Deacon, R

Douglas, Catriona

Mooney-Somers, Julie

English

Sydney eScholarship

Pap smear rates among Australian lesbian and bisexual women: some good news but disparities persistC Douglas1, R Deacon2, J Mooney-Somers3INTRODUCTIONCervical cancer is the second most prevalent cancer among women worldwide.1, 2 The Papanicolaou (Pap smear) test detects pre-cancerous changes on the cervix before cancer evolves. Since its advance 50 years ago there has been a dramatic decrease in the incidence and mortality of cervical cancer.2In Australia, current guidelines advise women to have a Pap smear test every 2 years between 18-70 years.5 HPV is spread during sexual contact  and is present in women who have sex with women.15, 16 This is partly attributable to a sexual history with men,17 studies have also found HPV in women with no sexual history with men.15, 17, 18AIMTo look at Pap smear testing rates among community-attached lesbian, bisexual and queer (LBQ) women.METHODSData taken from the Sydney Women and Sexual Health (SWASH) study 2002-2012, a self-complete biennial questionnaire of LBQ women’s health and wellbeing. Analysis conducted on surveys from non-heterosexual women, aged 18 years and older, living in NSW.RESULTS• 79% lesbian, 11% bisexual and 10% queer/other • Median age 32 years• 81% sexually active with a woman < 6 months• 65% ever sexually active with a man• 36% current smokers Two findings of concern for public health1. Significant and consistent proportion of LBQ women never had a Pap smear test2. Never having had sex with men a significant predictor of never having had a Pap smear test Possible Explanations: • Belief that HPV is only transmitted during sex with men. • Screening programs and health promotion materials not explicitly addressing irrelevance of sexual history with men and persistent perception of lower HPV risk for lesbian women.1,16• LBQ women being dissuaded by health practitioners,14, 24-27 or incorrect past advice not subsequently corrected. Or women unsure how to deal with conflicting advice.16• Association between STI testing and Pap smear testing suggests sexual and reproductive health not part of the health care experience for a significant minority of LBQ women. Pap smear testing may need to be promoted instead as part of regular health and wellbeing check-ups, like a regular blood pressure test.CONCLUSION Good news: no evidence of the significant disparities between LBQ women and general population seen in other similar countries. 2, 11-14Cause for concern: LBQ women with no sexual history with men are significantly less likely to have ever had a Pap smear test. The vast majority of women diagnosed with invasive cervical cancer had not had regular pap smear tests/were never-screened; under-screening among this group needs to addressed.1 School of Medicine and Dentistry, University of Aberdeen & Raigmore Hospital, Inverness, NHS Highland; 2 Discipline of Addiction Medicine, University of Sydney; 3 Centre for Values, Ethics and the Law in Medicine, University of Sydney Information on the Sydney Women and Sexual Health (SWASH) survey, copies of reports, as well as references and analysis tables available from Julie.MooneySomers@sydney.edu.auSWASH owes a deep debt of gratitude to ACON, particularly the staff in Policy, Strategy and Research and the Lesbian and Same Sex Attracted Women’s Health Project, for continued practical and financial support. This research could not have happened without their commitment, enthusiasm and contacts.Pap smear testing rates among LBQ women have not changed over timeAnalysis of SWASH surveys 2002-2012 (N 3974):• 73% timely screening (< 3 years)• 11% under-screened (>3 years)• 17% never screened No significant variation in the proportion of women who had:• ever attended for a pap smear test (range 83-85%)• never had a pap smear test (range 15-17%) Pap smear testing rate among LBQ women compares favourably to general populationCompared 3-yr participation rate for NSW women 2009-2010,22 with 3-yr participation rate for SWASH 2010 respondents aged 20-69 (N 746). NSW population = 70% SWASH sample = 76% Five characteristics predicted whether LBQ women had ever had a Pap smear testMLR of 2012 SWASH data (N 648) for characteristics significantly associated with ever having a Pap smear test:• ever having had an STI test (OR 3.46; 95% CI 2.12-5.63) • ever having had sex with men (OR 2.49; 95% CI 1.53-4.05)• being out to a regular doctor relative to not having a regular doctor (OR 2.35, 95% CI 1.37-4.04) • education past year 12 (OR 2.00, 95% CI 1.19-3.37)• age (OR 1.12 per 1yr increase, 95% CI 1.08-1.16)

Pap smear rates among Australian lesbian and bisexual women: some good news but disparities persist

https://ses.library.usyd.edu.au/bitstream/2123/12063/2/Sexual%20Health%20SWASH%20pap%20smear%20poster%20FINAL%20print.pdf

Pap smear rates among Australian lesbian and bisexual women: some good news but disparities persist

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