Hard to reach populations in cervical cancer screening in high income countries
Cet article passe en revue les facteurs entravant la participation aux programmes de dépistage des cancers du col de l'utérus dans les pays à haut revenu puis identifie des solutions pour réduire les inégalités d'accès aux examens de dépistage
Cervical cancer screening rates in the United States are generally high, yet certain groups demonstrate disparities in screening and surveillance. The populations at greatest risk of HPV and subsequent cervical cancer are often from medically underserved and/or marginalized groups and are typically less engaged with the healthcare system, making them hard to reach for screening and surveillance. Geographic/access-related barriers often prevent screening and detection of pre-cancers. Patients may also experience logistical barriers such as transportation, and difficulties with missing work and finding childcare. Socioeconomic and insurance status and high out-of-pocket costs may prevent individuals from receiving screenings and follow-up care. Racial/ethnic minorities are disproportionately impacted by these barriers. In addition, they may experience language and cultural barriers and report lower trust in providers. Sexual and gender minorities demonstrate lower screening rates due to perceived stigmatization, lack of provider recommendation and referral, and discomfort with pelvic exams. Comorbidities such as hypertension, diabetes, and obesity also result in lower rates of preventive care, irrespective of minority group membership. Interventions to address and mitigate these barriers are necessary to improve screening rates and preventive care among this hard to reach population. Use of patient navigators, travel vouchers and mobile screening units, and improvements in outreach, inreach, follow-up, and continuity of care can serve as solutions to reduce some of these gaps and address disparities in screening. HPV self-sampling may also be one solution that can address multiple barriers to cervical cancer screening.
Preventive Medicine , résumé, 2020