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Addressing Cervical Cancer Screening in Sexual Minorities

Tamara Wilson-Cisnero, MD, MSHA

Disclosures

October 20, 2022

Early in 2000, when I was a practicing physician in Cuba, I had two female patients who were lesbian who had refused to have a Pap smear with any provider for years. It took me time to get to know them, and eventually one of them agreed to undergo a Pap smear. Her main fear was having her provider react badly during the procedure. She had had a bad experience where the provider had expressed surprise during the procedure. The patient assumed that it was because she had enlarged labia minora. She said she noticed that the provider treated her differently afterward and avoided eye contact, and refused to see that doctor or any other doctor after that.

After getting her Pap smear with me, my patient shared her experience at my office and how much she trusted me as her physician with her partner and her friends. I performed a Pap smear for four of these women during that year. One had an abnormal Pap smear and required follow-up; she was grateful that she had gotten it done.

Treating these patients took an understanding that patients are at the center of what we do as physicians. We have to control our emotions and body language so we don't break our patients' trust in us, and in the system. I left Cuba in 2005, and those patients still ask my mom how I am doing. "They don't talk to anyone in the neighborhood, but they always talk to me and ask about you and your family," my mother tells me — a proud mom moment.

I can't believe that 20 years later, I'm reading an article on how cisgender women who are sexual minorities (SM) continue to have a significantly lower rate of screening for cervical cancer. And it pains me to know that the rate is even lower among Latinas.

In a study on sexual orientation and race and ethnicity in cervical cancer screening, recently published in the journal Cancer (a journal of the American Cancer Society), the abstract concludes that "SM participants were significantly less likely to have ever undergone a Pap test in comparison with heterosexual participants, with Hispanic SM participants having the lowest uptake. Future studies should further examine the roles of systemic discrimination and other key drivers of these disparities."

I can only ask, what's preventing clinicians from offering screening and following up with these populations?

The use of an interpreter during clinical visits with a Hispanic population can be complicated. Having a third person present when discussing this topic can be very difficult for patients, mainly because that interpreter could be someone from the patient's community. Making sure that the patient is comfortable can be achieved by asking precise questions.

Explaining to patients that sexual orientation has nothing to do with the fact that their body is subject to changes and at risk for diseases based on their assigned sex at birth takes time and specific tactics. We must be sensitive and factual. It requires a lot of compassion and understanding of the issues that these minorities face, including poor access to healthcare and lack of knowledge and guidance from a women's health perspective.

The study on cervical cancer screening did not show differences by country of origin due to the limited sample. The broad range of countries and the diversity within the Hispanic population in the US could make approaching these patients appropriately more difficult but not unattainable.

We must do our part to break the cycle of not addressing such essential screening in this already misunderstood and mistreated population.

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About Dr Tamara Wilson-Cisnero
Tamara Wilson-Cisnero is a physician by training, graduated in 1994, and has been ECFMG certified since 2016. She holds a master's in healthcare administration and is a Certified Professional of Healthcare Quality. Tamara has more than 25 years of experience in healthcare. She has spent the past 10 years working in clinical quality improvement and population health management. Tamara is an entrepreneur and the principal at Wilson-Cisnero Consulting. She collaborates with local western New York agencies to provide clear-cut and high-quality bilingual healthcare literacy. She enjoys reading, traveling, and spending quality time with her family and friends.

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