Association Between Immigration Status & Cervical Cancer Screening: Systematic Review & Meta-Analysis

Syeda RIZVI, University of Calgary, Canada
DIAZ R. 1 , RABI D. 1 , DICKINSON J. 2

1 (Department of Community Health Sciences, University of Calgary, Calgary, Canada)
2 (Department of Family Medicine & Community Health Sciences, University of Calgary, Calgary, Canada)

Background: In developed countries, much invasive cervical cancer, and the highest mortality rates occur in women who never had a Pap test. Immigrants appear less likely to have been screened for cervical cancer than non-immigrants due to various factors such as education, income, knowledge etc.
Objective: We aimed to determine the magnitude of association between immigration status and cervical cancer screening (ever been screened) among women in developed countries.
Approach: The search used guidelines of the Center for Reviews and Dissemination, using a combination of keywords related to cervical cancer and screening. Data was extracted using the 2009 PRISMA checklist. The Newcastle-Ottawa Quality Assessment Scale was used for confounding and quality assessment.
Results: From 7426 citations, ten articles were included in the systematic review and eight in meta-analysis. The studies were published between 2001 to 2013 from Australia, UK, USA, Canada & Spain. Immigrants are less than half as likely to have ever been screened as non-immigrants in Canada (pooled OR = 0.44; 95% CI:0.386- 0.511), Spain (OR = 0.41; 95% CI: 0.365-0.467), and Australia (OR = 0.44; 0.376-0.508). In the UK, the ratio is worse (OR = 0.23; 0.210-0.244) In the USA, the trend was similar but not significant (polled OR = 0.62; 0.190-2.083). Demographics showed immigrants are less likely to be educated, have lower income and are uninsured. Women born in Asia had lower odds of ever being screened compared to other immigrant groups.
Conclusion: A statistically significant association was found between immigration status and cervical cancer screening but there are limitations due to data reporting. Efforts to increase cervical cancer screening should focus on newly arrived immigrants, immigrants with low levels of education, with low household annual income, and particularly from Asian background. Improving access to care is important to increase cervical screening practices among immigrant populations.