Intimate Partner Violence and Cancer Screening among Urban Minority Women

Department of Family Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark.
The Journal of the American Board of Family Medicine (Impact Factor: 1.98). 05/2010; 23(3):343-53. DOI: 10.3122/jabfm.2010.03.090124
Source: PubMed


To evaluate the association of intimate partner violence (IPV) with breast and cervical cancer screening rates.
We conducted retrospective chart audits of 382 adult women at 4 urban family medicine practices. Inclusion criteria were not being pregnant, no cancer history, and having a partner. Victims were defined as those who screened positive on at least one of 2 brief IPV screening tools: the HITS (Hurt, Insult, Threat, Scream) tool or Women Abuse Screening Tool (short). Logistic regression models were used to examine whether nonvictims, victims of emotional abuse, and victims of physical and/or sexual abuse were up to date for mammograms and Papanicolaou smears.
Prevalence of IPV was 16.5%. Compared with victims of emotional abuse only, victims of physical and/or sexual abuse aged 40 to 74 were associated with 87% decreased odds of being up to date on Papanicolaou smears (odds ratio, 0.13; 95% CI, 0.02-0.86) and 84% decreased odds of being up to date in mammography (odds ratio, 0.16; 95% CI, 0.03-0.99). There was no difference in Papanicolaou smear rates among female victims and nonvictims younger than 40.
Because of the high prevalence of IPV, screening is essential among all women. Clinicians should ensure that victims of physical and/or sexual abuse are screened for cervical cancer and breast cancer, particularly women aged 40 or older. Cancer screening promotion programs are needed for victims of abuse.

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    • "List of studies: a (Loxton et al. 2009): 7312 middle-aged Australian women (45–50 years old) b (Gandhi et al. 2010): 371 women (21–40 years old) in 4 urban primary care settings c (Lemon et al. 2002): 1643 women, 18–54 years old from BRFSS d (Cronholm and Bowman 2009): 6285 women aged 18–96 years with a usual source of care e (Hathaway et al. 2000): 2043 women aged 18–59 years from the Massachusetts-BRFSS f (Modesitt et al. 2006): 101 women with breast, cervical, endometrial, or ovarian cancer from an oncology clinic g (Ramaswamy et al. 2011): 204 women in Kansas City jails h (Tello et al. 2010): 200 women receiving gynecologic services in an urban HIV clinic i (Coker et al. 2006): 470 women with low-grade cervical lesions interviewed at baseline and offered follow-up at 4-month and 6-month intervals for up to 24 months. "
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    ABSTRACT: The purpose of this paper is to critically examine the literature and present a comprehensive model of three pathways through which IPV increases the risk for cervical cancer. The first pathway is increased exposure to cervical cancer risk factors among IPV victims, including smoking, psychosocial stress, risky sexual behaviors, and sexually transmitted infections (STDs/STIs), particularly human papillomavirus infection. The second pathway is poor compliance with cervical cancer screening. The third pathway is delay/discontinuation in treatment for cervical dysplasia and neoplasia. Control imposed by the abusive partner, competing life priorities, and limited access to financial/support resources restrict a woman’s ability to seek cancer services. Higher rates, severity, and duration of IPV among low-income, Black, and Hispanic women may explain the pervasive cervical cancer disparities.
    Journal of Family Violence 05/2015; 30(8). DOI:10.1007/s10896-015-9733-7 · 1.17 Impact Factor
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    The Journal of the American Board of Family Medicine 05/2010; 23(3):277-9. DOI:10.3122/jabfm.2010.03.100053 · 1.98 Impact Factor
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    ABSTRACT: Few studies have examined the relation between abuse victimization and breast cancer, and results have been inconclusive. Using data from 35,728 participants in the Black Women's Health Study, we conducted multivariable Cox regression to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CI) for the association of abuse across the life span (childhood, adolescence, and adulthood) with breast cancer. Incident breast cancer diagnoses were reported during 1995-2009, and abuse histories were reported in 2005. No associations were found between abuse victimization in either childhood or adolescence and breast cancer. We found a weak positive association between abuse in adulthood and breast cancer (IRR = 1.18, 95% CI = 1.03-1.34). IRRs for physical abuse only, sexual abuse only, and both physical and sexual abuse in adulthood, relative to no abuse, were 1.28 (95% CI = 1.09-1.49), 0.96 (95% CI = 0.76-1.20), and 1.22 (95% CI = 1.00-1.49), respectively. IRRs for low, intermediate, and high frequencies of physical abuse in adulthood, relative to no abuse, were 1.28 (95% CI = 1.07-1.52), 1.37 (95% CI = 1.04-1.79), and 1.24 (95% CI = 0.95-1.62), respectively. Our data suggest an increased risk of breast cancer among African-American women who reported physical abuse in adulthood, but there was little evidence of a dose-response relation. These results require confirmation in other studies.
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