The vicious cycle of inadequate early detection: a complementary study on barriers to cervical cancer screening among middle-aged and older women.
BACKGROUND
Although rates of invasive cervical cancer have declined precipitously over the past 50 years, nearly 10,000 new cases and 3700 deaths result from this cancer annually. Given the efficacy of early detection, invasive cervical cancer should no longer constitute a health threat; however, national studies reveal that many women, especially older women, do not receive Papanicolaou (Pap) tests.


METHODS
In this complementary study, we examined data from the National Health Interview Survey focusing on the correlates of screening for women aged 55 years or older, an age group in which invasive cervical cancer rates escalate and rates of obtaining Pap tests decline. To more richly understand grounded perspectives, we queried 25 women who were rarely or never screened about factors and circumstances underlying their decision not to obtain a Pap test.


RESULTS
Quantitative data indicate an association between Pap test use and demographic factors (being married, being younger, and having suburban or urban residence) and access to preventive care (obtaining mammograms, having a regular source of health care, and having contact with an obstetrician/gynecologist). Participants who provided qualitative data echoed this theme of inadequate use of preventive services, particularly among women with weak social ties, who were older, and who lived in rural areas. Shortages of health care professionals and a lack of continuity of care and privacy contribute to suboptimal prevention.


CONCLUSIONS
A vicious cycle emerges: many women decline to pursue preventive care because of competing health and financial demands and insufficient resources to seek care. When such women do go to the doctor's office, they feel chastised by providers, which alienates them and thwarts future preventive care.
Leach
Corinne R
CR
Graduate Center for Gerontology, 306 Wethington Health Sciences Building, 900 S. Limestone, University of Kentucky, Lexington, KY 40536-0200, USA. corinne.leach@uky.edu
Schoenberg
Nancy E
NE
D000368:Aged; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007629:Kentucky; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000523:psychology; D019035:Rural Health Services; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data*; D014903:West Virginia