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