Black US women share their experiences with follow-up after abnormal cervical cancer screening

TL;DR

This study explores why Black women in Michigan may not follow up after abnormal cervical cancer screenings, highlighting emotional burdens and lack of knowledge about HPV.

Contribution

The study introduces the concept of the 'eternal cycle of HPV uncertainty' and its impact on follow-up behavior specific to Black women.

Findings

Only 14 out of 72 invited Black women completed the survey and interview.

Barriers to follow-up included emotional burdens and lack of knowledge about HPV.

New educational platforms tailored to racial/ethnic communities are needed for HPV screening.

Abstract

Black women have both high screening and high cancer rates, indicating a lack of appropriate follow-up after an abnormal screening. Our mixed methods study explores the experiences of Black women who had abnormal cervical cancer screening results in Michigan.

Sequential mixed-method study design.

We identified a random group of 72 Black women with recent abnormal screening results requiring colposcopy follow-up from the aggregated local healthcare systems and invited them to participate. We designed a quantitative survey based on validated national health survey modules and a qualitative interview structured on the Theoretical Domains Framework (TDF), which was analyzed using Applied Thematic Analysis (ATA). We calculated each person's social deprivation index (SDI) based on quantitative results.

Fourteen women completed the survey and interview. Five, seven, and two women chose no colposcopy, appropriate colposcopy, and missed colposcopy, but returned for close interval surveillance, respectively. The qualitative themes provided a potent emerging theme: the eternal cycle of human papillomavirus (HPV) uncertainty, which provided context for the other identified themes centered around lack of knowledge leading to emotional burdens, which intersected with being seen as a Black woman. We found similar barriers that have been noted for screening, such as relationships, positive and negative, having some influence on follow-up behavior.

With the shift to primary HPV screening, new educational platforms must be created and tailored to explain the HPV cycle for each racial/ethnic community.

The lack of knowledge about the eternal cycle of HPV uncertainty leads to Black women's lack of colposcopy follow-up.