title: Disparities in cancer screening: acceptance of Pap smears among homeless women.
abstract: OBJECTIVE
  Cervical cancer is a preventable disease through screening and early treatment. Rates of cervical cancer are higher in impoverished women, including homeless women. This study assessed the acceptance of free and accessible Pap smears offered to homeless women in a respite care setting.
  
  
  METHODS
  A convenience sample of 205 adult women receiving respite care at a facility for homeless people in Boston, Massachusetts, between 2004 and 2007 were offered screening for cervical cancer during routine encounters with the medical staff during their stay. Rates of acceptance of screening as well as medical and sociodemographic information were collected on the women.
  
  
  RESULTS
  Of 205 women enrolled in the study, 129 (63%) were in need of screening and offered a Pap smear; 80 (62%) accepted and 49 (38%) declined. Of those who agreed to be tested, 56 (70%) had a Pap smear performed, resulting in 10 (18%) atypical results (atypical squamous cells of undetermined significance [ASCUS] or low-grade squamous intraepithelial lesion [LGSIL]) and 15 (27%) benign findings needing follow-up (e.g., vaginitis without evidence of malignancy).
  
  
  CONCLUSIONS
  A large proportion of homeless women receiving respite care decline a free Pap smear despite being in medical need of cervical cancer screening. Access and cost may not be the only barriers to screening among homeless women, and new and innovative approaches to screening in vulnerable populations need to be investigated in order to close the disparity gap.
authors.affiliation: Boston Health Care for the Homeless, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02118, USA. mbharel@bhchp.org
authors.forename: Monica
authors.initials: M
authors.lastname: Bharel
authors.forename: Carolyn
authors.initials: C
authors.lastname: Casey
authors.forename: Eve
authors.initials: E
authors.lastname: Wittenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult