Since the introduction of systematic population-based cervical cancer screening in Australia in 1991, age-standardized incidence of cervical cancer has halved. Given recent advances in human papillomavirus (HPV) vaccination and screening, cervical cancer may be eliminated nationally within 20 years. However, immigrant women are not equitably reached by screening efforts. This study systematically reviewed evidence on cervical cancer screening practices among immigrant women in Australia. A systematic search of MEDLINE, Embase, PubMed, CINAHL, and PsycINFO and gray literature for English language studies published till March 1, 2019, was conducted. Observational and qualitative studies evaluating cervical cancer screening awareness and participation of immigrant women were screened. Of 125 potentially relevant studies, 25 were eligible: 16 quantitative (four cohort, 12 cross-sectional), six qualitative, and three mixed-methods studies. Quantitative studies indicated 1% to 16% lower screening rates among migrant women compared with Australian-born women, with participation of South Asian women being significantly lower. Qualitative studies illustrated factors affecting women’s willingness to participate in screening, including insufficient knowledge, low-risk perception, and unavailability of a female health professionals being key barriers. Future studies should focus on South Asian women, due to recent increase in their immigration.
BrayFFerlayJSoerjomataramISiegelRLTorreLAJemalA.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394-424.
2.
Global Burden of Disease Cancer Collaboration; FitzmauriceCAkinyemijuTF, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: a systematic analysis for the global burden of disease study. JAMA Oncol. 2018;4:1553-1568.
3.
SerranoBBrotonsMBoschFXBruniL.Epidemiology and burden of HPV-related disease. Best Pract Res Clin Obstet Gynaecol. 2018;47:14-26.
Australian Government. National Cancer Screening Register. Published 2019. Accessed September 10, 2020. https://www.ncsr.gov.au/
9.
HallMTSimmsKTLewJBSmithMASavilleMCanfellK.Projected future impact of HPV vaccination and primary HPV screening on cervical cancer rates from 2017-2035: example from Australia. PLoS One. 2018;13:e0185332.
10.
HallMTSimmsKTLewJB, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health. 2019;4:e19-e27.
11.
CooryMDFaganPSMullerJMDunnNA.Participation in cervical cancer screening by women in rural and remote Aboriginal and Torres Strait Islander communities in Queensland. Med J Aust. 2002;177:544-547.
12.
WhopLJGarveyGBaadeP, et al. The first comprehensive report on Indigenous Australian women’s inequalities in cervical screening: a retrospective registry cohort study in Queensland, Australia (2000-2011). Cancer. 2016;122:1560-1569.
AnikeevaOBiPHillerJERyanPRoderDHanGS.The health status of migrants in Australia: a review. Asia Pac J Public Health. 2010;22:159-193.
15.
GrulichAEMcCredieMCoatesM.Cancer incidence in Asian migrants to New South Wales, Australia. Br J Cancer. 1995;71:400-408.
16.
StrongKTrickettPBhatiaK.The health of overseas-born Australians, 1994-1996. Aust Health Rev. 1998;21:124-133.
17.
McDonaldJTKennedyS.Cervical cancer screening by immigrant and minority women in Canada. J Immigr Minor Health. 2007;9:323-334.
18.
AzerkanFSparénPSandinSTillgrenPFaxelidEZendehdelK.Cervical screening participation and risk among Swedish-born and immigrant women in Sweden. Int J Cancer. 2012;130:937-947.
19.
KristenssonJHSanderBBvon Euler-ChelpinMLyngeE.Predictors of non-participation in cervical screening in Denmark. Cancer Epidemiol. 2014;38:174-180.
MengeshaZBDuneTPerzJ.Culturally and linguistically diverse women’s views and experiences of accessing sexual and reproductive health care in Australia: a systematic review. Sex Health. 2016;13:299-310.
22.
MoherDLiberatiATetzlaffJAltmanDG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264-269.
23.
MoherDShamseerLClarkeM, et al; PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1.
24.
MichieSvan StralenMMWestR.The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.
25.
HongQNPluyePFàbreguesS, et al. Mixed Methods Appraisal Tool (MMAT), Version 2018. IC Canadian Intellectual Property Office, Industry Canada; 2018.
26.
PaceRPluyePBartlettG, et al. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. Int J Nurs Stud. 2012;49:47-53.
27.
PetrakA.Factors Influencing Breast and Cervical Cancer Control in Ethnically Diverse Groups of Women [thesis]. Sydney, Australia: Macquarie University; 2012.
28.
AnamanJA.Barriers to and Facilitators of Cervical Screening Practice Among African Immigrant Women From Refugee and Non-Refugee Backgrounds Living in Brisbane [thesis]. Brisbane, Australia: Queensland University of Technology; 2016.
29.
KarnakiP.Attitudes, Practices and Knowledge Regarding Cervical Cancer Screening Among Greek Women in the Area of Perth [thesis]. Joondalup, Australia: Edith Cowan University; 2000.
30.
MullerT.Understanding Young Women’s Cervical Cancer Screening Attendance [thesis]. Canberra, Australia: The Australian National University; 2016.
31.
MaiHT.Associated Risk Factors in Developing Cervical Cancer Among Vietnamese Women [thesis]. Brisbane, Australia: The University of Queensland; 2004.
KarnakiPHuntL.The Role of Health Professionals in Cervical Cancer Screening Among Greek Women in Perth, Western Australia [thesis]. Geelong, Australia: Deakin University; 2001.
34.
Hertzum-LarsenRKjærSKFrederiksenKThomsenLT.Participation in cervical cancer screening among immigrants and Danish-born women in Denmark. Prev Med. 2019;123:55-64.
35.
DonnellyTT.Challenges in providing breast and cervical cancer screening services to Vietnamese Canadian women: the healthcare providers’ perspective. Nurs Inq. 2008;15:158-168.
36.
LoftersAKNgRLobbR.Primary care physician characteristics associated with cancer screening: a retrospective cohort study in Ontario, Canada. Cancer Med. 2015;4:212-223.
37.
IceUV.Knowledge, Attitudes, and Beliefs Regarding Cervical Cancer and Screening and Perceived Barriers to Cervical Cancer Screening Programs Among Thai Immigrant Women Living in Germany [thesis]. Albuquerque, NM: University of New Mexico; 2012.
38.
GorBJChiltonJACaminguePTHajekRA.Young Asian Americans’ knowledge and perceptions of cervical cancer and the human papillomavirus. J Immigr Minor Health. 2011;13:81-86.
39.
DonnellyTTMcKellinW.Keeping healthy! Whose responsibility is it anyway? Vietnamese Canadian women and their healthcare providers’ perspectives. Nurs Inq. 2007;14:2-12.
40.
GangulyI.Promoting the health of women of non-English-speaking backgrounds in Australia. World Health Forum. 1995;16:157-163.
41.
MitchellHHirstSMitchellJAStaplesMTorcelloN.Effect of ethnic media on cervical cancer screening rates. Aust N Z J Public Health. 1997;21:265-267.
42.
Del MarCGlasziouPAdkinsPHuaTBrownM. Do personalised letters in Vietnamese increase cervical cancer screening among Vietnamese women?Aust N Z J Public Health. 1998;22:824-825.
43.
CullertonKGallegosDAshleyE, et al. Cancer screening education: can it change knowledge and attitudes among culturally and linguistically diverse communities in Queensland, Australia?Health Promot J Austr. 2016;27:140-147.
44.
KwokCLimD.Evaluation of a culturally tailored education to promote breast and cervical cancer screening among Chinese-Australian women. J Cancer Educ. 2016;31:595-601.
45.
MorrellSTaylorRZeckendorfSNiciakAWainGRossJ.How much does a reminder letter increase cervical screening among under-screened women in NSW?Aust N Z J Public Health. 2005;29:78-84.
46.
Anaman-TorgborJACorrea-VelezIKingJ.Potential mHealth tool for promoting cervical screening: The views of refugee and non-refugee African-born women living in Brisbane, Australia. J Technol Behav Sci. 2017;2:156-162.
47.
López-OlmosJ.Immigrant versus autochthonous women. Differences in sexual dysfunction, vaginal infections and cervical lesions. Clin Invest Ginecol Obstet. 2013;40:242-252.
48.
MooreMABaumannFFoliakiS, et al. Cancer epidemiology in the pacific islands—past, present and future. Asian Pac J Cancer Prev. 2010;11(suppl 2):99-106.
49.
HaasMFowlerS. A Synthesis of Qualitative Research on Cervical Cancer Screening Behaviour: Women’s Perceptions of the Barriers and Motivators to Screen and the Implications for Policy and Practice. CHERE Working Paper 2006/7. CHERE, University of Technology; 2006. Accessed April 2019. https://ideas.repec.org/p/her/chewps/2006-7.html
50.
TaylorRJMamoonHAMorrellSLWainGV.Cervical screening by socio-economic status in Australia. Aust N Z J Public Health. 2001;25:256-260.
51.
WeberMChiewMFelettoEKahnCSitasFWebsterL.Cancer Screening among immigrants living in urban and regional Australia: results from the 45 and up study. Int J Environ Res Public Health. 2014;11:8251-8266.
52.
MarkovicMMandersonLQuinnM.Embodied changes and the search for gynecological cancer diagnosis. Med Anthropol Q. 2004;18:376-396.
53.
McCredieMWilliamsSCoatesM.Cancer mortality in east and southeast Asian migrants to New South Wales, Australia, 1975-1995. Br J Cancer. 1999;79:1277-1282.
54.
MengeshaZBPerzJDuneTUssherJ.Challenges in the provision of sexual and reproductive health care to refugee and migrant women: AQ methodological study of health professional perspectives. J Immigr Minor Health. 2018;20:307-316.
55.
TejeroLMSFowlerC.Migration of women from the Philippines: implications for healthcare delivery. Collegian. 2012;19:59-63.
56.
KwokCSullivanG.Influence of traditional Chinese beliefs on cancer screening behaviour among Chinese-Australian women. J Adv Nurs. 2006;54:691-699.
57.
SavageSAClarkeVA.Older women’s illness representations of cancer: a qualitative study. Health Educ Res. 1998;13:529-544.
58.
JirojwongSMaclennanRMandersonL.Health beliefs and Pap smears among Thai women in Brisbane, Australia. Asia Pac J Public Health. 2001;13:20-23.
59.
AminisaniNArmstrongBKEggerSCanfellK.Impact of organised cervical screening on cervical cancer incidence and mortality in migrant women in Australia. BMC Cancer. 2012;12:491.
60.
MamoonHTaylorRMorrellSWainGMooreH.Cervical screening: population-based comparisons between self-reported survey and registry-derived Pap test rates. Aust N Z J Public Health. 2001;25:505-510.
61.
ShelleyJMIrwigLMSimpsonJMMacaskillP.Who has pap smears in New South Wales? Patterns of screening across sociodemographic groups. Aust J Public Health. 1994;18:406-411.
62.
Temple-SmithMJ.Promoting health beyond recruitment: beliefs and attitudes to breast and cervical cancer screening services among Italian born women in Melbourne. Health Promot J Austr. 1995;5:31-36.
63.
LesjakMWardJRisselC.Cervical screening of Arabic-speaking women in Australian general practice. J Med Screen. 1997;4:107-111.
64.
LesjakMHuaMWardJ.Cervical screening among immigrant Vietnamese women seen in general practice: current rates, predictors and potential recruitment strategies. Aust N Z J Public Health. 1999;23:168-173.
65.
KelaherMG. GillespieAAlloteyP, et al. The transtheoretical model and cervical screening: its application among culturally diverse communities in Queensland, Australia. Ethn Health. 1999;4:259-276.
66.
CheekJFullerJGilchristSMaddockABallantyneA.Vietnamese women and Pap smears: issues in promotion. Aust N Z J Public Health. 1999;23:72-76.
67.
TaylorRJMamoonHAMorrellSLWainGV.Cervical screening in migrants to Australia. Aust N Z J Public Health. 2001;25:55-61.
68.
WainGMorrellSTaylorRMamoonHBodkinN.Variation in cervical cancer screening by region, socio-economic, migrant and indigenous status in women in New South Wales. Aust N Z J Obstet Gynaecol. 2001;41:320-325.
69.
TaylorRJMorrellSLMamoonHAMacanshSRossJWainGV.Cervical cancer screening in a Vietnamese nominal cohort. Ethn Health. 2003;8:251-261.
70.
FernbachM.Exploration of factors linked with high cervical cancer rates in women from the former Yugoslavia in Victoria, Australia. Ethn Health. 2002;7:209-220.
71.
MarkovicMMandersonLKelaherM.The health of immigrant women: Queensland women from the former Yugoslavia. J Immigr Health. 2002;4:5-15.
72.
SiahpushMSinghGK.Sociodemographic predictors of pap test receipt, currency and knowledge among Australian women. Prev Med. 2002;35:362-368.
73.
JirojwongSMandersonL.Beliefs and behaviors about Pap and breast self-examination among Thai immigrant women in Brisbane, Australia. Women Health. 2001;33:47-66.
74.
CheungNWLiSTangKC.Participation in cardiovascular risk factor and cancer screening among Australian Chinese. Health Promot J Austr. 2011;22:147-152.
75.
KwokCWhiteKRoydhouseJK.Chinese-Australian women’s knowledge, facilitators and barriers related to cervical cancer screening: a qualitative study. J Immigr Minor Health. 2011;13:1076-1083.
76.
AminisaniNArmstrongBKCanfellK.Cervical cancer screening in Middle Eastern and Asian migrants to Australia: a record linkage study. Cancer Epidemiol. 2012;36:e394-e400.
77.
AminisaniNArmstrongBKCanfellK.Participation in cervical screening by older Asian and Middle Eastern migrants in new South Wales, Australia. Health Promot Perspect. 2012;2:274-286.
78.
UssherJMRhyder-ObidMPerzJRaeMWongTWNewmanP.Purity, privacy and procreation: constructions and experiences of sexual and reproductive health in Assyrian and Karen women living in Australia. Sex Cult. 2012;16:467-485.
79.
TeamVMandersonLHMarkovicM.From state care to self-care: cancer screening behaviours among Russian-speaking Australian women. Aust J Prim Health. 2013;19:130-137.
80.
OgunsijiOWilkesLPetersKJacksonD.Knowledge, attitudes and usage of cancer screening among West African migrant women. J Clin Nurs. 2013;22:1026-1033.
81.
AnamanJACorrea-VelezIKingJ.Knowledge adequacy on cervical cancer among African refugee and non-refugee women in Brisbane, Australia. J Cancer Educ. 2018;33:716-723.
82.
Anaman-TorgborJAKingJCorrea-VelezI.Barriers and facilitators of cervical cancer screening practices among African immigrant women living in Brisbane, Australia. Eur J Oncol Nurs. 2017;31:22-29.
83.
AnamanJACorrea-VelezIKingJ.A survey of cervical screening among refugee and non-refugee African immigrant women in Brisbane, Australia. Health Promot J Austr. 2017;28:217-224.
84.
MetuselaCUssherJPerzJ, et al. “In my culture, we don’t know anything about that”: sexual and reproductive health of migrant and refugee women. Int J Behav Med. 2017;24:836-845.
85.
AminisaniNArmstrongBKCanfellK.Participation in recommended cervical screening by Asian and middle eastern migrants in Australia: a record linkage study. Asia Pac J Clin Oncol. 2011;7:111-112.
86.
RisselC.The development and application of a scale of acculturation. Aust N Z J Public Health. 1997;21:606-613.
87.
Federation of Ethnic Communities’ Councils of Australia. Cancer and Culturally and Linguistically Diverse Communities. Federation of Ethnic Communities’ Councils of Australia; 2010.
88.
ReidSESimpsonJMBrittHC.Pap smears in general practice: a secondary analysis of the Australian Morbidity and Treatment Survey 1990 to 1991. Aust N Z J Public Health. 1997;21:257-264.
89.
MøenKAKumarBIglandJDiazE.Effect of an intervention in general practice to increase the participation of immigrants in cervical cancer screening: a cluster randomized clinical trial. JAMA Netw Open. 2020;3:e201903.
90.
ShresthaADNeupaneDVedstedPKallestrupP.Cervical cancer prevalence, incidence and mortality in low and middle income countries: a systematic review. Asian Pac J Cancer Prev. 2018;19:319-324.
91.
GakidouENordhagenSObermeyerZ.Coverage of cervical cancer screening in 57 countries: low average levels and large inequalities. PLoS Med. 2008;5:e132.
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