Thulien Naomi S
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto ON.
J Obstet Gynaecol Can. 2014 Mar;36(3):231-239. doi: 10.1016/S1701-2163(15)30631-9.
Female sex trade workers are among those at highest risk for developing and dying of cervical cancer, and yet many-particularly the most marginalized-are less likely than other women to be screened. This review summarizes global findings on innovative approaches to cervical cancer screening for female sex trade workers, highlights current gaps in the delivery of cervical cancer screening for female sex trade workers globally, and suggests areas for future research and policy development.
A scoping review of peer-reviewed publications and grey literature was conducted. Medline (OVID), PubMed, EMBASE, and SCOPUS were searched for relevant studies written in English. There were no limitations placed on dates. Grey literature was identified by hand searching and through discussion with health care providers and community outreach workers currently working with sex trade workers.
Twenty-five articles were deemed suitable for review. Articles detailing innovative ways for female sex trade workers to access cervical cancer screening were included. Articles about screening for sexually transmitted infections were also included if the findings could be generalized to screening for cervical cancer. Articles limited to exploring risk factors, knowledge, awareness, education, prevalence, and incidence of cervical cancer among sex trade workers were excluded from the review.
Successful screening initiatives identified in the studies reviewed had unconventional hours of operation, understood the difference between street-based and venue-based sex trade workers, and/or used peers for outreach.
Two significant gaps in health care service delivery were highlighted in this review: the limited use of unorthodox hours and the nearly exclusive practice of providing sexually transmitted infection screening for female sex trade workers without cervical cancer screening. In addition, although street-based (as opposed to venue-based) sex trade workers are likely at higher risk for developing cervical cancer, they are much less likely than other eligible women to participate in screening programs, meaning traditional outreach methods are unlikely to be successful.
女性性工作者是罹患宫颈癌并死于该病风险最高的人群之一，然而许多人，尤其是那些最边缘化的女性性工作者，接受筛查的可能性低于其他女性。本综述总结了全球范围内针对女性性工作者宫颈癌筛查创新方法的研究结果，突出了目前全球女性性工作者宫颈癌筛查服务提供方面存在的差距，并提出了未来研究和政策制定的方向。
对同行评审出版物和灰色文献进行了范围综述。检索了Medline（OVID）、PubMed、EMBASE和SCOPUS数据库中用英文撰写的相关研究。对日期没有限制。通过手工检索以及与目前与性工作者合作的医疗服务提供者和社区外展工作者进行讨论来识别灰色文献。
25篇文章被认为适合进行综述。纳入了详细介绍女性性工作者进行宫颈癌筛查创新方式的文章。如果研究结果可推广至宫颈癌筛查，那么关于性传播感染筛查的文章也被纳入。仅限于探讨性工作者中宫颈癌风险因素、知识、意识、教育、患病率和发病率的文章被排除在综述之外。
在所综述的研究中确定的成功筛查举措具有非传统的工作时间，了解街头性工作者和场所性工作者之间的差异，和/或利用同伴进行外展工作。
本综述突出了医疗服务提供方面的两个重大差距：非传统工作时间使用有限，以及几乎只对女性性工作者进行性传播感染筛查而不进行宫颈癌筛查的做法。此外，尽管街头（相对于场所）性工作者罹患宫颈癌的风险可能更高，但她们参与筛查项目的可能性远低于其他符合条件的女性，这意味着传统的外展方法不太可能成功。
