Perceived Financial Barriers to Cervical Cancer Screening and Associated Cost Burden Among Low-Income, Under-Screened Women

Abstract

Background: Despite screening's effectiveness in reducing cervical cancer incidence and mortality, disparities in cervical cancer screening uptake remain, with lower rates documented among uninsured and low-income individuals. We examined perceived financial barriers to, and the perceived cost burden of, cervical cancer screening. Materials and Methods: We surveyed 702 low-income, uninsured or publicly insured women ages 25-64 years in North Carolina, U.S., who were not up to date on cervical cancer screening according to national guidelines. Participants were asked about perceived financial barriers to screening and how much they perceived screening would cost. We used multivariable logistic regression to assess the sociodemographic predictors of perceived financial barriers. Results: Seventy-two percent of participants perceived financial barriers to screening. Screening appointment costs (71%) and follow-up/future treatment costs (44%) were most commonly reported, followed by lost pay due to time missed from work (6%) and transportation costs (5%). In multivariable analysis, being uninsured (vs. publicly insured), younger (25-34 vs. 50-64 years), White (vs. Black), and not reporting income data were associated with perceiving screening costs and future treatment costs as barriers to screening. Participants reported wide-ranging estimates of the perceived out-of-pocket cost of screening ($0-$1300), with a median expected cost of $245. Conclusions: The majority of our sample of low-income women perceived substantial financial barriers to screening, particularly related to screening appointment costs and potential follow-up/future treatment costs. Providing greater cost transparency and access to financial assistance may reduce perceived financial barriers to screening, potentially increasing screening uptake among this underserved population. Clinicaltrials.gov registration number NCT02651883.

Keywords: cancer screening; cervical cancer; financial barriers; health disparities; human papillomavirus; under-screened populations.

FIG. 1.

Perceived financial barriers to cervical cancer screening (N = 702). This figure shows the prevalence of perceived financial barriers to screening. Perceived barriers were assessed using the following survey question: “What are some reasons that you haven't had a Pap smear recently?” Answer options included “cost” and “no insurance,” in addition to other nonfinancial barriers. Participants were asked to mark all that apply. For each reason selected, participants were then asked to indicate, more specifically, what about that reason made it difficult to be screened. Open-ended responses were qualitatively coded as belonging to the discrete categories reported in the above figure. Pap, Papanicolaou.

FIG. 2.

Number of perceived financial barriers to cervical cancer screening (N = 702). This figure represents the number of financial barriers perceived by participants, included screening costs (Pap test appointment and laboratory costs), future treatment costs (including follow-up screening for abnormal results), lost pay due to time missed from work, and transportation costs.

FIG. 3.

Perceived cost burden of cervical cancer screening among MBMT-3 participants. This figure shows the distribution of perceived costs stemming from each of four components of cervical cancer screening. Screening costs were winsorized at the 95th percentile due to outliers. MBMT-3, MyBodyMyTest Phase Three.