An online evaluation of implicit association to cancer diagnoses among a group of gynecologic oncology clinicians found that cervical cancer was associated with implicit prejudice and stereotyping compared with ovarian cancer, particularly among nurses. This study was published in Gynecologic Oncology.

Recent evidence suggests that more negative perceptions are associated with a diagnosis of cervical cancer compared with ovarian cancer. This study was conducted to evaluate implicit emotions and beliefs, as opposed to self-reported explicit emotions and beliefs, of gynecologic healthcare providers regarding diagnosis of cervical vs ovarian cancer.

In this study, the Implicit Association Test (IAT) was administered online to healthcare providers recruited through membership in specific professional organizations. The IAT takes into account reaction times or error rates to assess relative associations, in this case between cervical cancer and ovarian cancer. An IAT implicit bias “d-score” of 0 was interpreted as a neutral association, whereas positive d-scores were considered to indicate implicit bias.  

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Participant demographic information was also collected, as well as responses to questions evaluating internal and external motivation, such as cultural competency and implicit bias training, to respond without prejudice toward women with cervical cancer

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Of the 151 respondents included in the study analyses, 61.6% were physicians and 38.4% were nurses; 74.1% were female; and mean age was 39 years, with an average of 12 years in practice. 

The overall group of respondents showed significant levels of implicit prejudice and stereotyping toward patients with cervical cancer. The mean score for implicit prejudice (standard deviation) was 0.17(0.47) and 95% confidence interval (CI), 0.10-0.25; the mean score for implicit stereotyping was 0.15(0.42); 95% CI, 0.08-0.21. 

When evaluated separately, significant levels of implicit prejudice and stereotyping were observed among nurses but not among physicians. When results were evaluated according to sex, only women showed significant levels of implicit prejudice and stereotyping. In addition, older respondents and those with more years in practice exhibited stronger implicit prejudice and stereotyping toward patients with cervical cancer. Those clinicians with no training in cultural competency had greater bias than those who had received such training (<.05). 

In conclusion, the study authors wrote that “interventions may be designed to target specific groups in gynecologic oncology such as nurses, older providers, and providers who have been practicing for a longer amount of time to improve interactions with patients.”


Liang J, Wolsiefer K, Zestcott CA, Chase D, Stone J. Implicit bias toward cervical cancer: provider and training differences [published online February 7, 2019]. Gynecol Oncol. doi: 10.1016/j.ygyno.2019.01.013