Background: Sexually transmitted infections (STIs) clinics have been identified as an important setting for conducting screening programs for cervical cancer. Studies have confirmed that STI patients are at very high risk of yielding abnormal Pap smears and that STI clinics have great potential to carry out cancer screening programs. Despite the fact that these groups of women who attend STI clinics are at higher risk of abnormal cervical cytology, none of the STI clinics in the island offer Pap testing which act as a screening tool for cervical cancer.

Study Objectives: To determine the prevalence of compliance of cervical cancer screening among women attending the Centro Latino Americano de Enfermedades de Transmisión Sexual (CLETS) in Puerto Rico and to develop an epidemiological profile of those women who reported not having a Pap smear in the last year.

Methods: An ongoing clinic-based cross-sectional study among women 21 years and older attending CLETS for clinical care. A screening of women attending the clinic was performed to determine those who reported to not have had a Pap test in the last year. Women eligible to participate in the study were only those who reported to not have had a (1) Pap test in the last year, (2) being older than 21 years and (3) not being pregnant at the time of the interview. Among these women, a behavioral interview was conducted including sociodemographic, behavioral risk factors (sexual practices), cancer prevention screening practices and self-report of STIs.

Results: At the time of this preliminary analysis, 68 participants were screened for participation in the study. Screening interview showed that 65.3% of the women attending the clinic have not had a Pap in the last year. The vast majority (75.0%) was interested in participating in the study; however 37.3% did not meet the inclusion criteria and were not qualified for the study. Among those who qualified (n=32), all of them agreed to participate in the study, indicating a 100% participation rate. The mean age of the study participants was (36±12.6) years old. Sociodemographic characteristics indicate that the majority of the women (76.6%) reported having an annual income less than $10,000, almost half (53.1%) of the sample reported to have not graduated from high school and 68.7% reported being currently unemployed. The majority of the participants were single at the time of the interview (59.4%). A high prevalence of lifetime high-risk number of sexual partners (6 sexual partners of more) was reported among the study sample (57.1%). Self-report data showed that the most common STIs were HIV (36.7%), Genital warts (28.1%) and Chlamydia (21.9%). A quarter (25%) of the women reported an abnormal Pap test and 12.5% reported not having a Pap test more than five years ago.

Conclusion: It has been documented that women who attend STI clinics have a high prevalence of sexual partners, as well as a high prevalence of viral and bacterial infections which might put them at risk for long-term sequelae such as cervical cancer. This study also showed a high prevalence of both previous abnormal Pap test and significant time since last Pap test. Behavioral interventions designed to increase awareness of cervical cancer screening prevention among vulnerable and disadvantage population are necessary and STI clinics might help in capturing a dynamic, at-risk population.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B103.

Copyright © September 18, 2011, American Association for Cancer Research
2011