ASPO Abstracts

Fear of cancer and HPV as barriers to clinic- and home-based cervical cancer screening among underscreened women in a safety net healthcare system

Authors: Parker SL, Amboree T, Daheri M, Escobar B, Chiao EY, Anderson ML, Deshmukh AA, Hilsenbeck SG, Schmeler K, Jibaja-Weiss ML, Bulsara S, Zare M, Scheurer ME, Montealegre JR

Category: Early Detection & Risk Prediction
Conference Year: 2023

Abstract Body:
Purpose of the study Many structural and individual-level barriers to cervical cancer screening are addressed by at-home self-sample human papillomavirus (HPV) testing. However, psychosocial barriers, including fear of cancer and HPV disease, may continue to hinder screening participation. Here we assess fear of finding cancer and HPV as reasons for non-participation in self-sampling, which was conducted as part of a pragmatic trial. Methods Mailed self-sampling kits were offered to underscreened patients as part of the pragmatic Prospective Evaluation of Self-Testing to Increase Screening (PRESTIS) trial. We conducted telephone surveys in English and Spanish among a subgroup of trial participants. The survey assessed barriers to clinic-based screening, acceptability of self- sampling, and reasons for using or not using the mailed kits. Results Most surveys (n=243) were conducted in Spanish (63%). Almost half (43.2%) of participants reported fear of finding cancer as a reason for not completing clinic-based screening (Pap), and this barrier was significantly more prevalent among Spanish- versus English-speaking participants (52.9% vs 26.7%, respectively; p<0.01). Similarly, about one-third (33.7%) of women reported fear of finding HPV as a reason for not completing clinic-based screening, with significantly more Spanish- versus English- speakers reporting this barrier (42.5% vs 18.9% respectively, p<0.01). Among women who reported not using the at-home self-sample HPV kit (n=31), fear of finding cancer (67.7%) and fear of finding HPV (46.7%) were common reasons for not using the kit, with no statistically significant differences between language-use groups. Conclusions Fear of finding cancer and HPV are important barriers to both clinic-and home-based cervical cancer screening among underscreened safety net health system patients, especially among Spanish-speaking patients. Further research is needed to address fear of cancer and HPV as barriers to participation in both clinic- and home-based screening programs.

Keywords: HPV self-sampling, safety net healthcare, barriers to care