January 22nd – 28th 2024 is Cervical Cancer Prevention Week. It is an opportunity to raise awareness of cervical cancer and recognise the symptoms to help women understand how to reduce their risk and prevent illness.
Approximately 14 high-risk types of human papilloma virus account for most cases of cervical cancer. Through regular cervical screening and HPV vaccination, it is a largely preventable disease, and in 2018, the World Health Organization (WHO) called for worldwide action to eliminate cervical cancer (defined as an incidence rate maintained below 4 per 100,000).[1] However, despite it being largely preventable, approximately 3,200 women in the UK, mostly aged 30-34 years old, are diagnosed annually, with more than 800 losing their lives. This equates to nine diagnoses and two deaths a day.[2] Furthermore, data shows that there are ethnic inequalities in the uptake of cervical screening. A YouGov survey (date not provided) commissioned by Jo’s Cervical Cancer Trust found that women from Black, Asian and minority ethnic backgrounds were more likely than White women to report never having attended a screening (12% vs 8%).[3]
The same survey identified barriers to accessing screening for this group of women. These included a lack of awareness about the purpose of the screening test:[3]
- Fewer Asian women aged 20-65 (70%) knew that screening is a test to check cells from the cervix to find pre-cancerous abnormalities than White women of the same age (91%).
- Just over half (53%) of Black, Asian and minority ethnic women aged 55-65 think screening is a necessary health test compared with 67% of White women in the same age group.
- Twice as many Black, Asian and minority ethnic women as White women said better knowledge about the test and its importance would encourage them to attend a screening appointment (30% against 14%).
Women from an ethnic minority background (28%) were also less likely to be comfortable talking to a male GP about cervical screening.[3]
This was reinforced by the findings from another study which found that some women, mostly of Asian ethnicity, would not attend if the option for a female was not there.[4]
Other barriers to cervical screening that have been identified as potentially being more common among women from ethnic minority backgrounds include:[4]
- Considering themselves low risk due to not having a partner or being married.
- Lack of familiarity with the terminology used to describe the test, even among English-speakers.
- Shame and stigma of cancer in some ethnic minority communities.
- Embarrassment among women from older generations.
Addressing ethnic inequalities in screening uptake is an important part of achieving the WHO’s goal of elimination. Targeted education to improve understanding and awareness of cervical cancer and cervical screening among women from ethnic minority backgrounds is likely to play a crucial part in this4. Delivery of such education in community settings may be of benefit, particularly for older women, and it should include translating screening invitation leaflets/letters into different languages. Furthermore, it should address the shame, stigma and embarrassment that is experienced by some women from ethic minority backgrounds.[4],[5]
The Faculty of Public Health’s Sexual and Reproductive Health Special Interest Group will continue to seek out opportunities to raise awareness of sexual and reproductive health inequalities, including ethnic inequalities, in line with the Faculty’s anti-racism framework and action plan.
Dr Natalie Daley
Chair of FPH’s Sexual and Reproductive Health Special Interest Group (SIG)
REFERENCES
[1] https://www.who.int/initiatives/cervical-cancer-elimination-initiative
[3] https://www.jostrust.org.uk/sites/default/files/bme_survey_website_final.pdf
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