Black Women More Likely to Get Screened for Cervical Cancer, Less Likely to Receive Follow-up for Abnormal Pap

Even though Black women were more likely than white women to undergo screening for cervical cancer, they were less likely to receive a follow-up recommendation for an abnormal Pap test, according to a study.

“More Black women were being screened for cervical cancer (compared to white women) but they were still dying from cervical cancer at twice the rate,” said study author Sabrina Ford, PhD, an associate professor in the Department of Obstetrics, Gynecology and Reproductive Biology at the Michigan State University College of Human Medicine, in a press release. “It didn’t make sense.”

Dr. Ford and her colleagues queried the 2010 National Health Interview Survey cancer module to compare human papillomavirus (HPV) knowledge, screening behavior, and follow-up to abnormal Pap test between Black versus white women aged 18 years or older who did not have a hysterectomy. Primary outcome variables included HPV awareness, Pap test in the last three years, provider recommended Pap test, received Pap test results, had an abnormal Pap test, recommended follow-up, and adhered to the recommendation for follow-up.

Final analysis included 7,509 women. Black women, compared to white women, had lower odds ratios (ORs) for HPV awareness (OR, 0.42; 95% confidence interval [CI], 0.36-0.49), reporting Pap screening was recommended (OR, 0.76; 95% CI, 0.66-0.88), and acknowledging receipt of Pap results (OR, 0.64; 95% CI, 0.49-0.83). Black women were more likely to report recent Pap screening (OR, 1.7; 95% CI, 1.42-2.03) but were less likely to receive a follow-up recommendation if they had an abnormal Pap (OR, 0.54; 95% CI, 0.31-0.95).

The reasons for this gap in follow-up are multifaceted, according to Dr. Ford.

“Culture does come into play because Black women do get their information from family, friends and personal experience,” she explained. “Sometimes there is medical mistrust, shame or fear and so, some women delay or don’t follow up.”

“We can’t blame the patient. We can’t blame the doctor either when the communication isn’t clear,” she added. “I want to move the needle forward on cervical cancer and HPV. They are highly preventable, curable and could be eradicated.”

The study was published in the February issue of Gynecologic Oncology.