Cervical cancer screening low, marked by racial disparity

Volume 8, Issue 2, June 2019

Summary

Mayo Clinic urges health professionals to find new ways to boost compliance with national guidelines.

Photograph of Kathy L. MacLaughlin, M.D.

Kathy L. MacLaughlin, M.D.

The percentage of women who are screened for cervical cancer may actually be far lower than national statistics suggest they are, according to a Mayo Clinic study recently published in the Journal of Women's Health.

Less than two-thirds of women ages 30 to 65 were up to date with cervical cancer screenings in 2016. The percentage is even lower for women ages 21 to 29, with just over half current on screenings. Those figures are well below the 81 percent screening compliance rate self-reported in the most recent survey.

"These cervical cancer screening rates are unacceptably low," said Mayo Clinic family medicine specialist Kathy L. MacLaughlin, M.D., the published study's lead author. "Routine screening every three years with a Pap test or every five years with a Pap-HPV cotest ensures that precancerous changes are caught early and may be followed more closely or treated."

In addition to lower-than-expected screening rates, Mayo Clinic researchers also found racial inequities in cervical cancer screening rates.

"African American women were 50 percent less likely to be up to date on cervical cancer screening than were white woman in 2016," Dr. MacLaughlin said. "Asian women were nearly 30 percent less likely than were white women to be current on screening. These racial disparities are especially concerning."

Mayo Clinic researchers reviewed medical records using the Rochester Epidemiology Project database to determine cervical cancer screening rates for more than 47,000 women living in Olmsted County in Minnesota from 2005 to 2016.

Dr. MacLaughlin said these study results should prompt health care providers to start considering new ways of reaching out to patients to help ensure they get screened. Ideas could include setting up Pap clinics with evening and Saturday hours and offering cervical cancer screenings at urgent care clinics. For women who qualify for the newest screening using primary HPV screening, clinics could explore the option of giving patients at-home testing kits.

"We, as clinicians, must start thinking outside the box on how best to reach these women and ensure they are receiving these effective and potentially lifesaving screening tests," Dr. MacLaughlin said.

Cervical cancer death rates have dropped dramatically in recent decades thanks to the development of the Pap test in the 1950s. A second type of cervical cancer screening is the HPV test, which detects the presence of high-risk human papillomavirus (HPV), a virus that can lead to precancerous changes and cervical cancer.

In 2012, national cervical cancer screening guidelines were updated to recommend Pap testing every three years for women ages 21 to 65 or Pap-HPV cotesting every five years for women ages 30 to 65. The Mayo Clinic study results show high rates of adoption of the 2012 guidelines by Olmsted County health professionals, both for appropriate use of cotesting and for appropriately not screening women younger than 21 or older than 65.

One limitation of this study is that Olmsted County is less ethnically and racially diverse than is the U.S. population. However, the county's demographic makeup is reflective of the Upper Midwest, and the study's findings related to racial disparities in screening are consistent with several other studies from across the country. Another limitation is the potential for over-counting young women as not screened who are insured by their parents and have an Olmsted County address but may have been screened outside of Olmsted County.

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