Disparities and Cervical Cancer


Cervical cancer became a preventable disease with the introduction of the Papanicolaou smear (Pap smear) in the 1940s. Trend data show that incidence rates have decreased steadily over the past several decades in both white and African American women living in the United States (American Cancer Society 2007). Mortality rates have declined steadily over the past several decades as well due to screening-related prevention and early detection (American Cancer Society 2007). Despite these trends, however, striking social and racial/ethnic inequities affect the entire cervical cancer continuum in different domains, including prevention, vaccination, diagnosis, follow-up, treatment, and survival (del Carmen et al. 2007; Newmann et al. 2005).


Cervical Cancer Human Papilloma Virus African American Woman Cervical Cancer Screening Hispanic Woman 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adams EK, Breen N, Joski PJ. 2007. Impact of the National Breast and Cervical Cancer Early Detection Program on mammography and pap test utilization among white, Hispanic, and African American women: 1996–2000. Cancer. (Nov 29) 109(S2):348–358.PubMedCrossRefGoogle Scholar
  2. American Cancer Society. Cancer Facts & Figures, 2007. Atlanta, Georgia. http://www.cancer.org/downloads/STT/CAff1007PWSecured.pdf
  3. Asian American Network for Cancer Awareness, Research and Training. http://www.aancart.org. Accessed October 18, 2007.
  4. Baker P, Hoel D, Mohr L, Lipsitz S, Lackland D. 2000. Racial, age, and rural/urban disparity in cervical cancer incidence. Ann Epidemiol 10(7):466–467.PubMedCrossRefGoogle Scholar
  5. Baquet CR, Mack KM, Mishra SI, et al. 2006. Maryland's Special Populations Network. A model for cancer disparities research, education, and training. Cancer. 107(8 Suppl):2061–2070.PubMedCrossRefGoogle Scholar
  6. Bazargan M, Bazargan SH, Farooq M, Baker RS. 2004. Correlates of cervical cancer screening among underserved Hispanic and African-American women. Prev Med 39(3):465–473.PubMedCrossRefGoogle Scholar
  7. Behbakht K, Lynch A, Teal S, Degeest K, Massad S. 2004. Social and cultural barriers to Papanicolaou test screening in an urban population. Obstet Gynecol 1046:1355–1361.CrossRefGoogle Scholar
  8. Bosch FX, Manos MM, Munoz N, Sherman M, Jansen AM, Peto J, Schiffman MH, Moreno V, Kurman R, Shah KV. 1995. Prevalence of human papillomarivus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) study group. J Natl Cancer Inst 87(11):796–802.PubMedCrossRefGoogle Scholar
  9. Burk RD, Kelly P, Feldman J, Bromberg J, Vermund SH, DeHovitz JA, Landesman SH. 1996. Declining prevalence of cervicovaginal human papillomavirus infection with age is independent of other risk factors. Sex Transm Dis 23(4):333–341.PubMedCrossRefGoogle Scholar
  10. Byrd TL, Peterson SK, Chavez R, Heckert A. 2004. Cervical cancer screening beliefs among young Hispanic women. Prev Med 38(2):192–197.PubMedCrossRefGoogle Scholar
  11. Carrillo JE, Green AR, Betancourt JR. 1999. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 130(10):829–834.PubMedGoogle Scholar
  12. Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi S. 2003. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer 88(1):63–73.PubMedCrossRefGoogle Scholar
  13. Committee on Infectious Diseases. Recommended Immunization Schedules for Children and Adolescents – United States, 2007. Pediatrics. 119(1):207–208.CrossRefGoogle Scholar
  14. Coughlin SS, King J, Richards TB, Ekwueme DU. 2006. Cervical cancer screening among women in metropolitan areas of the United States by individual-level and area-based measures of socioeconomic status, 2000 to 2002. Cancer Epidemiol Biomarkers Prev 15(11):2154–2159.PubMedCrossRefGoogle Scholar
  15. Cuzick J, Szarewski A, Terry G, Ho L, Hanby A, Maddox P, Anderson M, Kocjan G, Steele ST, Guillebaud J. 1995. Human papillomavirus testing in primary cervical screening. Lancet 345(8964):1533–1536.PubMedCrossRefGoogle Scholar
  16. DATA 2010. The Healthy People 2010 database. The Centers for Disease Control and Prevention. http://wonder.cdc.gov/scripts/broker.exe. Accessed May 15, 2007.
  17. del Carmen MG, Fidnley M, Muzikansky A, Roche M, Verrill CL, Horowtiz NE, Seiden M. 2007. Demographic, risk factor, and knowledge differences between Latinas and non-Latinas referred to colposcopy. Gynecol Oncol. (Jan) 104(1):70–76.PubMedCrossRefGoogle Scholar
  18. del Carmen MG, Montz FJ, Bristow RE, Bovicelli A, Cornelieson T, Trimble E. 1999. Ethnic differences in patterns of care of stage IA1 and stage IA2 cervical cancer: A SEER database study. Gyn Oncol 75:113–117.CrossRefGoogle Scholar
  19. Denny L, Quinn M, Sankaranarayanan R. 2006. Screening for cervical cancer in developing countries. Vaccine 24(3):S71–S77.CrossRefGoogle Scholar
  20. Department of Health and Human Services. Medicaid Special Coverage Conditions. Breast and Cervical Cancer: Prevention and Treatment. http://www.cms.hhs.gov/MedicaidSpecialCovCond/02_BreastandCervicalCancer_PreventionandTreatment.asp. Accessed November 01, 2007.
  21. Dignamm JJ. Differences in breast cancer prognosis among African American and Caucasian women. 2000. CA Cancer J Clin. 50:50–64.CrossRefGoogle Scholar
  22. Ell K, Vourlekis B, Muderspach L, et al. 2002. Abnormal cervical screen follow-up among low-income Latinas: Project SAFe. J Womens Health Gend Based 11(7):639–651.CrossRefGoogle Scholar
  23. Ferrante JM, Gonzalez EC, Roetzheim RG, Pal N, Woodard L. 2000. Clinical and demographic predictors of late-stage cervical cancer. Arch Fain Med 9(5):439–445.CrossRefGoogle Scholar
  24. Finkelstein JB. 2007. Screening program serves fraction of those eligible. J Natl Cancer Inst. (Feb 21) 99(4):270–271.CrossRefGoogle Scholar
  25. Fowler T, Steakley C, Garcia AR, Kwok J, Bennett LM. 2006. Reducing disparities in the burden of cancer: the role of patient navigators. PLoS Med. (Jul) 3(7):e193.CrossRefGoogle Scholar
  26. Flores E, Espinoza P, Jacobellis J, Bakemeier R, Press N. 2006. The greater Denver Latino Cancer Prevention/Control Network: prevention and research through a community-based approach. Cancer. 107(8 Suppl):2034–2042.CrossRefGoogle Scholar
  27. Freeman HP, Vydelingum NA. 2006. The role of the special populations networks program in eliminating cancer health disparities. Cancer. (Oct 15) 107(8 Suppl):1933–1935.CrossRefGoogle Scholar
  28. Gany FM, Shah SM, Changrani J. 2006. New York City‘s immigrant minorities. Reducing cancer health disparities. Cancer. 107(8 Suppl):2071–2081.CrossRefGoogle Scholar
  29. Goel MS, Wee CC, McCarthy EP, Davis RB, Ngo-Metzger Q, Phillips RS. 2003. Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med 18(12):1028–1035.PubMedCrossRefGoogle Scholar
  30. Hansen LK, Feigl P, Modiano MR, et al. 2005. An educational program to increase cervical and breast cancer screening in Hispanic women: a Southwest Oncology Group study. Cancer Nurs. 28(1):47–53.PubMedCrossRefGoogle Scholar
  31. Harlan LC, Bernstein AB, Kessler LG. 1991. Cervical cancer screening: who is not screened and why? Am J Public Health 81(7):885–890.PubMedCrossRefGoogle Scholar
  32. Harris R, Leininger L. 1993. Preventive care in rural primary care practice. Cancer 72(3 Suppl):1113–1118.PubMedCrossRefGoogle Scholar
  33. Healthy People 2010. The Centers for Disease Control and Prevention. http://wonder.cdc.gov/DATA2010.
  34. Healthy People 2010. US Department of Health and Human Services. http://www.healthypeople.gov/default.htm. Accessed May 16, 2007.
  35. Hiatt RA, Pasick RJ, Stewart S, Bloom J, Davis P, Gardiner P, Johnston M, Luce J, Schorr K, Brunner W, Stroud F. 2001. Community-based cancer screening for underserved women: design and baseline findings from the Breast and Cervical Cancer Intervention Study. Prev Med. 33(3):190–203.PubMedCrossRefGoogle Scholar
  36. Hildesheim A, Gravitt P, Schiffman MH, Kurman RJ, Barnes W, Jones S, Tchabo JG, Brinton LA, Copeland C, Epp J, et al. 1993. Determinants of genital human papillomavirus infection in low-income women in Washington, D. C. Sex Transm Dis 20(5):279–285.PubMedCrossRefGoogle Scholar
  37. Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. 1998. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med 338(7):423–428.PubMedCrossRefGoogle Scholar
  38. Howe HL, Wu X, Ries LA, Cokkinides V, Ahmed F, Jemal A, Miller B, Williams M, Ward E, Wingo PA, Ramirez A, Edwards BK. 2006. Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations. Cancer 107(8):1711–1742.PubMedCrossRefGoogle Scholar
  39. Howell EA, Chen YT, Concato J. 1999. Differences in cervical cancer mortality among black and white women. Obstet Gynecol. 94:509–15.PubMedCrossRefGoogle Scholar
  40. Jackson FE, Chu KC, Garcia R. 2006. Special Populations Networks – how this innovative community-based initiative affected minority and underserved research programs. Cancer. 107(8 Suppl):1939–1944.PubMedCrossRefGoogle Scholar
  41. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin 57(1):42–66.CrossRefGoogle Scholar
  42. Kamangar F, Dores GM, Anderson WF. 2006. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 224(14):2137–2150.CrossRefGoogle Scholar
  43. Kiefe CI, Funkhouser E, Fouad MN, May DS. 1998. Chronic disease as a barrier to breast and cervical cancer screening. J Gen Intern Med 13(6):357–365.PubMedCrossRefGoogle Scholar
  44. Krieger N, Quesenberry C Jr, Peng T, Horn-Ross P, Stewart S, Brown S, Swallen K, Guillermo T, Suh D, Alvarez-Martinez L, Ward F. 1999. Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, Black, Hispanic, and White residents of the San Francisco Bay Area, 1988–92 (United States). Cancer Causes Control 10(6):525–537.PubMedCrossRefGoogle Scholar
  45. Ley C, Bauer HM, Reingold A, Schiffman MH, Chambers JC, Tashiro CJ, Manos MM. 1991. Determinants of genital human papillomavirus infection in young women. J Natl Cancer Inst 83(14):997–1003.PubMedCrossRefGoogle Scholar
  46. Lorincz AT, Reid R, Jenson AB, Greenberg MD, Lancaster W, Kurman R J. 1992. Human papillomavirus infection of the cervix: relative risk associations of 15 common anogenital types. Obstet Gynecol 79(30):328–337.PubMedCrossRefGoogle Scholar
  47. Lorincz AT, Reid R. 1989. Association of human papillomavirus with gynecologic cancer. Curr Opin Oncol 1(1):123–132.PubMedCrossRefGoogle Scholar
  48. Margolis KL, Lurie N, McGovern PG, Tyrrell M, Slater JS. 1998. Increasing breast and cervical cancer screening in low-income women. J Gen Intern Med. 13(8):515–521.PubMedCrossRefGoogle Scholar
  49. Massad LS, Verhulst SJ, Hagemeyer M, Brady P. 2006. Knowledge of the cervical cancer screening process among rural and urban Illinois women undergoing colposcopy. J Low Genit Tract Dis. 10(4):252–255.PubMedCrossRefGoogle Scholar
  50. McDougall JA, Madeleine MM, Dailing JR, Li CI. 2007. Racial and ethnic disparities in cervical cancer incidence rates in the United States, 1992–2003. Cancer Causes Control 18(10):1175–1186.PubMedCrossRefGoogle Scholar
  51. McGuire TR, Leypoldt M, Narducci WA, Ward K. 2007. Accessing rural populations: role of the community pharmacist in a breast and cervical cancer screening programme. J Eval Clin Pract. 13(1):146–149.PubMedCrossRefGoogle Scholar
  52. Mensah G. 2006. Racial and Ethnic Approaches to Community Health (REACH) 2010. The Centers for Disease Control and Prevention. Atlanta, GA: U.S. Department of Health and Human Services.Google Scholar
  53. Merrill RM, Merrill AV, Mayer LS. 2000. Factors associated with no surgery or radiation therapy for invasive cervical cancer in Black and White women. Ethn Dis. 10:248–56.PubMedGoogle Scholar
  54. Miller SM, Siejak KK, Schroeder CM, Lerman C, Hernandez E, Helm CW. 1997. Enhancing adherence following abnormal Pap smears among low-income minority women: a preventive telephone counseling strategy. J Natl Cancer Inst. 89(10):703–708.PubMedCrossRefGoogle Scholar
  55. Mock J, McPhee SJ, Nguyen T, et al. 2007. Effective Lay Health Worker Outreach and Media-Based Education for Promoting Cervical Cancer Screening Among Vietnamese American Women. Am J Public Health 97:1693–1700.Google Scholar
  56. Mundt AJ, Connell PP, Campbell T, Hwang JH, Rotmensch J, Waggoner S. 1998. Race and clinical outcome in patients with carcinoma of the uterine cervix treated with radiation therapy. Gynecol Oncol. 71:151–8.PubMedCrossRefGoogle Scholar
  57. Newmann SJ, Garner EO. 2005. Social inequities along the cervical cancer continuum: a structured review. Cancer Causes Control. 16: 63–70.PubMedCrossRefGoogle Scholar
  58. Nuovo GJ, Pedemonte B. M. 1990. Human papillomavirus types and recurrent cervical warts. JAMA 263(9):1223–1226.PubMedCrossRefGoogle Scholar
  59. O’Malley AS, Forrest CB, Mandelblatt J. 2002. Adherence of low-income women to cancer screening recommendations. J Gen Intern Med. 17(2):144–154.PubMedCrossRefGoogle Scholar
  60. O'Malley AS, Forrest CB. 2002. Beyond the examination room: primary care performance and the patient-physician relationship for low-income women. J Gen Intern Med. 17(1):66–74.PubMedCrossRefGoogle Scholar
  61. O’Malley CD, Shema SJ, Clarke LS, Clarke CA, Perkins CI. 2006. Medicaid status and stage at diagnosis of cervical cancer. Am J Public Health 96(12):2179–2185.PubMedCrossRefGoogle Scholar
  62. Patel DA, Barnholtz-Sloan JS, Patel MK, Malone JM Jr, Chuba PJ, Schwartz K. 2005. A population-based study of racial and ethnic differences in survival among women with invasive cervical cancer: analysis of Surveillance, Epidemiology, and End Results data. Gynecol Oncol 97(2):550–558.PubMedCrossRefGoogle Scholar
  63. Peyton CL, Gravitt PE, Hunt WC, Hundley RS, Zhao M, Apple RJ, Wheeler CM. 2001. Determinants of genital human papillomavirus detection in a U. S. population. J Infect Dis 183(11):1554–1564.PubMedCrossRefGoogle Scholar
  64. Population Estimates. The US Census Bureau. 2007. http://www.census.gov/popest/estimates.php. Accessed November 1, 2007.
  65. Ries L, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, Hankey BF, Edwards BK (eds). 2005. SEER Cancer Statistics Review, 1975–2004, National Cancer Institute. Bethesda, MD, based on November 2005 SEER data submission, posted to the SEER web site. http://seer.cancer.gov/csr/1975_2004/.Google Scholar
  66. Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Eisner MP, Horner MJ, Howlader N, Hayat M, Hankey BF, Edwards BK (eds). 2006. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2003/, based on November 2005 SEER data submission, posted to the SEER web site, 2006.
  67. Riley GF, Potosky AL, Lubitz JD, Brown ML. 1994. Stage of cancer at diagnosis for Medicare HMO and fee-for-service enrollees. Am J Public Health 84(10):1598–1604.PubMedCrossRefGoogle Scholar
  68. Russell AH, Shingleton HM, Jones WB, Stewart AK, Fremgen A, Winchester DP, et al. 1998. Trends in the use of radiation and chemotherapy in the initial management of patients with carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys. 40:605–13.PubMedCrossRefGoogle Scholar
  69. Sankaranarayanan R, Ferlay J. 2006. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol 20(2):207–225.PubMedCrossRefGoogle Scholar
  70. Ryerson AB, Benard, V. B., and Major, A.C. 2005. The National Breast and Cervical Cancer Early Detection Program: 1991–2002 National Report. Atlanta, GA: The Centers for Disease Control and Prevention.Google Scholar
  71. Saraiya M, Ahmed F, Krishnan S, Richards TB, Unger ER, Lawson HW. 2007. Cervical cancer incidence in a prevaccine era in the United States, 1998–2002. Obstet Gynecol 109(2 Pt 1):360–370.PubMedCrossRefGoogle Scholar
  72. Shah M, Zhu K, Wu H, Potter J. 2006. Hispanic acculturation and utilization of cervical cancer screening in the US. Prev Med 42(2):146–149.PubMedCrossRefGoogle Scholar
  73. Shavers VL, Brown ML. 2002. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst. Mar 94(5):334–357.PubMedGoogle Scholar
  74. Stone KM. 1995. Human papillomavirus infection and genital warts: update on epidemiology and treatment. Clin Infect Dis 20(Suppl 1):S91–S97.PubMedCrossRefGoogle Scholar
  75. Taylor VM, Hislop TG, Jackson JC, et al. 2002. A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America. J Natl Cancer Inst. 94(9):670–677.PubMedGoogle Scholar
  76. Tejeda S, Thompson B, Coronado GD, Rees JM. 2006. A cervical cancer curriculum for Hispanic adolescents in rural high schools: a pilot study. J Health Care Poor Underserved. 17(4):734–744.PubMedCrossRefGoogle Scholar
  77. The Centers for Disease Control and Prevention. National Breast and Cervical Cancer Early Detection Program. http://www.cdc.gov/cancer/nbccedp/. Accessed March 29, 2007.
  78. Thoms WW, Unger ER, Carisio R, Nisenbaum R, Spann CO, Horowitz IR, et al. 1998. Clinical determinants of survival from stage Ib cervical cancer in an inner-city hospital. J Natl Med Assoc. 90:303–8.PubMedGoogle Scholar
  79. Tiro JA, Meissner HI, Kobrin S, Chollette V. 2007. What do women in the U.S. know about human papillomavirus and cervical cancer? Cancer Epidemiol Biomarkers Prev 16(2):288–94.PubMedCrossRefGoogle Scholar
  80. U.S. Census Bureau, 2004, “U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin”. http://www.census.gov/ipc/www/usinterimproj/.
  81. Wasserman M, Bender D, Lee S-Y D. 2007. Use of Preventive Maternal and Child Health Services by Latina Women. Med Care Res Rev. 64(1):4–45.PubMedCrossRefGoogle Scholar
  82. Winstead E. 2005. tHelping Patients Navigate the Health Care System. NCI Cancer Bulletin. NCI Cancer Bulleting. Vol 2.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Division of Gynecologic Oncology, Massachusetts General HospitalHarvard Medical SchoolBoston

Personalised recommendations