Cervical Cancer in Underserved Communities

Cervical cancer remains a significant public health challenge in the U.S., despite efforts to promote early detection through increased screening. The Centers for Disease Control and Prevention reports that approximately 12,500 new cases were diagnosed in 2021, with 4,000 deaths in 2022. States such as Florida and New Mexico reflect these troubling trends, where socioeconomic factors heavily influence both the incidence and mortality rates of cervical cancer.

According to the American Cancer Society, Florida is projected to report 1,950 new cases and 1,460 deaths from cervical cancer in 2024. In New Mexico, estimates for the same year include 140 new cases and 120 deaths. These numbers underscore the persistent impact of cervical cancer, particularly in communities with lower socioeconomic status and limited access to preventive health care services like Pap smears and HPV vaccinations.

Research in New Mexico highlights the striking disparities: Women with annual incomes below $50,000 are significantly less likely to receive recommended screenings, further widening health inequities. Addressing these challenges in both states requires a multifaceted approach, including expanding access to screenings, raising public awareness about prevention and early detection, and improving health care availability in underserved areas.

Cervical cancer remains a stark example of racial and ethnic health disparities in the United States, particularly in screening, treatment and outcomes. Black women are 30 percent more likely to develop cervical cancer and 60 percent more likely to die from it compared to White women. Hispanic women experience a 51percent higher incidence rate and a 20 percent higher mortality rate compared to white women, despite better survival outcomes after diagnosis. These disparities persist due to inequitable access to prevention and early detection. Black patients are significantly less likely to receive timely screenings, with only 65% returning for follow-up after abnormalities are detected, compared to 79% of Hispanic patients. Insurance status and site of care are critical mediators of these disparities, as many Black and Hispanic patients receive care at federally qualified health centers, which report lower screening rates than other care settings. Structural barriers such as underinsurance, delayed follow-up, and inadequate treatment after diagnosis further widen these gaps.

Additionally, co-testing and HPV primary testing, essential tools for effective screening, remain underutilized in safety-net settings where many marginalized populations seek care. Addressing these disparities requires a multifaceted approach, including expanded HPV vaccination efforts, increased access to affordable insurance coverage, and patient navigation systems to ensure follow-up care. A comprehensive, patient-centered approach is necessary to close these gaps, improve survival rates, and meet the World Health Organization’s goal of eliminating cervical cancer as a public health threat.

Sociodemographic status plays a significant role in cervical cancer disparities. Factors such as race, ethnicity, healthcare access, insurance coverage, social support, and education level all impact cervical cancer screening, diagnosis, treatment, and outcomes. Individuals with lower sociodemographic status often face more barriers to screening and treatment, as well as worse prognoses, due to limited access to and affordability of care. Additionally, health care provider biases and communication challenges contribute to these disparities.

A 2023 study in JAMA found that health insurance is linked to earlier cervical cancer diagnoses. Women across all racial and ethnic groups with Medicare or private insurance were diagnosed earlier than those who were uninsured or on Medicaid. Women in rural areas face greater challenges in cervical cancer prevention, detection, and treatment, resulting in higher mortality rates compared to those in metropolitan areas. Enhancing screening and early detection in rural areas is a key strategy to address this disparity. For over 20 years, the National Breast and Cervical Cancer Early Detection Program has aimed to provide screening for low-income, uninsured women. However, this program only reaches a small portion of those eligible, leaving many without essential care.

Physicians should remain up to date with current clinical guidelines to screen for cervical cancer and include discussion on screening in patient education post-examination. Current clinical guidelines by the U.S. Preventive Services Task Force recommend that cervical cancer screening should occur every three years for women aged twenty-one to twenty-nine years old with cervical cytology alone. Patients aged 30 to 65 can be screened every three years with cervical cytology alone or every five years with high-risk human papillomavirus (hrHPV) testing, which can also be combined with cytology or used alone. Physicians should also be sure to take a thorough history to identify if patients had exposure in utero to diethylstilbestrol, a synthetic nonsteroidal estrogen drug that has been linked to clear cell adenocarcinoma.

Although Black women have the lowest incidence of cervical cancer, they experience the highest rate of mortality due to cervical cancer. This highlights the relevance of early screening methods to prevent the further progression of the disease.

To conduct efficient health education outreach, physicians can use a variety of correspondence methods such as postcard reminders or email notifications in various languages about the importance of screening and how to schedule an appointment for a Pap smear. Providing screening materials in other languages, such as Spanish, can help to increase the number of Spanish speakers receiving Pap smears, who many of, cite lack of insurance as a main reason for foregoing screening. To accommodate the needs of uninsured or underinsured patients, physicians should also be aware of free cervical cancer screening tests, such as the Florida and New Mexico Department of Health Breast and Cervical Cancer (BCC) Early Detection program.

It is important to build trust in communities by discussing patient’s misconceptions and concerns about the HPV vaccine, a driving factor in why many minority communities do not consent to their children or selves in receiving the vaccine, when counseling patients physicians can include that the vaccine has a 99 percent efficacy rate for women who receive the vaccine before HPV exposure and significantly reduces the incidence of anogenital cancer and genital warts.