Vector Volume 11 Issue 1 - 2017

Factors that contribute to the reduced rates
of cervical cancer screening in Australian
migrant women - a literature review
[Review]
Archana Nagendiram
Archana is a fourth year medical student from James Cook University with interests in
global health and women’s health.
Abstract
AIM: This literature review presents factors that have led to decreased cervical cancer screening rates in Australian
migrant women. It also evaluates past interventions that have been implemented to solve this issue in screening.
METHODS: A wide range of peer reviewed articles from databases such as CINAHL and SCOPUS were analysed to
determine factors that have led to migrant women having a lower cervical cancer screening rate in comparison to
the general Australian population. This review also analysed the reference lists from these articles.
RESULTS: The factors that have led to this reduction in screening rates include cultural differences, limited acculturation,
modesty, and logistical issues. Specific cultural issues such as female genital mutilation and the use of Ayurvedic
medicine in certain ethnic groups may also contribute. There have been interventions aimed at increasing screening
rates, including ethnic media campaigns and education of health professionals, such as doctors and nurses who
work in these communities. However, their effectiveness is uncertain due to a lack of evaluation after implementation.
CONCLUSION: Whilst research has provided a basic understanding of the reasons that have contributed to
the difference in screening between these two populations, there have been insufficient strategies applied to
remedy it. Moreover, there has been inadequate appraisal of current interventions and discussion of the cultural
appropriateness of current programs.
Introduction
This year, the Australian government has renewed the
National Cervical Cancer Screening Program (NCSP) to
incorporate updated screening protocols in accordance
to new research. Hence, it is important to assess the value
of the previous screening protocols in underscreened
populations such as Australia’s migrant women. From 2012-
2013, 58.2% of the target population partook in the NCSP
and since the introduction of organised cervical cancer
screening in Australia, cervical cancer mortality has fallen
by 44% (95% CI 0.51-0.62).[1,2,3] Whilst migrant women
have benefited from screening, the results have not been
as favourable in comparison to the general population. The
incidence of cervical cancer is higher in migrant women from
countries with higher incidence of cervical cancer, including
Sub-Saharan Africa, Central America, South East Asia and
Melanesia.[1]
Consequently, this paper will examine relevant literature
since the current NCSP’s introduction in 1991. It will analyse
the factors that have caused lower screening rates in
migrants, at the level of both the individual and the health
system. It will also analyse past and future interventions that
may reduce these disparities evident in the rates of cervical
cancer screening in Australian migrant women.
Methods
This literature review used various online databases to
source information. It concentrated on articles that surveyed
Australian migrant women, however some larger international
studies were also used to provide global context. CINAHL
was searched with keywords “cervical cancer AND migrant
women”, and SCOPUS was searched with the key words
“cervical cancer AND migrant AND Australia”. Only peer
reviewed journal articles were used, and opinion papers were
excluded in the search. Relevant articles since 1991 were
analysed, from the implementation of the NCSP in Australia.
Additionally, reference lists of relevant articles were examined
using similar inclusion criteria.
What is a pap smear?
Pap smears are the recommended primary screening tool
for cervical cancer by the NCSP. During the procedure, the
doctor collects a cytological sample from the ectocervical
and endocervical canal of the uterus, which is then analysed to
see if any pre-cancerous or cancerous changes are present.
If a cytological abnormality is identified, the patient will then
be referred for colposcopy.[4] Pap smears are routinely
used in general practice and account for approximately 1.7
of 100 consultations.[5] Disease incidence and burden is
reduced in Australia through organised screening for cervical
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