Elsevier

Current Problems in Cancer

Volume 31, Issue 3, May–June 2007, Pages 157-181
Current Problems in Cancer

Factors Underlying Disparities in Cervical Cancer Incidence, Screening, and Treatment in the United States

https://doi.org/10.1016/j.currproblcancer.2007.01.001Get rights and content

Section snippets

Methods

Analyses of the incidence and mortality of cervical cancer, stratified by race/ethnic group (black, Hispanic, white, American Indian/Alaska Native, Asian, or Pacific Islander), were obtained from the 2002 SEERS database.32 We used the same search terms as Newmann and coworkers,33 including “cervical cancer” and “cervix cancer” and the following domains of social inequality: race/ethnicity, racism, socioeconomic position, social position, gender, age, language, literacy, immigrant status,

Race/Ethnicity

Race/ethnicity has often been implicated as a major factor underlying disparities in cervical cancer rates. ICC incidence in the U.S. between 1992 and 1998 was notably higher among black, Hispanic, and Asian and Pacific Islander women as compared with white, Alaska Native, and American Indian women (Figs 2 and 3A).32 Racial/ethnic differences in ICC incidence may be related to differences in cervical cancer screening rates, follow-up rates of abnormal Pap smears, and treatment rates of cervical

Access

Lack of access to health care has been correlated with reduced cervical cancer screening and treatment.67, 101, 105, 111 In most studies, health care access is measured by insurance status or having a usual source of care. Having insurance, particularly private insurance, has been positively associated with cervical cancer screening, earlier stage at diagnosis, receipt of guideline-based therapy, and improved survival.67, 99 In contrast, women who lack insurance coverage100 or who are covered

HPV Vaccine

In June 2006, the first vaccine targeted against the HPV virus was released (GARDASIL™, manufactured by Merck and Co., Inc., Whitehouse Station, New Jersey). This is a quadrivalent HPV vaccine which protects against four HPV types, that together cause 70% of cervical cancers and 90% of genital warts.1 The vaccine is currently licensed for use among females aged 9 to 26 years for prevention of HPV-related cervical cancer precursors, cervical cancer, vaginal and vulvar cancer precursors, and

Reducing Disparities in Cervical Cancer Incidence, Screening, and Treatment

This review provides some insights about the factors underlying disparities in cervical cancer incidence, screening, and treatment. It is important to recognize that no one factor completely accounts for these disparities. Rather, there are complex relationships between patient, provider, and health system factors that underlie the observed differences. Thus, efforts to reduce these disparities should target these different areas if we are to further increase cervical cancer screening rates.

Acknowledgments

We thank Rachel Palmeri and Brooke Hoots for their assistance in preparing the figures for this paper.

First page preview

First page preview
Click to open first page preview

References (130)

  • J.A. Chilton et al.

    Cervical cancer among Vietnamese women: efforts to define the problem among Houston’s population

    Gynecol Oncol

    (2005)
  • E.A. Howell et al.

    Differences in cervical cancer mortality among black and white women

    Obstet Gynecol

    (1999)
  • D.A. Patel et al.

    A population-based study of racial and ethnic differences in survival among women with invasive cervical cancer: analysis of Surveillance, Epidemiology, and End Results data

    Gynecol Oncol

    (2005)
  • M.G. del Carmen et al.

    Ethnic differences in patterns of care of stage 1A(1) and stage 1A(2) cervical cancer: a SEER database study

    Gynecol Oncol

    (1999)
  • A. Katz et al.

    Socioeconomic characteristics of patients with squamous cell carcinoma of the uterine cervix treated with radiotherapy in the 1992 to 1994 patterns of care study

    Int J Radiat Oncol Biol Phys

    (2000)
  • P.W. Grigsby et al.

    Comparison of clinical outcome in black and white women treated with radiotherapy for cervical carcinoma

    Gynecol Oncol

    (2000)
  • A.J. Mundt et al.

    Race and clinical outcome in patients with carcinoma of the uterine cervix treated with radiation therapy

    Gynecol Oncol

    (1998)
  • M. Bazargan et al.

    Correlates of cervical cancer screening among underserved Hispanic and African-American women

    Prev Med

    (2004)
  • M. Hewitt et al.

    Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey

    Prev Med

    (2004)
  • S.T. Lindau et al.

    The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women

    Am J Obstet Gynecol

    (2002)
  • L.C. Walter et al.

    Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence

    Am J Med

    (2005)
  • P.A. Mitchell et al.

    Cervical cancer in the elderly treated with radiation therapy

    Gynecol Oncol

    (1998)
  • L.C. Seeff et al.

    Cervical cancer mortality among foreign-born women living in the United States, 1985 to 1996

    Cancer Detect Prev

    (2003)
  • T.L. Byrd et al.

    Cervical cancer screening beliefs among young Hispanic women

    Prev Med

    (2004)
  • M.E. Fernandez-Esquer et al.

    Cervical cancer screening among Latinas recently immigrated to the United States

    Prev Med

    (2004)
  • L.T. Austin et al.

    Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model

    Womens Health Issues

    (2002)
  • L. Suarez et al.

    Knowledge, behavior, and fears concerning breast and cervical cancer among older low-income Mexican-American women

    Am J Prev Med

    (1997)
  • L.R. Chavez et al.

    The influence of fatalism on self-reported use of Papanicolaou smears

    Am J Prev Med

    (1997)
  • B.K. Rimer et al.

    Cancer screening practices among women in a community health center population

    Am J Prev Med

    (1996)
  • GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide IARC CancerBase, No. 5, version 2.0

    (2004)
  • S.S. Devesa et al.

    Cancer incidence and mortality trends among whites in the United States, 1947-84

    J Natl Cancer Inst

    (1987)
  • L.M. Martin et al.

    Cervical cancer incidence and screening: status report on women in the United States

    Cancer Pract

    (1996)
  • R.A. Smith et al.

    American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancersAlso: update 2001–testing for early lung cancer detection

    CA Cancer J Clin

    (2001)
  • M.H. Schiffman et al.

    Epidemiologic evidence showing that human papillomavirus infection causes most cervical intraepithelial neoplasia

    J Natl Cancer Inst

    (1993)
  • M.J. Khan et al.

    Socioeconomic status and the risk of cervical intraepithelial neoplasia grade 3 among oncogenic human papillomavirus DNA-positive women with equivocal or mildly abnormal cytology

    Cancer

    (2005)
  • J.S. Smith et al.

    Herpes simplex virus-2 as a human papillomavirus cofactor in the etiology of invasive cervical cancer

    J Natl Cancer Inst

    (2002)
  • J.S. Smith et al.

    Chlamydia trachomatis and invasive cervical cancer: a pooled analysis of the IARC multicentric case-control study

    Int J Cancer

    (2004)
  • R. Herrero et al.

    Invasive cervical cancer and smoking in Latin America

    J Natl Cancer Inst

    (1989)
  • N.S. Larsen

    Invasive cervical cancer rising in young white females

    J Natl Cancer Inst

    (1994)
  • E.M. de Villiers

    Relationship between steroid hormone contraceptives and HPV, cervical intraepithelial neoplasia and cervical carcinoma

    Int J Cancer

    (2003)
  • A.B. Williams et al.

    Anal and cervical human papillomavirus infection and risk of anal and cervical epithelial abnormalities in human immunodeficiency virus-infected women

    Obstet Gynecol

    (1994)
  • R. Herrero et al.

    A case-control study of nutrient status and invasive cervical cancerI. Dietary indicators

    Am J Epidemiol

    (1991)
  • R. Garcia-Closas et al.

    The role of diet and nutrition in cervical carcinogenesis: a review of recent evidence

    Int J Cancer

    (2005)
  • C.E. Butterworth et al.

    Folate deficiency and cervical dysplasia

    J Am Med Assoc

    (1992)
  • ACOG Practice Bulletin: clinical management guidelines for obstetrician-gynecologists. Number 45, August 2003. Cervical cytology screening (replaces committee opinion 152, March 1995)

    Obstet Gynecol

    (2003)
  • K.E. Hartmann et al.

    Screening for Cervical Cancer. Systematic Evidence Review. No. 25

    (2002)
  • R.A. Smith et al.

    American Cancer Society guidelines for the early detection of cancer

    CA Cancer J Clin

    (2002)
  • Guide to Clinical Preventive Services

    (1996)
  • D. Shelton et al.

    Race, stage of disease, and survival with cervical cancer

    Ethn Dis

    (1992)
  • D.T. Janerich et al.

    The screening histories of women with invasive cervical cancer, Connecticut

    Am J Public Health

    (1995)
  • Cited by (152)

    View all citing articles on Scopus
    View full text