Journal of Health Care for the Poor and Underserved

Call to Action: Advocating for Alternatives to Cervical Cytology

Abstract: The decline in cervical cancer incidence in the United States has not been uniform and has been influenced by access to care. Hence, we must explore cervical cancer screening routes that do not require a provider visit. This commentary is a call to action that highlights alternatives to cervical cancer screening, specifically the use of self-collected vaginal samples for testing and urine human papillomavirus (HPV) testing. We further must standardize protocols and provide resources to make these alternatives successful.

Raising Funds Through Social Media to Subsidise Cervical Cancer Screening with HPV Testing in Rural Ghana—The Battor Experience

Over 260,000 women die yearly from cervical cancer, mostly in low and middle-income countries. Molecular testing for high-risk Human Papilloma Virus (HPV) is now the method of choice for cervical cancer screening. A limiting factor for HPV testing, however, is the cost in setting up and running the tests. Our objective was to reduce the cost of cervical cancer screening to rural folk by absorbing the initial cost of setting up. Crowdfunding was done through WhatsApp© and mobile money transfer. Individuals pledged amounts ranging from United States of America dollars ($) 2.6 to $3,769.2 (median = $25.6, Inter Quartile Range (IQR) = $12.8 to $38.5). Over four months $15,153 was raised to purchase the initial equipment for an HPV-based cervical cancer screening program. Crowdfunding is possible through a combination of WhatsApp© and mobile money transfer in low-resource settings. It obviates the need to organize gatherings requiring a budget and enables donors to become fundraisers.

Using See, Test & Treat® to Increase Uptake of Breast and Cervical Cancer Screenings: Report from the Field

Summary: The See, Test, & Treat® program has provided free cervical and breast cancer screening to more than 8,500 medically underserved women across the U.S. since 2011. This report explores its successful uptake strategies, its outcomes, and the challenges it faces to enhance uptake.

Systematic Review on Socioeconomic Deprivation and Cervical Cancer: Inequalities in Survival

To evaluate the association between socioeconomic deprivation and survival in cervical cancer. A systematic search of Medline (1946-2020), Embase (1980-2020), Cinahl (1981-2020) and the Cochrane Controlled Register of trials was performed. Included were women (age ≥ 18 years) diagnosed with primary cervical cancer. Two reviewers independently selected studies and assessed bias using the Newcastle-Ottawa assessment scale. Data extraction was completed using pre-determined forms, and summary tables of evidences were created. Eight studies were included with a total number of at least 38,811 patients, with one study not reporting number of patients included. All eight studies showed that socioeconomic deprivation is associated with poorer survival in cervical cancer patients, with five studies confirming this association in multivariate analysis. Socioeconomic deprivation seems to be associated with poor survival in cervical cancer, however the impact of confounders such as smoking and obesity is unclear.

Does Spousal Engagement Improve Cervical Cancer Screening Discussions and Uptake? Lessons from a Before-After Study in a Rural Nigerian Community

This study determined spousal involvement and the effect of community-based spousal engagement on cervical cancer screening-related discussions and uptake in a rural Nigerian community. A before-after mixed methods study was conducted among 245 married men in a rural Nigerian community. Spousal engagement involved advocacy to men groups, awareness creation, and monthly meeting-based announcements/reminders about screening. Three months post-intervention, uptake was determined from facility registers. Thematic analysis and SPSS were used for data analysis. A large minority of respondents were aged 29-39 years (95/245, 38.8%). At baseline, respondents generally had poor spousal involvement. Post-intervention, inter-spousal discussion on screening increased from 17.2% to 46.9% (p<.001). There was no significant increase in uptake post-intervention. Having more than 5 children was a predictor of screening discussions (AOR=2.017; CI=1.196-3.403; p=.009). Despite increased inter-spousal discussions on cervical cancer screening, uptake remained low. We recommend community-driven interventions on cervical cancer screening with a gender-transformative perspective.

Opportunities for Cancer Health Care Disparities and Care Delivery Research: An Analysis of the NCI Health Care Delivery Research Program Portfolio

Cancer health care disparities are complex, involve patient, clinician and health care system factors, and are defined as adverse differences in cancer outcomes. This analysis describes NCI's Healthcare Delivery Research Program's (HDRP) portfolio of disparities-focused research and identifies future research opportunities. Grants through HDRP (fiscal years 2012 to 2016) focused on detecting, understanding, and/or intervening on disparities in or among health disparity populations were reviewed by co-authors. Forty-eight funded grants were identified, coded, and characterized. Descriptive analyses are reported. Most studies focused on racial/ethnic minorities and socioeconomically disadvantaged groups. Colorectal, breast, and cervical cancers were most frequently examined. Almost 40% of studies addressed the intervening phase of the disparities research continuum. Few studies focused on clinician-level factors or involved the community in the research design. A sustained disparities research emphasis is essential to addressing the determinants of and cancer burden among health disparity populations across the cancer care continuum.

Women's Health Screening and Mapped Community Resources for Refugees Resettled in Philadelphia, Pennsylvania

About 22,000 refugee women are resettled in the U.S. annually. Women's health screenings for breast and cervical cancer and reproductive health should be examined within the context of the built environment where refugees are resettled. 1) Analyze the proportion of resettled refugees who had women's health screenings and 2) map the available refugee, health, and social services organizations compared with the ZIP codes where refugees were resettled. Two clinical sites in Philadelphia conducted a retrospective chart review (N = 914). Community organizations were mapped. Within age guidelines, 460 (59%) women had a cervical cancer screening, 95 (63%) had a breast cancer screening, 296 (51%) were currently using contraception, and 118 (13%) became pregnant. Most community organizations were not located within ZIP codes where refugees resettled. There is a need for increased resources-which could increase women's screening rates-within a broader area of Philadelphia.

Perceptions of Cervical Cancer and Screening Behavior among Cambodian and Lao Women in the United States: An Exploratory, Mixed-Methods Study

This concurrent mixed method study examined barriers to cervical cancer screening (CCS) among Cambodian and Lao women and mother-daughter communication about women's health, cervical cancer, and screening. We conducted seven focus groups with purposeful samples of Cambodian and Lao women in the Midwest. The participants completed a survey on health characteristics and attitudes about CCS. Focus group data were analyzed using content analysis, and survey data were analyzed calculating descriptive statistics and bivariate hypothesis testing. Predominantly, women spoke about modesty, privacy, and screening only if symptoms were present. More Lao than Cambodian women reported having ever had a Pap smear, significantly higher knowledge about, and greater positive support for completing Pap smears from health providers, family, and friends. Results show cultural similarities among mothers and daughters in communication about women's health, but cultural and generational differences in knowledge, intent, and beliefs about cervical cancer and screening.

Understanding Black Women's Perspectives and Experiences of Cervical Cancer Screening: A Systematic Review and Qualitative Meta-synthesis

Cervical cancer is the third most common gynecological cancer. Effective population-based cervical cancer screening programs exist, but improvements in morbidity and mortality continue to demonstrate racial disparities. For example, Black women are 41% more likely to develop cervical cancer than White women and are 75% more likely to die from it. It is therefore important to understand whether these inequities in cervical cancer outcomes are related to differential access and uptake of screening programs. In this systematic review and qualitative meta-synthesis, we used an intersectional lens to understand Black women's experiences and perspectives of cervical cancer screening (CCS). We identified 12 factors related to the perspectives and experiences of Black women participating in CCS. Understanding Black women's experiences and perspectives of CCS can help individual clinicians and policymakers implement CCS in a way that is culturally appropriate and cognizant of structural oppression.