risk factors such as stress, smoking, and drinking.¹¹ Alternatively, IPV may be related to decreased adherence to cancer screening. Findings from the few studies about the association between IPV and cancer screening have been inconsistent. A recent Australian study of 7312 middle-aged women (aged 45 to 50) found that those who have experienced IPV were less likely to engage in cervical cancer screening.¹³ In contrast, a smaller US study of women (aged 18 to 54) indicated that victims of physical or sexual abuse were more likely to have a Papanicolaou smear.¹⁴ Other studies have suggested no difference in cancer screening rates between victims of IPV and nonvictims.^15–17 Using a population-based health survey, one study indicated that victims of IPV receive Papanicolaou smears and clinical breast examinations at similar rates as other women.¹⁶ Another study examined 101 women with breast, cervical, endometrial, or ovarian cancer and found that IPV victims and nonvictims did not differ in rates of annual Papanicolaou tests or annual mammograms.¹⁷ A third study found that exposure to physical violence was not associated with cancer screening, although women with safety concerns were less likely to report cervical cancer testing and mammography.¹⁵

The studies above were conducted with mostly white women. There is little research regarding adherence to cancer screening among minority victims of IPV. Compared with white women, minority women have lower mammography screening rates.¹⁸ Physical health status, such as comorbidity and obesity, have been found to be barriers to cancer screening among minority women.^19,20 However, the effect of social influences as barriers to cancer screening remains largely unexamined. Studies have suggested that IPV is a risk factor for medical noncompliance.^18,21 African-American women reported IPV as a social issue that made preventive health care less of a priority for them.¹⁸

This study aims to add to the literature by using chart audit data to examine the relationship of IPV and cancer screening in a population of predominantly minority women. To our knowledge this is the first study using chart audits to examine cancer screening rates of victims of IPV and nonvictims. Previous studies have relied on self-reported data about cancer screening rates, which may be limited by accuracy of recall and social desirability bias.^{13,14,22–24} Chart audit data are preferable over self-report data when determining cancer screening rates because patient report often leads to high false-positive rates.²⁵ Chart audits allowed us to take into account medical confounders of cancer screening that were not addressed in previous studies. We hypothesized that victims of IPV would have lower screening rates compared with nonvictims. In addition, we will add to the literature by examining nonlinear relations between IPV and cancer screening. We specifically explored the role of type of abuse and age in affecting cancer screening. The inconsistent findings from previous studies could suggest that nonlinear relationships exist between IPV and cancer screening.¹⁵ We hypothesized that types of abuse would affect cancer screening differently. Because middle-aged IPV victims (not younger populations) previously have been found to have lower rates of cervical cancer screening,^13–17 we hypothesized that age interacts with IPV to affect cervical cancer screening rates.

【 授权许可】

Unknown   

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