According to the American Cancer Society, over 10,000 women are diagnosed with cervical cancer in the United States every year. It is estimated that almost 4,000 women will die from this disease every year. Among the most common risk factors for cervical cancer are human papillomavirus (HPV) infection (the risk of acquiring is increased by intercourse at an early age, having many sexual partners, and having sex with uncircumcised males), smoking, HIV infection, Chlamydia infection, unhealthy diet, use of oral contraceptives, multiple pregnancies, and low socioeconomic status.
One of the most effective ways for women to avoid cervical cancer is to have a regular screening. This screening is done through the Papanicolaou Smear, also known as a Pap test or Pap smear. This simple test detects precancerous abnormalities in cells that can then be treated, allowing the patient to avoid developing cervical cancer.
Health disparities exist in the incidence and mortality rate of cervical cancer and in the use of screening services by women. According to the American Cancer Society, in 2000, 83.9 percent of Caucasian women 18 and over had a Pap test in the last three years, while 77.9 percent of Latina women had. The cervical cancer incidence rate for Caucasian women from 1996-2000 was 9.2 per 100,000 women and 16.8 per 100,000 for Latina women. The mortality rate was 2.7 per 100,000 for Caucasian women and 3.7 for Latina women.
A number of studies exist that have explored the lowered rates of Pap screening use among Latina women in the United States. These studies have utilized a variety of health behavior theories to explain and understand this health behavior. The following is a discussion of one of these studies.
In their study entitled Beliefs About Sexual Behavior and Other Predictors of Papanicolaou Smear Screening Among Latinas and Anglo Women, Hubbell, Chavez, Mishra and Valdez explore two intrapersonal theories of health behavior: locus of control and health belief model. In this study, the researchers conducted telephone interviews of Latina and Anglo women in the Orange County area of California. These interviews gathered information about demographics, acculturation, and cervical cancer knowledge, attitudes, and prevention behaviors.
This study found that while Latinas had high levels of knowledge of the true risk factors of cervical cancer, they also were more likely to believe in myths or falsities regarding risks for the disease, such as the belief that intercourse during menstruation increases one’s risk for developing cervical cancer. The researchers found that in Latinas, the particular beliefs held by the subjects did influence their probability of seeking cervical cancer screening services.
The findings of the researchers in this study can be best understood using the framework of the health belief model, specifically the ideas of perceived susceptibility, perceived benefits, and perceived barriers.
Perceived susceptibility seems to influence Pap smear use among Latina women. Latinas who believed that Pap smears were necessary only when they experienced abnormal vaginal bleeding were 70 percent less likely than others to access Pap tests. The concept of perceived benefit was also found to affect Pap smear use among Latinas in this study. Latinas who were married were more likely to access Pap services, due to their perceived benefit of preserving their health in order to care for their families. There also appeared to be the perceived barrier of the psychological cost to Latina women when experiencing a Pap test. The researchers report that women who experience embarrassment die to the correlation of cervical cancer to sexual activities are less likely to access services.
While not explored in depth in the research, this study also discussed the idea of locus on control. The researchers discovered that many Latinas felt that the development of cancer in an individual was a matter of fate, and that these fatalistic ideas lessen the likelihood of cancer screening behaviors. If a woman believes that having cancer is a matter of fate, that means she has an external locus of control, and she feels little power over influencing her health status. This logically leads to the conclusion that women with fatalistic beliefs about cancer would be less likely to access screening services.
American Cancer Society, www.cancer.org
Hubbell et al. Beliefs About Sexual Behavior and Other Predictors of Papanicolaou Smear Screening Among Latinas and Anglo Women. Archives of Internal Medicine. 1996; 156; 2353-2358.