Health Insurance Impacts Racial Inequities in Cervical Cancer Diagnoses

Health insurance coverage may help mitigate racial inequities in advanced-stage cervical cancer diagnoses, according to a study published in JAMA Network Open.

Undergoing regular cervical cancer screenings, such as Pap tests, can help identify and treat precancerous lesions or cancers. Individuals who receive diagnoses of early-stage cervical cancer have over a 90 percent five-year survival rate. Meanwhile, those who receive an advanced-stage diagnosis have a 59 percent five-year survival rate for regional cancers and a 17 percent survival rate for distant or metastatic cancers.

Past data has found that racial and ethnic minority groups, including Black, Hispanic or Latina, and American Indian or Alaska Native women, are more likely to receive a cervical cancer diagnosis and an advanced-stage cervical cancer diagnosis than White women. Black women are also more likely to receive inadequate treatment for and die of cervical cancer compared to White women.

Researchers used data from the Surveillance, Epidemiology, and End Results (SEER) Program on patients diagnosed with cervical cancer between January 1, 2007, and December 31, 2016, to determine if health insurance coverage helped mediate advanced-stage diagnoses among different racial and ethnic groups.

The study sample included 23,492 women diagnosed with localized, regional, or distant cervical cancer. Over half of the population was White (52.9 percent), 24.5 percent were Hispanic or Latina, 12.8 percent were Black, 9 percent were Asian or Pacific Islander, and 0.8 percent were American Indian or Alaska Native.

Nearly 60 percent of women had private insurance or Medicare, 32.5 percent received coverage through Medicaid, and 8 percent were uninsured. Women with private insurance or Medicare were more likely to be diagnosed with early-stage cervical cancer than those with Medicaid or without insurance (57.8 percent versus 41.1 percent).

A lower share of Black (41.7 percent), American Indian or Alaska Native (48.7 percent), Asian or Pacific Islander (49.9 percent), and Hispanic or Latina (51.6 percent) women received an early-stage diagnosis compared to White women (53.3 percent).

Meanwhile, Black and Hispanic or Latina women had higher odds of advanced-stage cervical cancer than White women.

More White women had private insurance or Medicare at the time of diagnosis compared to the other racial and ethnic groups. In addition, White women were more likely to undergo surgery for early-stage and advanced-stage cervical cancer than Black women.

In the mediation analysis, researchers found that being uninsured or insured by Medicaid accounted for more than half the estimated inequity in advanced-stage cervical cancer diagnoses across racial and ethnic groups compared with White women.

Specifically, uninsurance or Medicaid insurance accounted for 51.3 percent of inequities for Black women, 52.5 percent for American Indian or Alaska Native women, 53.8 percent for Asian or Pacific Islander women, and 55.1 percent for Hispanic or Latina women.

These findings indicate that private insurance or Medicare coverage may help minimize racial disparities in advanced-stage cervical cancer diagnoses.

“Health insurance status is a modifiable risk factor that could reduce these persistent cervical cancer mortality inequities among Black individuals,” researchers wrote. “Extrapolating our results, even among populations that do not possess differences in cervical cancer mortality, far fewer individuals of all races and ethnicities would receive a diagnosis of advanced-stage cancer and, thus, would have a higher 5-year survival rate.”

Uninsured individuals and people with Medicaid are the most likely populations to be underscreened for cervical cancer. If these groups receive screenings, they are more likely to experience delays in accessing diagnostic care.

According to the researchers, if private insurance or Medicare coverage was expanded or Medicaid eased physicians’ administrative burden, fewer women from racial and ethnic minority groups would receive advanced-stage cancer diagnoses.

In addition to health insurance status, societal, community, and individual factors are associated with cervical cancer screening rates.

For example, a Harris Poll conducted on behalf of BD (Becton, Dickinson and Company) found that limited health literacy posed a barrier to cervical cancer screening. More than eight in 10 women said they didn’t know how often they should get a Pap test and 51 percent said they were unaware of how often they should get an HPV test.