Despite the advent of the Pap smear and HPV vaccines and their establishment as major preventors of cervical cancer, there remains an underutilization of these prevention mechanisms, particularly amongst minority women leading to increased incidence of the disease amongst the underserved. In contributing to the existing literature, the author of this article details progress made in helping to close these gaps in cervical cancer health literacy, pap smears and HPV vaccine education.
This past year I served as an Albert Schweitzer fellow and I was tasked with continuing an established project dedicated to improving the health literacy of underserved women at one of Pittsburgh’s prominent free clinics. This project is aimed at not only educating women on the basic aspects of cervical cancer, arming them with the knowledge needed to seek informed care, but also to encourage them to undergo pap smears and receive human papillomavirus (HPV) vaccines. Pap smears involve collecting cells from the cervix and looking at these under a microscope to visualize changes that might be indicative of a malignant process. HPV vaccines were created to prevent infection caused by certain types of virus, which can ultimately lead to malignancy such as cervical cancer.
This experience has been immensely rewarding; however, I’ve come to realize that while tremendous strides have been made in the battle against cervical cancer, this progress has not been equally made across society. There’s still an underutilization of screening tools like pap smears by underserved women in the United States and in some developing countries in the world. (1,2) Moreso, in our clinic, we learn that most of the immigrant or uninsured women have never heard of or performed a pap smear.
The reason for this underutilization is multifactorial; underserved populations are less likely to have geographic access to cervical cancer screening centers, insurance to afford such screenings, and adequate information about pap smears, cervical cancer, or the HPV vaccine (3). Moreso, cultural beliefs, and negative experiences within the healthcare system can serve as barriers that further hinder patients access to these screenings. Issues like these are why scientific studies propose strategies that are multifaceted, patient-centered, and culturally congruent (3). For example, studies have demonstrated that to bridge the gap for cervical cancer screening, patients need to be thoroughly informed and educated on why they need to be screened in the first place (5).
This gap in health literacy served as the basis for our project with the free clinic. We seek to not only provide these pap smears to patients, but also to educate and have them understand why they need to undergo a pap smear in the first place. During these clinical periods, I don’t just talk to the patients, I have conversations with them. My ultimate goal is to assuage their worries and provide them with the knowledge they need to make an informed decision on their health.
Often, these conversations go well, and patients are motivated to have pap smears done to have something less to worry about. Other times, patients aren’t as excited to speak with me, as they have other pertinent issues they have to face. Even though in these situations I don’t discuss further with them, I provide them with a pamphlet detailing key information about cervical cancer, hoping these will help them in their decision making. I also encourage patients to receive HPV vaccines. While we do provide free pap smears to these patients, the free clinic doesn’t cover HPV vaccines for adult women, which raises another issue. Underserved women don’t have the funds to receive the expensive vaccine, further adding to the gap of inequity. There is still a suboptimal use of HPV vaccines globally, particularly in lower income countries, with the rate of introduction in low and middle-income countries, which carry the greatest share of disease burden, remaining lower than in high-income countries (4).
I believe that our program plays a small but integral role in helping to close the disparity gap in cervical cancer prevention for underserved women . Afterall, it has been shown that health literacy improves adherence to cervical cancer screening (5). This is a call to action for an increase in similar programs like ours globally, to increase access to early detection, particularly for vulnerable, underserved women. In addition, we need a call to action to improve HPV vaccine access in lower income countries. It all starts with prevention and awareness.
Zainab Balogun
References:
- Ma GX, Gao W, Fang CY, et al., “Health beliefs associated with cervical cancer screening among Vietnamese Americans.J Womens Health (Larchmt)”.
- Biddell CB, O’Leary MC, Wheeler SB, Spees LP., “Variation in Cervical Cancer Screening Preferences among Medically Underserved Individuals in the United States: A Systematic Review. Cancer Epidemiol Biomarkers Prev” 2020.
- Chidyaonga-Maseko F, Chirwa ML, Muula AS., “Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors.” 2015.
- “HPV cases (all cancers), women” 2018.
- Lindau ST, Tomori C, Lyons T, Langseth L, Bennett CL, Garcia P., “The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women.” 2002.
