Cervical cancer rates are climbing among low-income women. Here’s why.
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Cervical cancer rates in the United States have been declining overall for years.
A recent study, however, found that rates of the disease are rising among low-income women, particularly among low-income white women.
Experts aren’t entirely sure why this is happening. But they believe it might have to do with falling rates of cancer screenings and follow-up care.
Cervical cancer rates, long on the decline, are climbing among low-income women in the United States.
Cervical cancer was once the leading cause of death for American women, according to the American Cancer Society. But incidence and mortality rates for the disease have significantly dropped in recent decades thanks to increased screening efforts and the Food and Drug Administration’s 2006 approval of the vaccine for Human papillomavirus (HPV), which causes more than nine out of every ten cases of cervical cancer in the country, according to the Centers for Disease Control and Prevention.
A 2012 analysis of 35 years’ worth of federal data found that the incidence of cervical cancer dropped by 54 percent between the mid-1970s and mid-2000s.
And overall, new cases of cervical cancer and deaths from the disease are continuing to decline. But one recent study from the University of Texas MD Anderson Cancer Center found that its incidence is actually rising among low-income white women.
Further research is needed to fully understand why this is happening. But some health experts think it might be linked to decreased cancer screenings and an increase in interrupted follow-ups with healthcare providers.
“Part of the problem is that groups are not being screened on time, which can lend itself to developing cancer,” said Trisha L. Amboree, lead author of the study.
Screening rates for all types of cancer sharply dropped during the pandemic, and cervical cancer was no exception: 4.4 million fewer women underwent cervical cancer screenings in 2021 than in 2019, according to the American Cancer Society.
But data from the National Cancer Institute (NCI) shows that cervical cancer screening rates were in decline across races and income levels long before that — since the year 2000.
And screening rates for women with incomes 200 percent below the federal poverty level have generally been lower than those with higher incomes, according to NCI data.
It’s not entirely clear why the number of women overdue for cervical cancer screenings is growing. Among one group of women surveyed in 2022, the most common reason they cited for not undergoing such screenings was that they didn’t know they needed to be.
Another common reason they pointed to was a lack of access to cervical cancer screenings.
Cervical cancer screenings are usually performed during a pelvic exam at a health care provider’s office, which can be a doctor’s office, a walk-in clinic like Planned Parenthood, or an urgent care clinic.
During the exam, the provider will insert a small brush into the vagina to collect cells from the cervix, which are then sent to a lab to check for any abnormalities or HPV.
Women should get their first Pap smear at 21 and once every three years after that, according to the United States Preventative Service Task Force. The task force recommends that women between the ages of 30 and 65 undergo cervical cancer screens by either getting an HPV test every 5 years, having HPV and Pap smear every five years or getting a Pap smear every three years.
The drop in the rate of these screenings may only be part of the problem. Amboree, along with other health experts, said there appears to be an issue in women seeking or receiving follow-up care once they receive an abnormal Pap smear test result or test positive for HPV.
This skipped follow-up care can lead to cancer advancing to the point where it becomes more difficult to treat, she added.
“You maybe identify a person [that has cancer] but maybe that person falls through the cracks and does not receive the follow-up treatment that they need,” said Amboree.
Many things could prevent a person from following up with a healthcare provider after getting abnormal test results, according to William Dahut, chief scientific officer for the American Cancer Society.
Among the most common reasons are a healthcare provider no longer taking a type of insurance or someone losing their health insurance entirely, said Dahut.
The cost of co-pays is another barrier for many in low-income communities, according to Fred Wyand, a spokesperson for the American Sexual Health Association and National Cervical Cancer Coalition.
Gallup data shows that the portion of Americans forgoing needed medical care because of expense has generally been rising since 2001.
And a poll from health policy research group KFF released earlier this month found that one out of every four Americans has put off getting needed healthcare within the past year because of cost. That rate is even higher for the uninsured, according to the poll: about six out of ten.
Most of the roughly 26 million Americans who did not have health insurance in 2023 were members of a low-income family with one breadwinner, according to data from the Department of Health and Human Services.
And most low-income Americans don’t have any savings that they could draw on for medical expenses. One 2021 report analyzing Federal Reserve data found that only about a third of households earning under $26,267 annually, just under the federal poverty level for a family of four that year, had a savings account.
A cervical cancer screening test that requires follow-up might involve multiple visits to a healthcare provider. This often requires women to schedule time off from work, find childcare or arrange for transportation if the doctor’s office or healthcare clinic is far away — all of which is costly, Wyand said.
“It’s devastating to see a woman with advanced metastatic cervical cancer because you know, it’s just such a preventable disease,” said Dahut.
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