Foreign birth and Cervical Cancer: Screening, HPV Awareness, and Acculturation in California, Stage and Survival in 18 Surveillance Epidemiology and End Results (SEER) Registries
Introduction: Previous literature indicates that foreign-born women have lower rates of cervical cancer testing and higher mortality rates when compared to U.S.-born women. Factors that influence receipt of cervical cancer screening among foreign-born women include acculturation and human papillomavirus (HPV) knowledge. Methods: In this cross-sectional study, the 2007 California Health Interview Survey (CHIS) was used to examine the impact of acculturation on cervical cancer screening and HPV knowledge and the 2000-2008 Surveillance Epidemiology and End Results (SEER) database was used to determine differences in stage of diagnosis and survival time. The study population included a total of 3,603,412 foreign-born and 6,749,557 U.S-born women in the CHIS between the age of 18 to 65 and a total of 10,733 U.S.-born and 5,069 foreign-born women in the SEER database. Logistic regression was used to examine the predictors for cervical cancer screening and Cox’s proportional hazards ratios were used to determine the effect of covariates on survival time. Kaplan-Meier survival analysis generated survival curves. Results: Acculturation levels were positively associated with ever having a Pap test, ever hearing about HPV, knowledge that HPV causes cancer and HPV does not cause AIDS, but not with current receipt of a Pap test, knowledge that HPV can be sexually transmitted and that HPV can go away without treatment. Women with low (0.38, (CI, 0.22, 0.66)) and medium (0.50, (CI, 0.39, 0.81) levels of acculturation were less likely to ever receive a Pap test and less likely to ever hear of HPV compared to highly acculturated women. Foreign-born women had a lower risk of death than U.S.-born women. Conclusions: Despite a reported lower risk of death, foreign-born women, particularly those less acculturated, may benefit from targeted interventions to increase cervical cancer screening utilization and general HPV awareness.