Cervical cancer screening failure linked to poverty

African-American women living in communities with high poverty rates are less likely to be screened for cervical cancer, even after adjusting for other factors known to raise the risk of non-screening, such as older age, lower educational attainment, and smoking. The study, appearing in the February 1, 2006 issue of CANCER (http://www.interscience.wiley.com/cancer-newsroom), a peer-reviewed journal of the American Cancer Society, demonstrates that a community's income status predicts cervical screening rates.

Screening for cervical cancer using the Pap test has long been shown to be a cost-effective screening tool to reduce mortality. Mortality rates from cervical cancer have dropped 50 to 70 percent since the test's introduction. However, disparities in screening rates persist among different ethnicities, often blamed on individual factors, such as lack of access to regular healthcare, older age, obesity, and health status. A few studies now show that community and state level factors contribute to low screening rates among black women. However, those studies have thus far failed to distinguish the impact between these and other factors.

Led by Geetanjali Dabral Datta, Sc.D., M.P.H. of the Harvard School of Public Health in Boston, researchers investigated the relationship between individual characteristics and larger socioeconomic factors and their impact on recent cervical cancer screening rates. To do this they analyzed responses from over 40,000 African American women across the United States who participated in the Black Women's Health Study of Boston University and Howard University.

The investigators found that after adjusting for individual factors, residing in a community where at least 20 percent of the population lives below the poverty line was a significant predictor of failure to receive cervical cancer screening using the Pap test. State of residence was also found to be a predictor, but this association was not explained by the level of poverty in the state.

"The study adds to the literature by demonstrating that [community] and state factors influence cervical cancer screening behaviors above and beyond individual factors," the authors conclude. Further, they recommend "that community outreach programs should focus on high poverty neighborhoods to decrease the proportion of black women who are not adhering to cervical cancer screening recommendations."