Cervical cancer screening: Knowledge, attitudes, and practices among New York city homeless women

Background: Socioeconomically disadvantaged populations receive substantially less Pap tests, and these populations have misconceptions about Pap smears, HPV, and cervical cancer. Data regarding cervical cancer screening in the homeless population is scarce. Methods: We surveyed 90 women over age 18 on their knowledge, attitudes, and practices related to Pap smears and HPV infection using the Health Information National Trends Survey for Cervical Cancer at multiple women's shelters in New York City. Results Mean age was 45 years. Majority was Black, single, and had a high school or lower education. 40% were smokers. 33.3% had been homeless for more than 1 year. 65% did not know how often they needed Pap smears. 76% had a Pap smear within the last 3 years, and 50% had their second to last Pap smear within 5 years of their most recent. Only 40% knew about HPV's relationship to cervical cancer. Only 20% received information about HPV from health care providers. There were misconceptions including: HPV is not contracted through sexual contact, HPV is rare, and HPV does not cause abnormal Pap smears. Women who were homeless less than one year had a significantly lower rate of Pap smear (p<0.05) than those who were homeless longer. Conclusion: Cervical cancer knowledge and screening among the homeless population needs to be improved. We recommend: (1) increasing active counseling at any level of clinical encounter with a focus on newly homeless individuals, (2) targeted training for providers, and (3) using patient navigators to improve knowledge and increase screening.