Facilitators Of Cancer Screening Research Articles

Participation, Barriers, and Facilitators of Cancer Screening Among LGBTQ+ Populations: A Review of the Literature

ABSTRACT Compared with cisgender and heterosexual individuals, members of the LGBTQ+ community experience worse health outcomes. This is due to a combination of structural inequities and life experiences, including higher rates of mental illness and suicidality, sexually transmitted infections, and certain cancers. Men who have sex with men are at higher risk of anal cancer, and lesbian and bisexual women are often diagnosed with breast cancer at younger ages than heterosexual women partly due to lower parity and higher bodyweight. Despite these increased risks, some evidence shows the LGBTQ+ population is less likely to participate in early detection and cancer screening programs; however, the etiology of this is unknown. This review aims to summarize the current literature on cancer screening uptake in the LGBTQ+ population, including barriers and facilitators associated with screening participation. Studies published between January 2001 and April 2022 involving individuals identified as a gender or sexual minority that assessed participation in and/or facilitators and barriers to a cancer screening procedure were included. Barriers and facilitators identified in quantitative studies were reported on the individual-, provider-, and administrative/system-level scale. A total of 50 publications were included, 38 of which were quantitative, 10 were qualitative, and 2 used mixed methods. Among 16 relevant studies, considerable variation was identified when analyzing whether sexual minority women had lower participation in cervical cancer screening programs. Among 15 studies assessing the participation of sexual minority women compared with heterosexual women in breast cancer screening, 5 studies found no difference, whereas the remainder suggested lower rates of screening among sexual minority women. Fewer studies assessed screening among sexual minority men; however, sexual minority men were more likely to report anal cancer screening than heterosexual men. Cervical cancer screening participation among transgender men and gender diverse participants was lower than cisgender participants in almost all studies. Of 9 studies reporting breast cancer screening among gender diverse or transgender individuals, 5 found lower participation among transgender or gender diverse individuals compared with cisgender women. One study identified greater odds of up-to-date mammography among transgender men compared with cisgender women. The most common individual-level barriers to screening are related to knowledge of the screening tests themselves, including screening guidelines, procedures, pain, embarrassment, and a fear of results. One of the strongest correlates in studies was perceived discrimination from health care providers, which often resulted in lack of disclosure of sexual orientation or gender identity. Provider-level factors mostly included provider communication and relationship with the patient, and patients preferred providers experienced with LGBTQ+ clients and that used sexuality-inclusive language. Having open communication about sexual orientation and gender identity was a positive facilitator for all patients. System-level barriers included inclusive documentation and physical environments in health care. This review highlights key disparities including the lower screening rates among transgender patients in all categories and lower screening rates for cervical cancer and mammography among sexual minority women. It also highlights a significant need for representative data on all LGBTQ+ populations.

Abstract P024: Participation, barriers, and facilitators of cancer screening among sexual and gender minority groups: a scoping review

Abstract Background: Sexual and gender minority populations are at higher risk for certain cancers but less likely to engage with preventive healthcare such as cancer screening services. Despite this, the barriers, and facilitators to cancer screening among this population are not well understood. Methods: We conducted a systematic search of MEDLINE articles published between January 2001 and April 2021 related to sexual and gender minority group participation in cancer screening, as well as barriers and facilitators to participation. The search yielded 3,058 results and, following abstract and full-text screening, 51 quantitative and qualitative studies were included in the final synthesis. Results: When compared to their heterosexual counterparts, sexual minority women were less likely to participate in cervical cancer screening and mammography, while sexual minority men were more likely to participate in anal and colorectal cancer screening. Transgender individuals had lower rates of screening than cisgender individuals for all cancer types. Barriers to participation were found at the individual-, provider-, and administrator-levels. Individual-level factors included lack of knowledge about screening, fear of pain and embarrassment, and a fear of results (which could be both a negative and positive factor for screening participation). Not disclosing sexual orientation or gender identity to a healthcare provider was a barrier to screening participation, where perceived or previous experiences with discrimination from healthcare providers was an important factor in deciding whether to disclose. Lack of provider knowledge and use of (mis)gendered or heteronormative language by providers were significant barriers to screening and prevented patients from disclosing their identity. The strongest administrative barrier was a lack of LGBTQ-inclusive documentation and physical environments in healthcare. Conclusions: Our findings provide insights into how participation rates for sexual and gender minorities in cancer screening can be improved. Patient-centered approaches should draw on core guiding principles to inform the provision of sexual and gender minority care, including anticipating sexual and gender minority patients (including establishing a safe space for sexual and gender minority patients), improving knowledge about care for these patients, and confronting individually held biases that may affect care, to improve care experiences and participation rates in preventive services. Citation Format: Emily Heer, Cheryl Peters, Rod Knight, Lin Yang, Liam Sutherland, Steven J. Heitman. Participation, barriers, and facilitators of cancer screening among sexual and gender minority groups: a scoping review. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P024.

Abstract PO-041: The impact of COVID-19 on cancer care in the Latinx community in Northern California: A mixed method community-engaged research study

Abstract The COVID-19 pandemic has negatively impacted cancer care including delayed diagnosis, procedures, and patient fears of COVID-19 infection. However, less is known about the impact on specific populations, including Latinx adults, who have been disproportionately affected by COVID-19. Cancer is the leading cause of death among Latinx adults. Alarmingly, they have low participation rates in cancer prevention programs and face multiple barriers in accessing healthcare, even before the pandemic. Rigorous methods and community-engaged approaches are needed to uncover key barriers and facilitators to cancer care across the socio-ecological spectrum and to translate findings into culturally congruent educational strategies and dissemination efforts. The present mixed methods study entails a bi-directional partnership between the Stanford Medicine Office of Community Engagement and Latinas Contra Cancer, a community-based organization increasing equitable cancer care access for Latinxs. This study aims to determine barriers and facilitators of cancer screening, diagnostics, and treatment in the Latinx community as a result of COVID-19 using a community-based survey (n=500) in Northern California. To gain a deeper understanding of the lived experience of Latinxs obtaining cancer-related care during the pandemic, we will conduct focus groups (n=4) with study participants stratified by barriers and facilitators they endorse across the socio-ecological spectrum, as well as by key demographics (e.g., socioeconomic status, nativity, health literacy). Moreover, medical providers and community clinics will be interviewed (n=15) to understand their unique circumstances during this pandemic (e.g., changing healthcare system logistics, telehealth challenges). Data collection is ongoing and expected to be complete by the end of the summer. We will present descriptive data and statistical analysis (e.g., chi-square tests, logistic regressions) exploring associations key sociocultural and demographic participants characteristics and their endorsement of a variety of barriers and facilitators to care. We will also present key themes from the qualitative data to further contextualize survey findings and gain deeper meaning of the complexities of cancer related care during the pandemic. Study findings will allow us to understand the complexity of barriers and facilitators of cancer prevention and care for Latinxs adults, inform the development of health promotion resources, and guide policy and solutions to reduce excess cancer burden for Latinxs communities. Citation Format: Patricia Rodriguez Espinosa, Darcie Green, Yessica Martinez Mulet, Miriam L. Trigo, Natalia M. Zamora Zeledon, Eric Meléndez, Lisa G. Rosas. The impact of COVID-19 on cancer care in the Latinx community in Northern California: A mixed method community-engaged research study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-041.

Perceptions and Receipt of Cancer Screening among African Americans: A Community Networks Program Project

Objective: Minority groups constitute one of the nation’s highest cancer risk groups. Historically, these groups have not been adequately informed about cancer, its prevention and/or treatment. The purpose of this study was to examine participants’ receipt of cancer screening and to explore perceptions of barriers to and facilitators of cancer screening. Methods: A two-part study design consisting of a survey and focus group was conducted among African Americans residents of neighborhoods geographically defined as low-income areas of Chattanooga, Memphis, and Nashville in the state of Tennessee. The survey was administered to 1071 participants, and 12 focus groups were conducted with a total of 112 participants, with both sets of participants being residents of similarly defined underserved communities served by the community health centers. Results: Overall, 51% of surveyed respondents were females; the majority (75%) had a yearly income of less than $25,000; and 67% reported 12 years of education or less. Most surveyed respondents had a family history of cancer. More than 30% and 64% of male respondents over 50 years old did not receive prostate cancer and colorectal cancer screening, respectively; 58% of women 50 years and older were not screened for colorectal cancer; 28% of women over 40 years old did not receive breast cancer screening. Barriers to cancer screening included: lack of information about cancer screening and treatments, cost of cancer treatment and fear. The need for more information about cancer and cancer treatment, as well as the involvement of churches to increase cancer screening awareness was identified as facilitators. Conclusion: This study provides information into the structural and psychological barriers in cancer screening. It describes the self-reported prevalence/frequency of screening among men and women in our target population, and the associated facilitators to screening.

Barriers and Facilitators of Cervical Cancer Screening among Women of Hmong Origin

This qualitative study explored the barriers and facilitators of cancer screening among women of Hmong origin. Using a community-based participatory research approach, we conducted focus groups (n=44) with Hmong women who represented four distinct demographic groups among the Hmong community. The participants described sociocultural barriers to screening, which included a lack of accurate knowledge about the causes of cervical cancer, language barriers, stigma, fear, lack of time, and embarrassment. Structural barriers included attitudes and practices of health care providers, lack of insurance, and negative perceptions of services at clinics for the uninsured. Health care providers may require additional training and increased time per visit to provide culturally sensitive care for refugee groups such as the Hmong. Health-related social marketing efforts aimed at improving health literacy may also help to reduce health inequities related to cancer screening among the Hmong.

Self-Reported Willingness to Have Cancer Screening and the Effects of Sociodemographic Factors

BackgroundThe relative effects of race/ethnicity and other sociodemographic factors, compared to those of attitudes and beliefs on willingness to have cancer screening, are not well understood. MethodsWe conducted telephone interviews with 1148 adults (31% African American, 27% Puerto Rican American, 43% white) from 3 cities in mainland United States and Puerto Rico. Respondents reported their sociodemographic characteristics, attitudes about barriers and facilitators of cancer screening, and willingness to have cancer screening under 4 scenarios: when done in the community vs one's doctor's office, and whether or not one had symptoms. ResultsRacial/ethnic minority status, age, and lower income were frequently associated with increased willingness to have cancer screening, even after including attitudes and beliefs about screening. Having screening nearby was important for community screening, and anticipation of embarrassment from screening for when there were no cancer symptoms. Associations varied across 4 screening scenarios, with the fewest predictors for screening by one's doctor when there were symptoms. ConclusionsSociodemographic characteristics not only were related to willingness to have cancer screenings in almost all cases, but were generally much stronger factors than attitudinal barriers and facilitators. Cancer screening campaigns should affect attitudinal change where possible, but should also recognize that targeting screening to specific population groups may be necessary.

Cervical cancer screening among Latinas recently immigrated to the United States

Background. Little is known about the cancer screening practices of women whose behavior may place them at a high risk for cervical cancer. We explored factors that influence repeated Pap smear screening among recently immigrated Latinas working in bars also called cantinas. Methods. Face-to-face interview were administered to 360 women working in 60 cantinas. Participants provided information about their cancer screening practices including the number of Pap smears completed in the 5 years before the interview. A theory-based model proposing that demographic characteristics, cancer screening barriers and facilitators, and psychosocial factors influence repeated Pap smear screening was tested with a hierarchical linear regression. Results. Facilitators of cancer screening (recent visit to a physician and receiving a Pap smear in a clinic) and psychosocial variables (Pap smear beliefs, cancer screening intentions and lack of encouragement) were significantly associated with the total number reported Pap smears (adjusted R 2 = 0.31, P < 0.0001). Cervical cancer risk behaviors were not significantly associated with repeated screening. Conclusions. While risk behaviors did not act as barriers, access to health care measures facilitated repeated Pap smear screening. Psychosocial factors hypothesized to function as antecedents of Pap smear screening appear instead to follow from repeated experience with the examination.