Abstract A058: "That’s our culture...”: A qualitative study on factors that influence cervical cancer stigma in the Caribbean
Authors: Thomas-Purcell Kamilah B. , Sealy Diadrey-Ann , Bailey Althea , Joseph Sherry-Ann , Ashing Kimlin 
Published: December 2023

Abstract
Background: Cancer stigma, which encompasses the negative responses of nations, communities, families, and individuals towards those affected by cancer, presents a growing challenge in low-resourced societies and various parts of the world. In particular, cervical cancer (CCA) stigma has become increasingly prevalent in numerous cultures and societies. This stigma is fueled by the fact that nearly 99% of CCA cases and pre-cancerous cervical lesions are attributed to infection with the sexually transmitted human papillomavirus (HPV). Despite the substantial burden CCA stigma and the availability of widely accessible, cost-effective services, Caribbean women exhibit alarmingly low rates of appropriate CCA screening practices and HPV vaccination for their children, both in the U.S. and the Caribbean. To enhance the effectiveness of CCA prevention efforts in the U.S, it is imperative to include studies involving Caribbean nations with significant immigration to the U.S. Objective: This study aimed to explore the manifestations of cancer stigma among men and women aged 18-85 in Grenada, Jamaica, and Trinidad & Tobago, and its potential impact on CCA prevention behaviors. Design and Methods: Employing a community-based participatory research approach, academic institutions collaborated with community leaders in each country to conduct a cross-sectional qualitative study using focus groups. Thematic analysis was performed using MAXQDA data analysis software to examine the role of stigma in CCA prevention behaviors. Results: Three focus groups were conducted in each country, with a total of 69 participants. Major themes emerged regarding the influence of stigma on CCA cancer prevention efforts, including fatalism, cultural views, and confidentiality. Participants demonstrated knowledge of the sexually transmitted nature of HPV, which causes CCA, contributing to the stigmatization of the disease. Stigma was associated with unwarranted assumptions of female promiscuity. The stigmatization of CCA was characterized by blame and the belief that women with the disease should feel ashamed, creating significant barriers to HPV vaccination and pap testing. Cancer was often regarded as a death sentence and rarely discussed among family and friends, further deterring women from seeking screening, early detection, and support. Fear and misinformation surrounding the pap testing procedure, as well as concerns about medical confidentiality, also hindered screening. Conclusion: Generalized cancer stigma (viewing cancer as a death sentence) and specific CCA cancer stigma (shame and blame) have adverse effects on CCA prevention efforts. Further research is needed to assess the multifaceted dimensions of cancer stigma and inform interventions aimed at improving CCA cancer screening and HPV vaccination in the Caribbean. Investigating and addressing the various dimensions of cancer stigma within the non-patient population are required to inform strategies to reduce stigma’s influence; and thus improve CCA screening and HPV vaccination to prevent cancer and save lives.
Citation Format: Kamilah B. Thomas-Purcell, Diadrey-Ann Sealy, Althea Bailey, Sherry-Ann Joseph, Kimlin Ashing. "That’s our culture...”: A qualitative study on factors that influence cervical cancer stigma in the Caribbean [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A058.