Unmarried women do not feel comfortable at doctors

Regardless of sexual orientation, unmarried women ages 40 to 75 voiced reluctance to undergo routine cancer screening tests, feeling out of place or misunderstood in health care settings, according to the first wave of information from a five-year Brown University Cancer Screening Project for Women.

Unmarried women said their feelings were based on everything from the wording used in pre-visit questionnaires to conversations with health care providers. For example, doctors’ intake forms did not allow them to indicate any partner other than a husband, and, during the exam, their doctors did not ask them about their intimate relationships.

“Regardless of partnership preference, women in this age group were uncomfortable when their doctors assumed they did not have a partner because they were not married,” said Melissa A. Clark, assistant professor of community health and the project leader. “Women wanted a trusting relationship with at least one provider who knows about their life and is informed about the health issues related to their sexual history and intimate relationships.”

The Cancer Screening Project for Women is one of the first studies to focus on why the more than 20 million unmarried women between the ages of 40 and 75 in this country are less likely than married women to obtain regular screening tests for breast, cervical and colorectal cancer. With the aging baby boomer population, the size of that population promises to grow significantly in the coming years.

Some women think that they are not at risk for certain types of cancer because they are not in a sexual relationship with a man, said Clark. Often they do not realize that there are a number of factors that must be considered in determining risk for cancer.

For example, a woman’s sexual history, among other factors, has a bearing on her chances of getting cervical cancer and, therefore, on whether she should be tested. While pap tests are recommended for women who have at some point in their lives had a sexual relationship with a man, about 80 percent of women who partner with women fall into that category.

The project’s initial results come from a series of focus groups with 28 women – both lesbian and straight – who receive their health care in Rhode Island. The findings were published in the most recent issue of Women & Health and will inform the design of the next phase of the project.

In addition to feeling out of place in medical offices, focus group participants listed other barriers to obtaining cancer screening tests, including administrative concerns such as lack of insurance, pain or discomfort associated with the tests, and discomfort with their own body images.

The Cancer Screening Project for Women is the first study of women’s decisions surrounding cancer screening that focuses on an entire state and encompasses both urban and suburban health care settings, said Clark. The small size of the state and the presence of a single medical school – Brown Medical School – provide a unique opportunity for study results to effect policy and health care practices for an entire population of women.

“The results of our study can be used to inform a whole system of care,” Clark said. “In order for health care professionals to care for women in the best possible ways, it is critical for them to know what issues are important to women.”

Researchers plan to share the project’s findings with physicians and other health care professionals such as mammography technicians and nurses, and the state’s policy-makers.

The study is currently recruiting 600 unmarried women between the ages of 40 and 75 for the second phase. All information will be kept confidential. Participants will be randomly assigned to provide information in one of three ways: by telephone, by computer, or by filling out a questionnaire by hand. Anyone interested in more information should call toll-free (866) 434-2384, or email [email protected].

The Cancer Screening Project for Women is supported by a $459,000 award from the National Cancer Institute. Clark is collaborating on the study with other researchers affiliated with Brown’s Department of Community Health and Center for Gerontology and Health Care Research, including Laura Bonacore, Shirley Wright, Gene Armstrong, and William Rakowski,