Study: Latina Immigrants Reluctant to Seek Pap Smear

Latina immigrants are much less inclined to seek exams to detect cervical cancer than white women and U.S.-born Latinas, in part because of cultural beliefs associating the disease with immoral behavior, a UC Irvine study found.

Also, Latina immigrants were more likely to prefer not to know if they have cervical cancer, to fear telling their spouses, to believe that Pap-smear examinations are necessary only in the presence of vaginal bleeding and to be fatalistic about the disease.

The study is part of a five-year comprehensive review of health-care access, funded by a $1.2-million grant by the National Cancer Institute. The aim is to find better ways to prevent cervical and breast cancer in the Latina community. Latinas suffer higher rates of both diseases than other ethnic groups.

“The bottom line to this whole study is that we believe you have to address these issues in a culturally sensitive manner, [bring in] Latina women providers, if necessary, and incorporate these beliefs into educational efforts and not dismiss them as silly beliefs,” said Dr. F. Allan Hubbell, lead author of the study, published last month in the Archives of Internal Medicine.

But an Orange County Latina health activist cautioned against ascribing to culture what may have more to do with education, socioeconomic standing and an unaccommodating health-care system.

“My concern is we tend to blame culture for everything,” said Dr. America Bracho, founder of Latino Health Access, a nonprofit health education and promotion group. “I question more the style of the [health] education, the inappropriateness of the system.”

Bracho said she suspects that if researchers compared impoverished women from Appalachia and white women from New York City, they would have reached some of the same conclusions about the less affluent group.

“It’s because they are poor,” she said.

Hubbell agreed that health insurance status (which is associated with class) is probably the most important factor influencing women’s access to preventive care. Marital status is important as well: Married Latinas were more than two times as likely as single women to report receiving a Pap smear in the last three years.

But Hubbell said the study used a statistical method that accounted for these factors, as well as age, education, income and employment status. Even so, he said, cultural beliefs were found to be “highly significant.”

In general, Latina immigrants were more likely than U.S.-born Latinas and whites to agree that starting sexual intercourse at an early age and having multiple sexual partners increases the risk for cervical cancer.

And they are right. It is becoming increasingly accepted in the medical community that cervical cancer is a sexually transmitted disease, caused by infection with the human papilloma virus. Yearly Pap exams are recommended after age 18.

But the immigrant group also is more inclined to believe in more farfetched sexual risk factors, such as having sex during menstruation, Hubbell said. Previous studies have shown these women believe the cancers result from their being “unwise” or that they were being punished by God for immoral behavior.

“The interpretation of that is open to question,” Hubbell said. “But one possible [conclusion] is that because of their . . . cultural beliefs, they may be more reluctant to acknowledge they have a disease associated with sexual activity, and more reluctant to seek preventive care.”

The challenge, Hubbell says, is to educate these women in a way that is not alienating or inclined to aggravate their fears.

“Physicians should be cautious when counseling these patients about the cause of the disease,” the study concludes. “Indeed, stressing the sexual transmission of cervical cancer could even discourage Latina immigrants from obtaining appropriate Pap smear screening.”

Education is a critical concern because cervical cancer is an almost entirely preventable illness, Hubbell said.

Bracho stresses making realistic, tailored outreach efforts. It does no good to hold a special clinic for Pap smears, she said, if child care is not available for an unemployed Latina mother.

She agreed with Hubbell on this much: “It is not only more education that is needed,” she said, “but more sensitive and supportive education.”

The study was based on a telephone survey of 1,225 women aged 18 or older in Orange County. Participants included 803 Latinas (533 immigrants) and 422 white women.

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Reluctant Patients

Latinas, particularly immigrants, are less likely to get a pap smear than are their U.S.-born or white counterparts. Last reported pap smear:

Immigrant Latinas

Less than 1 year: 43%

1-2 years: 14%

2-3 years: 6%

More than 3 years: 6%

Never: 32%

*

U.S.-born Latinas

Less than 1 year: 63%

1-2 years: 19%

2-3 years: 7%

More than 3 years: 5%

Never: 6%

*

Whites

Less than 1 year: 61%

1-2 years: 21%

2-3 years: 11%

More than 3 years: 6%

Never: 2%

Note: May total more than 100% due to rounding

Source: UCI