Improving the Uptake of Cervical Cancer Screening among Women from Ethnic Minority Groups

Introduction

Cervical cancer, a type of cancer affecting women, has become a priority health issue over the last few years (Parkhurst and Vulimiri, 2013). According to Parkhurst and Vulimiri (2013), when discussing female only cancers, ‘cervical cancer is the second leading cause of cancer deaths for women globally’ (pg.1093), resulting in significant morbidity and life impairment, before ultimately leading to death. Evidence from Cancer Research UK (2017) shows that in the UK, that there has been up to 5% increase in the prevalence and incidence of cervical cancer, with ethnic origin playing a role in who get a diagnosis. Cervical cancer diagnosis is usually done when a patient is referred by their GP, and 53% of patients are likely to undergo surgical procedures as part of the treatment regime (Cancer Research UK, 2017).

Furthermore, Cancer Research UK (2017) reports that, cervical cancer is  most common among women 35 years old and younger, and while there is an increase in the incidence of this type of cancer, it is interesting to note that when diagnosed early, 63% of people who are diagnosed with cervical cancer  are likely to survive. More importantly, using evidence from research conducted in 2015, Cancer Research UK (2017) suggests that, 99.8% of cervical cancer cases are preventable  through the Human Papilloma Virus (HPV) Vaccine. The HPV Vaccine, is designed to prevent cervical cancer, and should be given to girls between the age of 12 and 18 years (NHS Choices, 2017). Due to the age limit for the HPV vaccine, this has an implication for women born outside the UK in countries where HPV vaccination is not routinely available, as it increases their risk of developing cervical cancer. (Ginsburg and Paskett, 2018). As suggested by Ginsburg and Paskett (2018), social inequality continues to be a strong predictor of whether an adult woman will adopt behaviours that will promote their health, and reduce the global burden of cancer.

Cervical cancer is a priority health issue in the UK. This is as due to the fact that, while it is a cancer that can be prevented, a significant number of women are not vaccinated. Hence, the NHS cervical screening program was developed to address this (Public Health England, 2017). The frequency of screening invitations is dependent on age, as women under the age of 49 years are offered a screening appointment once every three years, while women over the age of 50 years are offered screening appointments once every five years (Public Health England, 2017). It is interesting to note that, the uptake of the screening program has been falling below the expected national average every year (Public Health England, 2017), and as indicated by Johnson et al. (2018), women from ethnic minority groups are less likely to attend cervical screening appointments. Marlow et al. (2015) suggests that, ‘low perceived risk of cervical cancer due to sexual inactivity, belief that screening is unnecessary without symptoms and difficulty finding an appointment that fits in with other commitments’ (pg. 833) are some of the reasons women from ethnic minority populations do not attend cervical cancer screening appointments. As indicated by Marlow et al. (2015), there is need for bespoke intervention targeting women from ethnic minority populations, to address the importance of cervical cancer screening, and thus, improve uptake of the NHS Screening programme. Hence, this report will discuss two approaches to improve uptake of cervical cancer screening among ethnic minority women.

How to Improve Screening Uptake – Proactive Strategies

Cervical Cancer Roadshows

In the UK, the utilisation of roadshows to highlight health issues have been shown to raise awareness, improve service utilisation, and increase people’s understanding of health issues affecting them (Crosbie et al., 2018). Evidence from Crosbie et al. (2018) shows that it is possible to raise awareness of cancer, and offer basic screening within local communities. Visiting local communities with the specific aim of proactively engaging people and giving them information is referred to in this report as a roadshow.

With respects to cervical cancer, a leading UK charity, Jo’s Cervical Cancer Trust, visited 16 cities across the UK in 2017 to raise awareness, educate and signpost women to relevant services to enable them take up cervical screening appointments (Jo's Cervical Cancer Trust, 2017). As reported, the Be Cervix Savvy Roadshow (Jo's Cervical Cancer Trust, 2017) was the first ever cervical cancer awareness raising activity in the UK, and it was suggested to have engaged with many women, resulting in over 9,000 conversations, distribution of 19,332 information materials, and lasting over 66 days. Many of the barriers preventing women from taking up the screening appointments were discussed, and the importance of health literacy was highlighted, especially since many women did not understand why they were offered cervical screening appointments when they were either sexually inactive or asymptomatic.

While the success of the Be Cervix Savvy Roadshow should be lauded, there is more to be done to engage women from ethnic minority populations, in ensuring that many more are being screened to prevent the development of cervical cancer. Beyond giving information about cervical cancer and signposting to the GP and other healthcare professionals, cervical cancer roadshows should also include on-the spot low-risk screening. Since difficulty incorporating screening appointments with other existing commitments (Marlow et al., 2015) has been identified as a barrier to uptake of screening appointments, the roadshows should include an element that will give women the option having the smear test being conducted, and where there is an indication of abnormal result, women can then be referred to their GPs for further tests and confirmation. By using this proactive approach, there is the likelihood that many women from ethnic minority groups will be screened. Although there is the likelihood that screening on-site may generate false-positive results (Crosbie et al., 2018), which may then increase the anxiety of women regarding whether they have cancer, this can be addressed by ensuring that all women understand that the screening is not a diagnosis, and that they would be required to visit their GP to confirm the result of the smear test.

Health Education and Campaigns at Ethnic Minority Groups Strategic Locations

According to Releford et al. (2010), in order to engage people from ethnic minority groups with issues affecting their health, it is important to approach them in their local communities, and areas where they normally meet. Evidence from the literature synthesis by Linnan et al. (2014) shows that barbershops, salons and other beauty parlours are areas where health education can be delivered. Furthermore, Balls-Berry et al. (2015) highlights that, barbershops, churches, mosques and other areas where people from ethnic minority groups might meet are a ‘culturally safe site in which to promote health through screening and education among a vulnerable population’ (pg.2).

With respect to women’s health, Linnan and Ferguson (2007) contends that targeting beauty salon owners, stylists and staff for health education interventions has the potential to increase knowledge and raise awareness of various health issues. In addition, since the salon is a safe space for women, salon owners being informed and talking about health issues is likely to be well received by customers and others present at the salon. Thus, healthcare professionals can proactively increase the uptake of cervical cancer screening by working with salons and beauty parlour owners serving customers from ethnic minority groups. This will entail providing bespoke campaign materials about cervical cancer that can be presented to customers. The campaign materials will need to take into consideration the language needs of women, especially since language barrier was identified as one of the factors mitigating uptake of screening appointments (Marlow et al., 2015). Furthermore, it is important that additional resources are provided to ensure women who self-refer for screening are attended to, rather than being made to wait for longer periods before they can have a smear test appointment (Jo's Cervical Cancer Trust, 2017).

Conclusion

This report has focused on cervical cancer, a topical health issue in the UK. Although cervical cancer is one of the leading cause of mortality among women globally, it is a preventable cancer, as a result of the HPV vaccine. There has been a 5% increase in number of new cases of cervical cancer, and a steady decline in the uptake of the NHS cervical cancer screening programme. In this report, it was highlighted that ethnic origin plays a role in the number of diagnosis, especially since many women are likely to migrate to the UK after the age that the HPV vaccine can be administered.

Existing evidence shows that many people from ethnic minority groups are less likely to attend their screening appointments as a result of the misconception and misinformation about cervical cancer. Factors such as language barriers, lack of sexual activity, being asymptomatic and conflicting appointments with existing commitments were highlighted in this report.

In order to improve the uptake of cervical cancer screening uptake, two proactive strategies were suggested. Firstly, it was suggested that cervical cancer roadshows be done in areas with significant ethnic minority population groups. Beyond giving information about cervical cancer, it was suggested that on-site screening be offered to women, with further signposting to their GPs for the result of their test. The second strategy presented in this report suggested using barbershops, salons and beauty parlours as avenues for health education and cervical cancer campaign.

Reference:

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