Women’s Misconceptions a Major Barrier to Cancer Screening

      The most common reason women fail to seek Pap smears or mammograms is their belief that they don’t need to be screened since they feel healthy or don’t have a family history of cervical or breast cancer, according to a new study.

      The findings, which included embarrassment and inconvenience as prominent barriers, contrast with previous research, where the most commonly mentioned reason for not being screened was that the woman’s doctor didn’t recommend the test to her (see a related story ).

      The study authors, led by Russell Glasgow, Ph.D., of the AMC Cancer Research Center in Lakewood, Colo., also found that many of the women who are at particularly high risk for cancer are not getting screened, suggesting that current screening programs aimed at the general population are not reaching those who need it most and that such programs need refinement.

      “It is crucial that health care systems focus on this subgroup of women,” they wrote.

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      William Rakowski, Ph.D., associate professor of community health at Brown University in Providence, R.I., noted that many of the barriers arose from the patients’ misunderstandings about their cancer, the screening tests, and how the tests can help prevent the cancer.

      “One of the major educational messages [of cancer screening],” he said, “is that all women are at risk of breast cancer, and that cervical cancer can be prevented if malignant changes are found soon enough.”

      The survey participants were 522 women from the metropolitan Portland, Ore., area ages 52 to 69 who had all been recruited through the northwest division of the Kaiser Permanente HMO. Each woman completed a detailed survey on her basic demographic and medical characteristics, her history of cancer screening and other preventive methods, and her perceived barriers to getting Pap smears and mammograms.

      Across 15 listed barriers, women were asked to rate how strong each was with regard to each of the two tests. The percentage of respondents who answered “moderately” or “a great deal” was compared between three subgroups of women: those who had not received a mammogram in the previous two years and had not had a Pap smear in the previous three years; those who had received one of the tests but not the other; and those who had received both tests.

      The results of the survey, which were published in the latest issue of the Annals of Behavorial Medicine, ranked the top three barriers as being healthy or not having a family history of the cancer, feeling embarrassed or uncomfortable about screening, and the inconvenience of the screening appointment.

      The absence of a doctor’s recommendation, which was the most common barrier in previous studies, was ranked sixth as a barrier to mammograms and seventh as a barrier to Pap smears.

      For 11 of the barriers, women who had not recently had either test were more likely to rate the barrier as moderate or strong than women who had undergone one of the tests. The latter group was in turn more likely to give these ratings than women who had undergone both tests.

      In addition, for almost all of the barriers, if a woman rated as strong for mammograms, she was likely to do the same for Pap smears.

      Rakowski viewed the findings as underscoring the need for screening programs that are tailored to the unique needs and perceptions of different groups of women. “What’s important here is the types and variety of barriers reported,” he said. “Just the range of barriers cited shows that there isn’t a ‘magic bullet’ reason to address here.”

      The researchers agreed. “These data,” they wrote, “suggest that an individualized, patient-centered intervention approach is appropriate.”

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