Cervical cancer screening among marginalized women: A cross-sectional intervention study

Thomas H.G. Bongaerts*, Marlieke Ridder, Josephina C.J. Vermeer-Mens, Jeanette J. Plukkel, Mattijs E. Numans, Frederike L. Büchner

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
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Background: Many countries organize population-based cervical cancer screening programs (CSP). In the Netherlands, eligible women are invited by mail. Marginalized women living in unstable conditions and homeless women often fail to receive the invitation letter. These women also experience access barriers to regular healthcare. Consequently, despite presumably being at higher risk of developing cervical cancer due to prevalent risk factors, marginalized women are rarely screened for cervical cancer. The aim of the study was to identify the prevalence of (pre)cancerous abnormalities among marginalized women, and subsequently explore invitation approaches to enhance their screening participation. Methods: A cross-sectional intervention study was conducted in Rotterdam, the Netherlands. Between February and May 2019, marginalized women aged 20–60 years were invited to participate in cervical screening. A participant was considered screen-positive when they tested positive for high-risk human papilloma virus (HR-HPV) and showed cytological abnormalities. Data of the study population were compared with regional data of the Dutch CSP. Various invitation approaches were used to recruit women. Results: Out of 74 included women, 12 participants (16%) were found screen-positive, against 3.4% in women screened by the Dutch CSP. The prevalence ratio for the study population was 4.4 (95% CI 1.9–8.6) compared with women screened by the Dutch CSP. Using a direct, pro-active approach resulted in participation of 92% of the included women. Conclusion: Marginalized women have an increased risk of (pre)cancerous cervical abnormalities in screening, compared with women screened by the Dutch CSP. A direct pro-active approach was the most effective to stimulate screening participation. Enhancement of screening uptake for this population needs special effort.

Original languageEnglish
Pages (from-to)549-556
Number of pages8
JournalInternational Journal of Women's Health
Publication statusPublished - 8 Jun 2021

Bibliographical note

Funding Information:
The authors wish to thank all partners who welcomed the medical team with trust and expertise on how to engage the study population. Many acknowledgements to Annelies van Vliet-Klerk from the Erasmus Medical Center for coordinating the liquid-based cytology sam-pling, and to all members of the cytology team for analyz-ing the cervical samples. Appreciation for Stichting Bevolkingsonderzoek Zuid-West for covering a part of the costs and by supporting this research. Gratitude to the Netherlands Streetdoctors Group for solving the financial puzzle, regarding the cytology sampling.

Publisher Copyright:
© 2021 Bongaerts et al.


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