Racial and ethnic disparities in the cervical cancer screening cascade in three U.S. health care settings.

Abstract

109 Background: There are wide disparities in cervical cancer incidence and mortality in the US by race and ethnicity. Our objective was to characterize racial and ethnic differences in routine cervical cancer screening and follow-up of abnormal findings across three US healthcare settings. Methods: We used 2016 to 2019 data from three sites participating in the METRICS research center, part of the PROSPR II consortium. We evaluated screening among average risk, screen-eligible patients receiving care at participating sites, by race and ethnicity as captured in the EHR. Among patients with a high-risk abnormal finding, we evaluated the proportion receiving colposcopy or biopsy within six months. We conducted multivariate regression to assess the extent to which clinical, socioeconomic, and structural characteristics mediate observed differences in screening. Results: We identified 188,415 eligible patients; 74.6% received cervical cancer screening during the 3-year study window. Screening use was lower among non-Hispanic Black (66.8%) patients and higher among Hispanic (82.5%), Asian/Pacific Islander (75.8%) patients, and those who identified as multi-racial or “other” race (75.8%) compared to non-Hispanic White (71.4%) patients. In multivariate regression, most differences were explained by the distribution of patients across sites, with the lowest screening rate observed at the site caring for the majority of both Black and Hispanic patients. However, Hispanic patients remained more likely to be screened even after controlling for a variety of clinical and sociodemographic factors (Risk Ratio: 1.14 [1.12, 1.16]). Among those receiving a screening test, Black and Hispanic patients were more likely to receive Pap-only testing (vs. HPV DNA co-testing) compared to non-Hispanic White patients and were more likely to have abnormal findings. Follow-up from abnormal results within six months was low for all groups (68.7%) but highest among Hispanic participants (77.7%). Conclusions: In a large cohort of patients receiving care in three community settings, cervical cancer screening and follow-up were lower than national targets. Lower screening for Black women is strongly driven by insurance and site of care, underscoring the value of addressing systemic inequity. More research is needed to characterize the relatively higher screening for Hispanic women, which is not explained by observed individual or systemic factors. Additionally, it is crucial to focus on follow-up after abnormalities are identified, which is low for all populations.