Socioeconomic barriers limit successful cervical cancer screening

PHILADELPHIA — Screening for cervical cancer has been a “great success,” according to a speaker at the American College of Physicians Internal Medicine Meeting. However, socioeconomic barriers prevent all women from gaining equal access to screening.

“Although the mortality rate from cervical cancer has continued to drop since the 1970s in parallel with incidence, our treatments aren’t really better,” Kathleen McIntyre-Seltman, MD, of Magee Womens Hospital at the University of Pittsburgh School of Medicine, said during a presentation. “The reason women aren’t dying as much from cervical cancer is because there is less cervical cancer. Cervical cancer screening has been a great success with the incidence and mortality from cervical cancer dropping dramatically since screening was introduced. However, there are still failures—including racial, economic and social disparities – associated with screening.”

A significant barrier to screening is cost. Some women, even those with insurance, cannot afford the copays, McIntyre-Seltman said. To help mitigate this barrier, she urged primary care physicians to conduct HPV screening instead of cytology, which she said was both more sensitive and more cost-effective.

According to McIntyre-Seltman, it is also difficult for some women to access screening due to location, because women in rural areas often do not have transportation to a screening center and cannot afford it. She suggested primary care physicians engage in outreach and provide women with self-collection kits so that they can be tested in their own homes.

Finally, McIntyre-Seltman discussed fear, which she said was the biggest reason women do not get screened for cervical cancer. Women who identify as part LGBTQ or have been victims of intimate partner violence or sexual assault are often uncomfortable with the screening process, she said. Keeping these concerns in mind can help primary care physicians to create a safe space for their patients.

“There is work being done in trying to access that group of women who is not currently being accessed and, again, we should all remember that those are the women that are at the highest risk for cervical cancer,” McIntyre-Seltman said. “What I’ve discussed today are things on the forefront for the future and ideas that you can consider introducing into your own practice to help women get access to screening and be protected.”– by Melissa J. Webb

Reference:

McIntyre-Seltman K. Cervical cancer screening and HPV update for the internist. Presented at: ACP Internal Medicine Annual Meeting. April 11-13, 2019; Philadelphia.

Disclosure: McIntyre-Seltman reports no relevant financial disclosures.