Racial and Ethnic Disparities in Cervical Cancer Screening From Three U.S. Healthcare Settings

Introduction: This study sought to characterize racial and ethnic disparities in cervical cancer screening and follow-up of abnormal findings across 3 U.S. healthcare settings. Methods: Data were from 2016 to 2019 and were analyzed in 2022 from sites within the METRICS Research Center (part of the PROSPR consortium), including a safety-net system in the southwestern U.S., a northwestern mixed-model system, and a northeastern integrated healthcare system. Screening uptake was evaluated among average-risk patients by race/ethnicity using chi-square tests. Among patients with abnormal findings requiring follow-up, the proportion receiving colposcopy or biopsy within 6 months was reported. Multivariable regression assessed how clinical, socioeconomic, and structural characteristics mediate observed differences. Results: Among 188,415 eligible patients, 62.8% received cervical cancer screening during the 3-year period. Screening use was lower among non-Hispanic Black patients (53.2%) and higher among Hispanic (65.4%) and Asian/Pacific Islander (66.5%) patients than among non-Hispanic White patients (63.5%, all p<0.001). Most differences were explained by distribution of patients across sites and differences in insurance. Hispanic patients remained more likely to screen after controlling for clinical and sociodemographic factors (RR≈1.14–1.18). Among those receiving any screening test, Black and Hispanic patients were more likely to receive Pap-only testing. Follow-up from abnormal results was low for all groups (72.5%) but highest among Hispanic participants (78.8%, p<0.001). Conclusions: Across 3 diverse healthcare settings, cervical cancer screening and follow-up were below 80% targets. Lower screening for Black patients was attenuated after controlling for insurance and site, underscoring systemic inequity. Improving follow-up after abnormalities is crucial for all populations.

Jennifer C Spencer, Jane J Kim, Jasmin A Tiro, Sarah J Feldman, Sarah C Kobrin, Sugg Celette Skinner, Lei Wang, Anne Marie Mccarthy, Steve J Atlas, Sandi L Pruitt, Michelle I Silver, Jennifer S Haas