title: Social and cultural barriers to Papanicolaou test screening in an urban population.
abstract: 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, chi(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)..
  
  
  CONCLUSIONS
  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.
authors.affiliation: Divisions of Gynecologic Oncology and Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado, USA. Kian.Behbakht@uchsc.edu
authors.forename: Kian
authors.initials: K
authors.lastname: Behbakht
authors.forename: Anne
authors.initials: A
authors.lastname: Lynch
authors.forename: Stephanie
authors.initials: S
authors.lastname: Teal
authors.forename: Koen
authors.initials: K
authors.lastname: Degeest
authors.forename: Stewart
authors.initials: S
authors.lastname: Massad
mesh_terms: D000368:Aged; D002641:Chicago; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D014504:Urban Health; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health / Q000208:ethnology