Abstract C17: Racial/ethnic variation in psychological distress following an abnormal Pap test
Authors: Montealegre Jane R. , Scheurer Michael E. , Shinn Eileen H. , Carrillo Thelma , Mulla Zuber , Follen Michele , Basen-Engquist Karen 
Published: May 2016

Introduction: While racial/ethnic disparities in cervical cancer incidence are mostly attributed to screening test utilization, lower rates of adherence to diagnostic and clinical follow-up after an abnormal Pap test may contribute to the higher cervical cancer mortality among racial/ethnic minorities. Psychological distress is a known contributor to non-adherence to diagnostic and therapeutic follow-up. The objective of this analysis is to explore racial/ethnic differences in distress following an abnormal Pap.

Methods: Data were collected as part of a clinical trial to evaluate emerging optical technologies for the diagnosis of cervical dysplasia. Participants were non-pregnant women, age ≥18 years, with a recent abnormal Pap test and were recruited at one of the participating colposcopy clinics. Participants answered questionnaires before and after their colposcopy procedure. Distress regarding the abnormal Pap was assessed using the Cervical Dysplasia Distress Questionnaire (CDDQ). The CDDQ measures multiple domains of distress, including those related to the colposcopy procedure (i.e., Tension and Discomfort, Embarrassment), as well as those related to having a positive screening test for cervical cancer (i.e., Health Consequences, Sexual/Reproductive Consequences). Additional items assessed participants' fear of cancer. Subscale scores range from 1 to 4, with higher scores indicating higher levels of distress. Linear regression models were built to assess the differences in distress scores among Hispanic, non-Hispanic black, and non-Hispanic white women after controlling for age and education (Model 1) and age, education, trait anxiety and depression (Model 2). Trait anxiety and depression were respectively measured using the State-Trait Anxiety Inventory for Adults and the Center for Epidemiologic Studies Depression (CESD) scale.

Results: Eighty-five Hispanic, 55 non-Hispanic black, and 86 non-Hispanic white women were included in these analyses. After controlling for age and education, there were statistically significant differences by race/ethnicity in distress scores, particularly for the domains of health consequences (p=0.02) and cancer worry (p = 0.014). In both domains, scores were highest among Hispanic women, compared to non-Hispanic black and non-Hispanic white women (mean health consequences scores = 2.45, 2.02, and 2.16, respectively; mean cancer worry scores = 2.02, 1.62, and 1.75, respectively). Furthermore, these racial/ethnic differences in domain-specific distress remained statistically significant after controlling for differences in underlying depression and trait anxiety.

Discussion: Our results suggest that there are racial/ethnic differences in levels of distress following an abnormal Pap test, particularly related to concerns over health consequences and fear of cancer. Distress scores in these domains were significantly greater among Hispanic women compared to non-Hispanic blacks and non-Hispanic whites. Hispanic women may be more likely to perceive that their abnormal Pap test will have long-term health consequences and develop into cancer. Clinical and ancillary health professionals who communicate Pap test results to Hispanic patients should reinforce messages to address unrealistic fears about disease and alleviate distress.

Citation Format: Jane R. Montealegre, Michael E. Scheurer, Eileen H. Shinn, Thelma Carrillo, Zuber Mulla, Michele Follen, Karen Basen-Engquist. Racial/ethnic variation in psychological distress following an abnormal Pap test. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C17.