Racial disparities in healthcare and the challenges of serving a diverse population as part of cervical cancer prevention and treatment were topics of a recent roundtable discussion sponsored by RAD-AID International, a nonprofit global health organization.
The interdisciplinary panel was moderated by Dr. Haywood Brown, Professor of ObGyn, Associate Dean for Diversity, Morsani College of Medicine, University of South Florida and a past president of ACOG. Other participants included Dr. Jessica Shepherd, ObGyn at Baylor University Medical Center; Dr. Jane Delgado, President and CEO of the National Alliance for Hispanic Health; Dr. E. Blair Holladay, CEO of the American Society for Clinical Pathology; and Dr. Tara Hayes Constant, a nurse practitioner at Sea Mar Community Health Centers.
“Black women in the US die from cervical cancer at two times the rate of White women,” said Dr. Delgado. “I think the biggest challenge we have now is the proposed American Cancer Society Guidelines for Preventing Cancer, because those guidelines are going to hurt specifically Hispanic, African American, and poor women.”
In 2020, The American Cancer Society ignited a debate when they proposed raising the age at which cervical cancer screening starts from 21 to 25 years. The ACS also recommended replacing the current guidance of cytology alone every three years, or co-testing with cytology and HPV testing every five years, with HPV testing alone every five years as the primary mode of screening.
“The guidelines acknowledge that Black and Latino women have higher rates of cervical cancer,” Dr. Shepherd said. “But if we’re going to limit the screening options and have testing for fewer women, we know that that is going to widen that gap of disparity. And what we’re going to see is potentially an increase of exposure to cancers for these women.”
“The challenge is that we’re still practicing medicine where one size fits all. And it doesn’t fit all and you’re actually hurting patients,” Dr. Delgado said. “It’s going to hurt them because you have a pattern of people that, oh, you don’t really have to come. You can wait. And unfortunately for many women, especially low-income women, they have a lot on their plate. So, they will push off stuff for themselves to take care of their families.”
Delaying the age at which screening starts was a key area of concern, given that cervical cancer screenings serve as an important gateway to bring women into the healthcare system.
“We want that person to come in annually for an evaluation,’ Dr. Brown said. “Whether they get a cervical cytology, a screen or not for cancer, because it may not be time, but we do need to see them and we need to track them.”
“If we push off that initial screening from 21 years to 25, we are missing a big portion of people’s lives in not only education but having them understand the importance of getting the PAP test plus HPV,” Dr. Shepherd said. “We really need to emphasize and put the importance on what occurs early on at a well-woman visit. If we’re able to capture these women earlier on, start these conversations early on, we will see that that’s what we’re trying to accomplish – is decrease the numbers of cervical cancer.”
“The moment where you’re talking to women about cervical cancer and HPV is also a great moment to plug the HPV vaccine,“ Dr. Hayes said. “It’s a moment to say okay, here is why we’re doing this for you. And here is this additional recommendation for your children, the younger people in your family.”
Panelists stressed that one of the most important elements in improving healthcare for communities of color is developing relationships between women and their healthcare providers.
“We have to create an environment where that trust is built over time,” Dr. Delgado said. “The reality is, is for a lot of women, they still have a lot of misinformation. One of the surprising findings from our recent surveys is that most women, Hispanic, non-Hispanic Black and non-Hispanic White, all think that cervical cancer is a hereditary disease. And therefore, they don’t think that it’s something that they can prevent or there’s anything that they can do.”
“When we think about the diversity of our population, as a provider, we want to think about the diversity of experience that people are bringing into the consult room,” Dr. Hayes said. “Explain what a PAP smear is and discuss the difference between the check of your cervix and the check for the virus. Because frankly, a lot of people aren’t even aware of the anatomy. And so, having those conversations is important as well.”
“There is a way to bend this curve,” Dr. Holladay said. “But we have to do a better job to take accountability for making sure the patients get access to this information.”
When it comes bridging the health and equity gap, panelists issued calls to action, including urging practitioners to educate themselves about racial and healthcare disparities, calling for better data and research that includes previously underrepresented populations, and finding better ways to support healthcare professionals.
“Equality and access is not enough. You have to get good outcomes and that means letting healthcare providers decide with their patients what they need,” Dr. Delgado said. “We need to reimburse healthcare providers for talking to their patients. And I mean, not just doing the little check off list that’s in front of their screen that they have to do because of the healthcare system they are a part of. But really, reimburse healthcare providers for having the conversation that will instill trust. That will instill the long-term self-care habits that women need to develop.”
Reduce Disparities in Gynecological Care
Women’s Health professionals have posted a petition as a call to action to (1) maintain the current ACOG cervical cancer screening guidelines (2) reduce disparities in gynecologic care and (3) ensure patient choice and individualizion of care. To learn more about the petition, click the button below