The incidence of cervical cancer in Eastern Europe (EE) is significantly higher than Western Europe (WE) despite the introduction of screening and vaccination programs in many EE counties. The migration of women from EE has been hypothesised to contribute the rising incidence of cervical cancer in WE. The aim of this study was to explore the effect of migration to the UK on the cervical screening behaviours of EE-born women.
A mixed methods study using quantitative surveys and in-depth semi-structured qualitative interviews was conducted in the UK and Latvia. Women were recruited from three groups, migrant EE-born women (nEE), native English-born Caucasian women (nEN) and native Latvian-born women (nLV). Data were analysed using SPSS software and thematic analysis.
489 surveys were completed and 66 interviews were conducted. Knowledge of the purpose of cervical cancer screening was lower in the nEE and nLV groups compared to the nEN. The nEE and nLV women believed that a cervical smear test was performed as part of a routine gynaecological examination. The natural history of cervical cancer and its association with HPV infection was poorly understood resulting in some women from nEE and nLV groups requesting more frequent smears. There was general distrust of the healthcare system in the country of migration and consequently there was a delay in engaging with screening services. nEE women either continued to have screening in their country of birth, have screening in England and additional smears in their country of birth and others did not participant in any form of screening. The screening behaviours and knowledge of the nEE and nLV group were similar, suggesting that there is little change following migration. However the length of stay in the country of migration may contribute to how much the nEE women adapt their screening behaviours.
The role of cervical cytology as part of a structured screening programme is poorly understood. The screening behaviours of many nEE women appears to be governed by their pre-existing knowledge of cervical cancer and screening prior to migration. Targeted education both prior to and after migration may help to increase screening coverage.