Perceived barriers and benefits to cervical cancer screening in Latin America I. Agurto, Ph.D., a, * A. Bishop, M.S.W., M.P.H., b G. Sa ´nchez, M.P.H., c Z. Betancourt, M.D., d and S. Robles a a Pan American Health Organization, Washington, DC 20037, USA b Program for Appropriate Technology in Health, Seattle, WA 98107, USA c Fundacio ´n INCIENSA, San Jose ´, Costa Rica d Health Consultant, Quito, Ecuador Available online 13 May 2004 Abstract Background. This article describes the results of studies on the barriers and benefits of cervical cancer screening from the perspective of women, men, and health providers in five Latin American countries and compares them to other findings from the literature. Methods. Five separate qualitative studies (focus groups and interviews) were conducted among low-income women in Venezuela, Ecuador, Mexico, El Salvador, and Peru regarding barriers and benefits of cervical cancer screening. Views from health providers and men were also included. Results. The main barriers identified by all participants are accessibility and availability of quality services, facilities that lack comfort and privacy, costs, and courtesy of providers, which interact with poor service delivery. Barriers that pertain to women’s beliefs are anxiety borne by women awaiting test results, associated with negligence and fear of cancer (although not to a particular cancer or a particular procedure). Benefits of screening are peace of mind and being in control of their health, which then enable other life activities to continue unhindered. Conclusions. Except for the accessibility and availability of quality services, these results are consistent with findings from other studies in developed and developing countries. Barriers could be lifted if health service delivery was enhanced, for instance, through quality improvement techniques that are available at low cost. Women’s anxiety over test results still needs to be further assessed to devise risk communication strategies that take into account broader cultural frameworks. It is to be noted that such strategies should permeate the way health services are provided for cervical cancer prevention regardless of the specific test used. Vulnerability perceived by low-income women with respect to their capacity to cope with diseases and trust the health services and how this affects their perceptions of risk and their behaviors have not been studied as yet. D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. Keywords: Cervical cancer; Focus groups; Benefits of screening Introduction Every year, more than 68,000 new cases of cervical cancer are reported in the region of the Americas with the lowest incidence being found in Canada and the United States and the highest in Peru and Brazil [1]. Epidemiolo- gical studies suggest that incidence and mortality from cervical cancer are projected to increase in Latin America and the Caribbean by 2020 [2]. Longstanding opportunistic screening in Latin America has not reduced the high incidence and mortality rates of cervical cancer. In Mexico, for instance, although a national detection program has been implemented for 23 years, cervical cancer continues to be the first cause of death due to neoplasias among women 35 years old and over [3]. Several Latin American countries with rates similar to Cana- da’s 1960 rate (Brazil, Colombia, Cuba, Guatemala, Uruguay, and Venezuela) saw their cervical cancer mortality remain at the same level over a 33-year period without showing significant declines, whereas mortality rates in Canada and the United States decreased steadily over the same period [1]. There is a need for well-organized and effective programs in 0091-7435/$ - see front matter D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2004.03.040 * Corresponding author. Pan American Health Organization, 525, 23rd Street NW, Washington, DC 20037. Fax: +1-202-974-3331. E-mail address: agurtoir@paho.org (I. Agurto). www.elsevier.com/locate/ypmed Preventive Medicine 39 (2004) 91 – 98