Impact of prior underinsurance on cervical cancer screening among Davidson County, Tennessee, women diagnosed with invasive cervical cancer, 2008-2018

Structural Racism in Cervical Cancer Care and Survival Outcomes: A Systematic Review of Inequities and Barriers

Purpose of Review

Despite cervical cancer (CC) being a cancer that can be eliminated, CC disparities persist such that minoritized populations shoulder a disproportionate mortality burden. This may reflect upstream, fundamental drivers of health that impede equitable access to prevention, screening, early detection, and treatment among some groups. This systematic review summarizes evidence on the relationships between structural racism and CC care across the continuum.

Recent Findings

Following PRISMA guidelines, we conducted a comprehensive search for peer-reviewed, English-language studies relevant to our research question that were published from 2012-2022 using PubMed, CINAHL, Web of Science, and Embase. Of 8,924 articles identified, 4,383 duplicates were removed, and 4,541 underwent screening, with 206 articles meeting eligibility criteria for inclusion in our data synthesis. Among reviewed studies, 60.2% (n = 124) compared CC outcomes by race and ethnicity, often as proxies for upstream racism. Key findings included evidence of lower CC screening rates among Asian American and Pacific Islander women and higher rates among Black and Hispanic/Latinx women. Barriers to healthcare access and socioeconomic status (SES) factors contributed to delayed follow-up, later-stage CC diagnoses, and poorer outcomes, particularly for Black and Hispanic/Latinx women and those residing in low-SES neighborhoods.

Summary

This review underscores associations between race, ethnicity, SES, and outcomes across the CC continuum. Most studies examined racial and ethnic disparities in the outcomes of interest rather than directly evaluating measures of structural racism. Future research should refine measures of structural racism to deepen our understanding of its impact on CC across the care continuum.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40471-025-00360-y.

U.S. Women with Invasive Cervical Cancer: Characteristics and Potential Barriers to Prevention

Objectives: Although invasive cervical cancer (ICC) rates have declined since the advent of screening, the annual age-adjusted ICC rate in the United States remains 7.5 per 100,000 women. Failure of recommended screening and management often precedes ICC diagnoses. The study aimed to evaluate characteristics of women with incident ICC, including potential barriers to accessing preventive care. Materials and Methods: We abstracted medical records for patients with ICC identified during 2008-2020 in five U.S. population-based surveillance sites covering 1.5 million women. We identified evidence of adverse social and medical conditions, including uninsured/underinsured, language barrier, substance use disorder, incarceration, serious mental illness, severe obesity, or pregnancy at diagnosis. We calculated descriptive frequencies and compared potential barriers by race/ethnicity, and among women with and without symptoms at diagnosis using chi-square tests. Results: Among 1,606 women with ICC (median age: 49 years; non-White: 47.4%; stage I: 54.7%), the majority (68.8%) presented with symptoms. Forty-six percent of women had at least one identified potential barrier; 15% had multiple barriers. The most common potential barriers among all women were being underinsured/uninsured (17.3%), and language (17.1%). Presence of any potential barrier was more frequent among non-White women and women with than without symptoms (p < 0.05). Conclusions: In this population-based descriptive study of women with ICC, we identified adverse circumstances that might have prevented women from seeking screening and treatment to prevent cancer. Interventions to increase appropriate cervical cancer screening and management are critical for reducing cervical cancer rates.

Racial/Ethnic Disparities in Cervical Cancer Stage at Diagnosis: Mediating Effects of Neighborhood-level Socioeconomic Deprivation

BACKGROUND

Mortality from cervical cancer has declined steadily in the United States over the past several decades due to widespread screening for precancerous and early-stage cervical cancer (ECC), which are significantly easier to treat compared with late-stage cervical cancer (LCC). Unequal screening access continues to cause significant racial/ethnic disparities in cervical cancer diagnosis stage. This study examined the underlying role of neighborhood-level socioeconomic disadvantage as a potential mediator of the association between race/ethnicity and cervical cancer diagnosis stage.

METHODS

We analyzed Texas Cancer Registry data for cervical cancer cases diagnosed among women ages 18 or older from 2010 to 2018. We performed causal mediation analyses of the association between race/ethnicity and cervical cancer stage at diagnosis mediated by neighborhood-level socioeconomic disadvantage.

RESULTS

Of the 9,192 women with cervical cancer, 4,720 (51.3%) had LCC at diagnosis. Compared with non-Hispanic white (NHW) women (106.13, standard deviation (SD) = 13.32), non-Hispanic Black (NHB; 111.46, SD = 9.55) and Hispanic (112.32, SD = 9.42) women had higher area deprivation index (ADI) and had greater odds of LCC diagnosis [total effects: adjusted odds ratios (AOR) = 1.29 (95% CI, 1.11-1.46) and AOR 1.14 (95% CI, 1.03-1.25), respectively]. Approximately 34.7% and 71.6% of the disparity in LCC diagnosis were attributable to higher neighborhood socioeconomic disadvantage among NHB and Hispanic women, respectively.

CONCLUSIONS

LCC disparity varied by race/ethnicity and was partly attributable to neighborhood disadvantage. The disparity among Hispanic women due to neighborhood deprivation was twice as high among NHB women.

IMPACT

Findings may be used to develop targeted race- and place-specific interventions to improve cancer care equity.