Immigrants and Cervical Screening: Addressing Barriers and Misconceptions

Written By Meyss Hussein

Introduction

Cervical screening is one of the most effective cancer prevention programmes available, with the NHS Cervical Screening Programme estimated to prevent 70% of cervical cancer deaths (1). However, significant disparities exist in uptake rates, particularly among immigrant communities. Women from Black, Asian and Minority Ethnic (BAME) backgrounds are less likely to attend cervical screening than White British women, with non-attendance rates ranging from 44-71% versus 12% among White British women (2). This disparity stems from a complex interplay of mistrust, cultural barriers, and widespread misinformation about the screening process.

Immigrants and the Healthcare System: Understanding the Roots of Mistrust

The relationship between immigrant communities and healthcare systems is often due to deep-seated mistrust that has developed through multiple interconnected factors. Barriers in health service delivery, cultural, religious and language factors, gaps in knowledge and awareness, and emotional, sexual and family support have been identified as significant obstacles to breast and cervical cancer screening among Black, Asian, and Minority Ethnic women in the United Kingdom (3). This mistrust reflects real experiences of discrimination, communication barriers, and systemic failures to accommodate diverse cultural needs.

Language barriers represent a fundamental challenge, with people who don't speak English well struggling to understand information about cervical screening when material isn't available in their language, leading to lower uptake (4). Beyond language, cultural and religious considerations create additional layers of complexity. Healthcare providers do not consistently provide patients with adequate information about cervical screening, and the resulting lack of awareness is a key factor behind poor uptake rates (4). Many immigrant women face practical barriers including difficulty registering with GPs, limited appointment availability that accommodates work schedules, and financial constraints that may prevent time off work for medical appointments.

The historical marginalisation of certain immigrant communities compounds these issues. Roma communities, estimated at 197,000 in the UK as of 2013, face particular challenges due to historically low educational status and high levels of deprivation, with those practices serving the most deprived areas having significantly lower smear uptake rates (3). Additionally, up to 6% of immigrants had not registered themselves with a GP, compared with 0.5% of native populations, which reduces the effectiveness of screening programme reminders (5). Research shows that breast and cervical cancer screening uptake varies significantly among women from different ethnic groups, with certain communities facing compound barriers that affect participation rates (6).

Cervical Screening Misconceptions and the Truth

Misinformation about cervical screening is widespread and particularly prevalent among immigrant communities, often perpetuated through cultural networks and worsened by limited access to accurate, culturally appropriate health information. Understanding these misconceptions is crucial, as research demonstrates that non-attendance is often linked to specific beliefs and knowledge gaps about the screening process (7).

Here are five common misconceptions and the evidence-based facts:

1. "Cervical screening is a test for cancer"

Myth: Many believe that cervical screening is only done when cancer is suspected or present. 

Truth: Cervical screening is a test to prevent cancer. It looks for conditions that may lead to cervical cancer, which can be detected years before cancer develops. Screening looks for high-risk types of human papillomavirus (HPV), which is linked with nearly all cases of cervical cancer, aiming to find HPV and cell changes long before cervical cancer develops (8). Age differences in screening attendance often reflect different understanding of the preventive nature of the test (9).

2. "Screening is only necessary for sexually active women"

Myth: Some communities believe that women who are not currently sexually active or have never had penetrative sex do not need screening. 

Truth: All women and people with a cervix aged 25 to 64 are entitled to cervical screening on the NHS, as soon as they receive their first invitation (8). While sexual history may influence someone's risk, it shouldn't determine whether or not they can have cervical screening. It can take between 10 and 20 years for cervical cancer to develop from an HPV infection, so a woman's current sexual behaviour does not necessarily reflect her current risk (9). Knowledge about HPV transmission and its relationship to cervical cancer is often limited, contributing to these misconceptions (10).

3. "The procedure will affect virginity or is culturally inappropriate"

Myth: In some families, cervical screening is discouraged due to the misconception that it would affect virginity status (4). 

Truth: Virginity is constructed around a sexual or intimate experience, whereas cervical screening is a health test. The hymen is not a good indication of whether someone has been sexually active and may not be intact even if the patient has never had penetrative sex. Cervical screening should not be forceful enough to 'break' any part of the anatomy (8). These cultural concerns represent significant barriers that require sensitive healthcare provider communication (11).

4. "Screening checks for other cancers and sexually transmitted infections"

Myth: There is confusion about what cervical screening actually tests for, with some believing it provides comprehensive reproductive health screening. 

Truth: Cervical screening does not check for other types of cancer. One in five people mistakenly believe cervical screening can detect ovarian cancer, and some ask whether it checks for sexually transmitted infections. The test specifically looks for HPV and abnormal cervical cells (8). This misconception highlights the need for clearer public health messaging about the specific purpose of cervical screening (12).

5. "The test is always painful and traumatic"

Myth: Fear of pain prevents many women from attending, sometimes based on secondhand accounts or cultural beliefs about the procedure. 

Truth: Many women and people with a cervix don't find cervical screening painful. However, some do find it painful, so it's important to acknowledge this (8). Some women described the procedure as uncomfortable or even painful and reported side effects including lasting pain and bleeding, whilst others had misconceptions about the procedure, believing that the cervix was 'frozen' or that 'pieces are cut from the womb with the speculum' (1). Healthcare providers can offer adjustments to help reduce discomfort. Research shows that barriers to hypothetical screening tests can significantly affect perceived benefits and uptake (13).

Addressing the Challenges

Research shows that when healthcare services use culturally appropriate approaches - such as providing information in different languages and offering various ways to access screening - participation rates among immigrant women can increase by at least 15% (2). The key is addressing both practical barriers (like language and appointment times) and cultural concerns through community engagement and better training for healthcare staff. A comprehensive systematic review has identified multiple barriers and facilitators to cervical screening that need to be addressed through targeted interventions (14).

One exciting development is self-sampling kits, which allow women to collect their own sample at home. Even having just one self-collected test at age 30 can reduce a woman's risk of cervical cancer by about 40% (3). This option is particularly helpful for women who face cultural or religious barriers to traditional screening methods.

It's important to recognise that immigrant women who don't attend screening fall into different groups with different needs. Some are simply unaware of the service or face language barriers, whilst others may have specific concerns about the relevance of screening to their personal circumstances (7). Understanding these differences helps healthcare providers offer more tailored support. The NHS continues to work on improving uptake rates, with recent appeals highlighting that five million women are not up to date with their cervical screening (15).

Conclusion

Addressing cervical screening disparities among immigrant women requires a comprehensive understanding of the complex factors that contribute to mistrust and non-attendance. By debunking common misconceptions, improving cultural competency within healthcare services, and developing tailored interventions that respect diverse cultural perspectives, we can work towards ensuring that all women have equal access to this life-saving preventive care. The evidence clearly demonstrates that targeted, culturally sensitive approaches can significantly improve uptake rates, ultimately reducing cervical cancer incidence and mortality in these vulnerable populations.

References

  1. Waller J, Bartoszek M, Marlow L, Wardle J. Barriers to cervical screening attendance in England: a population-based survey. J Med Screen. 2009;16(4):199-204. doi:10.1258/jms.2009.009073

  2. Ali Z, Chew L, Campain NJ, et al. Interventions to increase cervical screening uptake among immigrant women: A systematic review and meta-analysis. PLOS ONE. 2023;18(5):e0285827. doi:10.1371/journal.pone.0285827

  3. Public Health England. Health matters: making cervical screening more accessible. GOV.UK. Published August 31, 2017. https://www.gov.uk/government/publications/health-matters-making-cervical-screening-more-accessible/health-matters-making-cervical-screening-more-accessible--2

  4. Adunlin G, Cyrus JW, Asare M, et al. Barriers to cervical cancer screening faced by immigrants: a registry-based study of 1.4 million women in Norway. Eur J Public Health. 2017;27(5):873-879. doi:10.1093/eurpub/ckx054

  5. Adkins A, Seidu AA, Duku E, et al. Barriers to breast and cervical cancer screening uptake among Black, Asian, and Minority Ethnic women in the United Kingdom: evidence from a mixed-methods systematic review. Cancer Causes Control. 2023;34(4):361-379. doi:10.1007/s10552-023-01682-z

  6. Forbes LJL, Atkins L, Thurnham A, Layburn J, Haste F, Ramirez AJ. Breast and cervical cancer screening uptake among women from different ethnic groups in London: a population-based cohort study. Br J Cancer. 2011;104(10):1605-1613. doi:10.1038/bjc.2011.132

  7. Marlow LAV, Waller J, Wardle J. Understanding cervical screening non-attendance among ethnic minority women in England. Br J Cancer. 2015;113(5):833-839. doi:10.1038/bjc.2015.248

  8. Waller J, Jackowska M, Marlow L, Wardle J. Exploring age differences in reasons for nonattendance for cervical screening: a qualitative study. BJOG. 2012;119(1):26-32. doi:10.1111/j.1471-0528.2011.03030.x

  9. Waller J, Ostini R, Marlow LAV, McCaffery K, Zimet G. Validation of a measure of knowledge about human papillomavirus (HPV) using item response theory and classical test theory. Prev Med. 2013;56(1):35-40. doi:10.1016/j.ypmed.2012.10.028

  10. Healthwatch England. Barriers and inequalities in cervical screening. Published January 22, 2024. https://www.healthwatch.co.uk/blog/2024-01-22/barriers-and-inequalities-cervical-screening

  11. Marlow LAV, Wardle J, Waller J. Understanding cervical screening non-attendance among ethnic minority women in England. Br J Cancer. 2015;113(5):833-839. doi:10.1038/bjc.2015.248

  12. Jo's Cervical Cancer Trust. Myths and facts about cervical screening. Published June 4, 2025. https://www.jostrust.org.uk/professionals/cervical-screening/myths-facts/

  13. Smith MA, Canfell K. Testing whether barriers to a hypothetical screening test affect unrelated perceived benefits and vice versa: A randomised, experimental study. Patient Educ Couns. 2017;100(2):e1-e24. doi:10.1016/j.pec.2016.09.007

  14. Doyle E, Marlow L, Wardle J. Barriers and facilitators to cervical screening: A systematic review. Psychooncology. 2017;26(10):1485-1495. doi:10.1002/pon.4287

  15. NHS England. NHS makes fresh uptake appeal as five million women not up to date with cervical screening. Published November 14, 2024. https://www.england.nhs.uk/2024/11/nhs-makes-fresh-uptake-appeal-as-five-million-women-not-up-to-date-with-cervical-screening/


Meyss Hussein
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