Deaths from cervical cancer have been reduced by 90 percent in the United States since the implementation of the Papanicolaou (Pap) smear 60 years ago. Nevertheless, an estimated 11,000 new cases of cervical cancer are diagnosed and 4,000 deaths occur each year from this disease. In approximately one half of new cases, the women report suboptimal screening. Behbakht and colleagues studied behaviors, attitudes, and beliefs that impose barriers to optimal screening for cervical cancer.

The authors studied women recently diagnosed with cervical cancer at three urban hospitals. Using an advisory panel, inventories from national cancer organizations, and a literature review, they developed a questionnaire. The questionnaire addressed lifestyle issues, fatalistic attitudes, patient relationships with health care professionals, and demographic information. It was translated into Spanish and pretested on patients who were eligible for, but not included in, the study. Using the data gathered by the questionnaires, the responses of women who had never had a Pap smear was compared with the responses of women who reported receiving at least one Pap smear before being diagnosed with cancer.

One fourth (n = 36) of the 146 patients recently diagnosed with cervical cancer reported never being screened for cervical cancer. Women in the never-screened group were more likely to be Hispanic, recent immigrants, and to have no health insurance and limited education and family support. They also were much more likely to believe that cancer occurred because of bad luck, and to report not wanting to know the diagnosis. The two groups did not differ in: age; the influence of religion on health care choices; access to physicians; trust for physicians, or aspects of knowledge about cancer causation, detection, prevention, and treatment. Only 16 percent of women stated that they would rather do a home test for cancer than have a physician perform a conventional Pap smear.

The authors conclude that fatalistic attitudes, lack of family support, and low levels of information about cervical cancer are associated significantly with lack of Pap screening in women with cervical cancer, as are the previously identified risk factors of recent immigration and low levels of education. They argue that attitudinal, financial, and cultural barriers must be overcome to improve cervical cancer screening in the United States, and that development of home testing may have only limited acceptability. They recommend mobilization of community resources to address attitudinal barriers to cervical cancer screening.