Cervical Cancer Screening Is Essential, but Access to Good Treatment Can Be the Difference Between Life and Death

"When we talk about the Black community … there are always conversations in the community or with families about maybe diabetes and heart disease and hypertension, but not so much when it comes to cancer," said Rhonda M. Smith, executive director of the California Black Health Network. "It's just a conversation that's still kind of taboo."

And cervical cancer is often less of a focus than other types, such as breast cancer, according to Smith, although it's the fourth most common cancer among women and women do seem to understand the importance of getting screened.

In fact, 88% of respondents in the HealthyWomen/NPWH survey reported that they believe cervical cancer screening is important to managing their overall health and well-being. Black (95%) and Hispanic (92%) women were more likely than white (86%) women to say so.

Black women may also be more knowledgeable about the Pap test than white women; 91% of Black women reported being familiar with the Pap test compared with 84% of white women and 83% of Hispanic women.

This awareness is reflected in screening rates among women over age 18 who have not had a hysterectomy. According to the Centers for Disease Control and Prevention (CDC), 80% of Black women had had a Pap test in the prior three years compared with approximately 71% of both Hispanic and non-Hispanic white women.

CDC data also show that lower-income women and women without a high school diploma or GED were less likely to have had a Pap test, as were women without health insurance. Overall, only 60% of uninsured women had had one, compared with 79% of women with health insurance.

Isis was lucky in this regard. Though she was uninsured at the time of her diagnosis, she'd been able to get screened — and treated with a procedure to remove abnormal cells from her cervix — without financial hardship. But just the cost of screening can deter some women.

"Too often, women skip screenings because they can't afford them," Pierce said. "We see this in 50% of women diagnosed with cervical cancer."

But Pierce says there's no financial reason to skip cervical cancer screening. Every state offers free screening and treatment for uninsured and underinsured women through the Breast and Cervical Cancer Early Detection Program.

Screening is important, but on its own, it's not sufficient to prevent cervical cancer deaths.

Black women are more likely to die from cervical cancer, even with higher screening rates. According to a study that looked at women who have not had a hysterectomy, the death rate among Black women is more than double that of white women: 10.1 per 100,000 compared with 4.7 per 100,000.

Studies have shown that Black women tend to find cervical cancer later in its progression, get less aggressive treatment, and have less access to care, which may explain why their outcomes are worse.

"There are differences in access to treatment and followup as well as differences in treatment for cancer," Pierce said. "We continue to march closer to equity in this area but most of these differences can be explained by social domains of health, all of which are impacted by systemic racism such as poverty, rurality, access [and] education."

To reduce cervical cancer deaths, Pierce urges young women and teens to talk to their healthcare provider about HPV vaccination.

"After 15 years on the market, we know it's safe. We know it's effective," she said. "And we are already seeing significant reductions in disease in vaccinated patients."

Stigma still surrounds HPV and the cancers it causes, but Isis encourages other women not to let that get in the way of getting the screening and the care they need.

"I don't think that there's really any shame in having had HPV or being exposed to HPV," Isis said. "There's really so little you can do about it, so the best thing is prevention."

*Isis asked us not to use her last name.