ONCOLOGY Understanding barriers to cervical cancer screening among Hispanic women Luisa Watts, BA; Naima Joseph, MS; Amanda Velazquez, BA; Marisa Gonzalez, MD; Elizabeth Munro, MD; Alona Muzikansky, MA; Jose A. Rauh-Hain, MD; Marcela G. del Carmen, MD, MPH OBJECTIVE: We investigated issues affecting Papanicolaou smear screening access, health services utilization, acculturation, social net- working, and media venues most conducive to acquiring health infor- mation among Hispanics. STUDY DESIGN: Self-identified Hispanics were surveyed. Participants were stratified based on age, time living in the United States, and Pa- panicolaou screening frequency. RESULTS: Of 318 participants, Hispanics aged 30 years or older and living in the United States less than 5 years prefer speaking Spanish. Women with 5 or more lifetime Papanicolaou smears were 1.610 times more likely to have lived in the United States 5 or more years, 1.706 times more likely to speak a second language, and 1.712 times less likely to need a translator during their health care encounter. CONCLUSION: Age and years living in the United States may be independent risk factors for participation in Papanicolaou screen- ing programs. Social difficulties inherent to acculturation inform health behavior and translate to health disparity among Hispanics. Our results may help design federally funded and community-level programs. Key words: cervical cancer screening, disparities, Hispanics Cite this article as: Watts L, Joseph N, Velazquez A, et al. Understanding barriers to cervical cancer screening among Hispanic women. Am J Obstet Gynecol 2009;201:199.e1-8. S ince the institution of Papanicolaou screening program, both the inci- dence and mortality of cervical cancer in the United States have steadily declined. 1 Although the decline in incidence and mortality rates of cervical cancer in the United States have occurred across all ra- cial and ethnic groups, significant dis- parities in these rates continue to exist. 1 Hispanic women in the United States shoulder a disproportionate burden, both in rates of incidence and mortality from cervical cancer. According to the Surveillance, Epidemiology, and End Results database, Hispanic women are diagnosed with cervical cancer twice as often as non-Hispanic white women. 1 The average annual cervical cancer mor- tality rate from 2000 to 2004 for Hispanic women in the United States was reported to be 1.5 times greater than that for non- Hispanic white women. 1 Several factors may account for the observed disparity in cervical cancer in- cidence and mortality among Hispanic women in the United States, as com- pared with these rates among non-His- panic white women. These factors in- clude differences in screening and follow-up rates and practices, treatment, behavioral risk factors, and potentially underlying biological variations. Al- though this disparity in cervical cancer incidence and rate is not uniquely shoul- dered by Hispanic women in the United States and also affects African American and American Indian/Alaskan Native and Asian-American/Pacific Islander women, Hispanic women represent a special group with certain unique needs. These needs include language profi- ciency, cultural preferences, legal status, and social networking. Hispanics repre- sent the fastest growing minority group in the United States, with an estimated 41 million Hispanics currently living in this country (14% of the total population). 2 It is estimated that by the year 2050, 102.6 million Hispanics will live in the United States, comprising 24% of the to- tal population. 2 As Hispanics become a growing segment of the US population, this continued disparity may have a sig- nificant impact on their community’s in- frastructure secondary to increased mor- bidity and mortality rates from an entirely preventable malignancy. 2 The growing number of Hispanics in the United States and their disparity across many disease spectra, including cervical cancer, will result in a continued burden to the US health care system. The factors that may play a role in His- panic women’s cervical cancer screening and treatment need to be elucidated to better design program and create oppor- tunities that will lead to the resolution of the disparity that currently exists. To better understand the factors that have an impact on cervical cancer screening and care among Hispanics in the United States, we conducted a large-scale survey study, in which self-identified Hispanic women were directly asked about issues affecting their access of Papanicolaou From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology (Ms Watts, Ms Joseph, Ms Velzquez, and Drs Gonzalez, Munro, Raugh-Hain, and del Carmen), and the Department of Biostatistics (Ms Muzikansky), Massachusetts General Hospital, Harvard Medical School, Boston, MA. Received Jan. 30, 2009; revised April 10, 2009; accepted May 12, 2009. Reprints: Marcela G. del Carmen, MD, MPH, 55 Fruit St., Yawkey 9E, Boston, MA 02114. mdelcarmen@partners.org. 0002-9378/$36.00 © 2009 Mosby, Inc. All rights reserved. doi: 10.1016/j.ajog.2009.05.014 Research www. AJOG.org AUGUST 2009 American Journal of Obstetrics & Gynecology 199.e1