Health Literacy, Care Access Barriers to Cervical Cancer Screening

Nearly one in 10 women have never had a common cervical cancer screening, like a Pap test, with issues such as limited health literacy and poor access to care getting in the way, according to a Harris Poll conducted on behalf of BD (Becton, Dickinson and Company).

These trends are more common in racial minorities, with Black and Hispanic women being more likely to say they have never had a Pap test. Compared to the 6 percent of White women who said they’ve never had a Pap test, 12 percent of Hispanic women and 13 percent of Black women said the same.

Pap tests and HPV tests are key tools for the early detection and treatment of cervical cancer, one of the few types of cancer that are nearly entirely preventable. Pap tests help detect pre-cancerous cells that can turn into cervical cancer, while HPV tests can detect human papillomavirus, the virus that causes cervical cancer.

But receipt of Pap tests is extremely low, the survey of 872 women ages 18 to 64. Overall, 71 percent of respondents have delayed getting a Pap test, with 15 percent saying their last OB/GYN check-up was three years ago.

Although not explicitly explored in the survey, it’s key to note that timeline aligns with the outbreak of the COVID-19 pandemic when access to primary and preventive care stalled.

Perhaps more troubling, 9 percent of respondents said they have never had a Pap test at all, with that trend being more common among Black and Hispanic women. In addition to the 12 and 13 percent of Hispanic and Black women who have never had a Pap test, 12 percent of Hispanic women and 8 percent of Black women said they have never had an OB/GYN appointment for routine care.

About a fifth of Hispanic women said they delayed getting a Pap test because they were embarrassed (22 percent), were afraid it would hurt (18 percent), or didn’t have an OB/GYN (21 percent). Black women were less likely to say they were embarrassed about getting a Pap test (4 percent), while White women were less likely to experience any of those barriers (9 percent, 9 percent, and 11 percent, respectively).

The good news is, around three-quarters of all respondents, regardless of race, said they have resolved to get back on track with their primary and preventive care, including Pap tests and HPV screenings, in the new year.

But doing so will require some leg work from the healthcare industry, which should note some patient health literacy and convenient care access snags getting in the way.

Even though nearly every respondent said they are knowledgeable about women’s health (91 percent), a whopping 81 percent admitted they don’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.

Moreover, many respondents did not entirely understand the link between HPV and Pap tests, with about two-thirds saying they were unaware that HPV causes cervical cancer. Just under half (47 percent) said they did not know the difference between and HPV and Pap test—HPV detects the human papillomavirus while Pap detects cancerous and pre-cancerous cells on the cervix. Black women were more likely than White women to say they did not know the difference between the two.

What’s more, respondents revealed that they did not quite know how common HPV is, with 66 percent saying they did not know that nearly all sexually active men and women would get HPV at some point in their lives. Sixty-one percent did not know there were different strains of HPV.

Respondents also displayed uncertainty about the frequency of getting a Pap test, with 67 percent saying they thought women ages 30 to 65 needed to get one every year (experts recommend every three years). That uncertainty was more common among younger women.

Healthcare providers should work to clarify this information with their patients while also conducting strong patient outreach to make sure care gaps get filled. Three-quarters of respondents said they defer to their OB/GYN for guidance about when to get a Pap test.

But that guidance doesn’t matter if a patient doesn’t have an OB/GYN or convenient access to care. About a quarter of Hispanic women said they don’t have health insurance coverage and 12 percent said they did not live close to a healthcare provider.

The data indicated that at-home tests could fill in these care gaps and that patients are receptive. Around eight in 10 respondents said they’d be interested in using an at-home collection kit for HPV testing or cervical cancer testing.

Particularly among younger women, these at-home test options seemed attractive because they might be less expensive (38 percent), might hurt less than traditional Pap tests (21 percent), and they don’t have health insurance coverage (18 percent).