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- Azerkan, Fatima
(författare)
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Cervical cancer : incidence, screening and prognosis among immigrant women in Sweden
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Immigrant studies may help further our understanding of the aetiology of cervical cancer and improve its prevention. The overall aim of this thesis is to study the risk of cervical cancer among immigrant women in Sweden, their cervical screening attendance and their prognosis after cervical cancer diagnosis. Quantitative cohort study designs using data from population-based registers were carried out and analysed using Poisson regression and Cox proportional hazard models. A quantitative explorative design was used to analyse the results of focus group discussions (FGDs) according to the principles of content analysis. Compared to Swedish-born women, immigrant women in Sweden had a higher relative risk of invasive cervical cancer, particularly women from Denmark, Norway and Central America; the opposite was true for immigrant women from Eastern Africa and South Central Asia. Moreover, age at immigration and follow-up time were important effect modifiers for the risk of cervical cancer among immigrant women (Study I). Average cervical screening attendance was 62% and 49% among Swedish-born and immigrant women, respectively, and was lowest among women who immigrated at older ages. Adherence to recommended screening intervals is very effective in preventing cervical cancer (Study II). The qualitative study using FGDs revealed a complex rationale for postponing cervical screening that included aspects related to immigration itself, including competing needs, organisational and structural factors, and differences in mentality (Study III). Non-Nordic immigrant women had a slightly lower risk of dying from cervical cancer than Swedish-born women. Both Swedish-born and immigrant women with symptomatic cervical cancer showed a 3 to 4-fold excess mortality compared to screening-detected cases. Both immigrant and Swedish-born women with low socioeconomic status had an excess risk of dying from cervical cancer (Study IV). In conclusion, these results suggest a need for targeted prevention both among Swedish-born and immigrant women with low socioeconomic status and immigrant women at high-risk for cervical cancer, particularly those from Denmark, Norway and Central America, and specifically women who immigrate at older ages, during the first 10 years after their arrival. The results on cervical cancer prognosis indicate that there is equal access to health care in Sweden, irrespective of country of birth. The rationale of immigrant women in FGDs to postpone cervical screening reveals an opportunity to motivate these women to attend.
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- Azerkan, Fatima, et al.
(författare)
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Cervical screening participation and risk among Swedish-born and immigrant women in Sweden
- 2012
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 130:4, s. 937-947
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Tidskriftsartikel (refereegranskat)abstract
- Cervical cancer is one of the most common cancers among women worldwide, although cervical screening has reduced the incidence in many high-income countries. Low screening uptake among immigrant women may reflect differences in risk of cervical cancer. We investigated the degree of participation in cervical screening among immigrant and Swedish-born women and their concurrent risk of cervical cancer based on individual information on Pap smears taken both from organized and opportunistic screening. Mean degree of participation in cervical screening was estimated for women between 23 and 60 years from 1993 to 2005, stratified by birth region and age at migration. In Poisson regression models, we estimated relative risks (RRs), incidence rates and incidence rate ratios of cervical cancer for women adhering or not to the cervical screening program. We also assessed effect of adherence to screening on the risk of cervical cancer among immigrant groups compared to Swedish-born women. The degree of participation was 62% and 49% among Swedish-born and immigrant women, respectively, with large variations between immigrant groups. Participation was lowest among those immigrating at older ages. Swedish-born and immigrant women who where nonadherent to the cervical screening program had a fivefold excess risk of cervical cancer compared to adherent women. After adjustment for screening adherence, excess RRs of cervical cancer were statistically significant only for women from Norway and the Baltic States. Participation to screening is lower among immigrant than Swedish-born women, and adherence to the recommended screening intervals strongly prevents cervical cancer.
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- Azerkan, Fatima, et al.
(författare)
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When Life Got in the Way : How Danish and Norwegian Immigrant Women in Sweden Reason about Cervical Screening and Why They Postpone Attendance
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:7
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Danish and Norwegian immigrant women in Sweden have an increased risk of cervical cancer compared to Swedish-born women. In addition, Danish and Norwegian immigrant women follow the national recommendations for attendance at cervical screening to much lesser extent than Swedish-born women. The aim of this study was to explore how Danish and Norwegian immigrant women in Sweden reason about attending cervical screening, focusing on women's perceptions as to why they and their compatriots do not attend. Methods Eight focus group discussions (FGDs) were conducted with Danish and Norwegian immigrant women living in Stockholm. The women were between 26 and 66 years of age at the time of the FGDs, and were aged between <1 and 48 years old when they immigrated to Sweden. A FGD guide was used, which included questions related to cervical screening, and obstacles and motivators to attend cervical screening. The FGDs were tape recorded and transcribed, and the results analysed according to the principles of qualitative content analysis. Results The main theme was "Women have a comprehensive rationale for postponing cervical screening, yet do not view themselves as non-attenders". Investigation of women's rationale for non-attendance after being invited to cervical screening revealed some complex reasons related to immigration itself, including competing needs, organisational and structural factors and differences in mentality, but also reasons stemming from other factors. Postponing attendance at cervical screening was the category that linked all these factors as the reasons to why women did not attend to cervical screening according to the recommendations of the authorities. Conclusions The rationale used to postpone cervical screening, in combination with the fact that women do not consider themselves to be non-attenders, indicates that they have not actively taken a stance against cervical screening, and reveals an opportunity to motivate these women to attend.
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