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Many homeless women are reluctant to get free Pap smears

Research Activities, August 2010, No. 360

Women who are homeless often have difficulty accessing quality health care and paying for it. Such is the case with cervical cancer screening, where homeless women have higher rates of the disease. Yet when barriers to access and cost are removed, homeless women remain reluctant to get a free Pap smear and decline the offer, reveals a new study.

The researchers studied 205 women who were admitted to a medical care facility specifically designed to offer health care services to homeless people. Any woman receiving routine medical care was screened for eligibility for a Pap smear. The researchers collected a variety of medical and demographic information on participants. They interviewed each woman prior to screening and recorded all Pap smear results in the medical record. About half (55 percent) of the women were white; another 32 percent were black. Out of the 205 participants, 129 needed a Pap smear at the time they were interviewed. All of these women were offered screening; however, only 80 (62 percent) accepted and 56 of these women (70 percent) had the test performed. Ten women (20 percent of the group studied) were found to have atypical results requiring further investigation. Another 15 had benign results (for example, vaginitis without evidence of malignancy), but required followup. Forty-nine women (38 percent) declined to have a Pap smear. Women's reasons for refusing getting screened included not feeling hygienic enough or believing they were not at risk for cervical cancer.

While 20 percent of the homeless women studied required additional investigation of an atypical lesion, in the general population, this rate is only 2.3 percent. This suggests that homeless women may be more vulnerable to cervical cancer. The authors suggest that more creative screening methods need to be developed and offered to women in nontraditional settings. Their study was supported in part by the Agency for Healthcare Research and Quality (HS14010).

See "Disparities in cancer screening: Acceptance of Pap smears among homeless women," by Monica Bharel, M.D., Carolyn Casey, M.D., and Eve Wittenberg, M.P.P., Ph.D., in the Journal of Women's Health 18(12), pp. 2011-2016, 2010.

Page last reviewed August 2010
Internet Citation: Many homeless women are reluctant to get free Pap smears: Research Activities, August 2010, No. 360. August 2010. Agency for Healthcare Research and Quality, Rockville, MD.