Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States

Madina Agénor^{1

2

3

4}, Madeline Noh^{5

6}, Rose Eiduson⁷, Merrily LeBlanc^{8

9}, Emmett C Line¹⁰, Roberta E Goldman¹¹, Jennifer Potter^{8

12

13}, S Bryn Austin^{14

15

16}

Affiliations

¹ Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA. madina_agenor@brown.edu.
² Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA. madina_agenor@brown.edu.
³ Department of Epidemiology, Brown University School of Public Health, MPH Box G-S121-4, Providence, RI, 02912, USA. madina_agenor@brown.edu.
⁴ The Fenway Institute, Fenway Health, Boston, MA, USA. madina_agenor@brown.edu.
⁵ Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
⁶ Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
⁷ Larner College of Medicine, University of Vermont, Burlington, VT, USA.
⁸ The Fenway Institute, Fenway Health, Boston, MA, USA.
⁹ Department of Sociology, Northeastern University, Boston, MA, USA.
¹⁰ Teachers College, Columbia University, New York, NY, USA.
¹¹ Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
¹² Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹³ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹⁴ Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁵ Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
¹⁶ Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

PMID: 38907205
PMCID: PMC11191319
DOI: 10.1186/s12905-024-03151-7

Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States

Madina Agénor et al. BMC Womens Health. 2024.

. 2024 Jun 21;24(1):362.

doi: 10.1186/s12905-024-03151-7.

Authors

Madina Agénor^{1

2

3

4}, Madeline Noh^{5

6}, Rose Eiduson⁷, Merrily LeBlanc^{8

9}, Emmett C Line¹⁰, Roberta E Goldman¹¹, Jennifer Potter^{8

12

13}, S Bryn Austin^{14

15

16}

Affiliations

¹ Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA. madina_agenor@brown.edu.
² Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA. madina_agenor@brown.edu.
³ Department of Epidemiology, Brown University School of Public Health, MPH Box G-S121-4, Providence, RI, 02912, USA. madina_agenor@brown.edu.
⁴ The Fenway Institute, Fenway Health, Boston, MA, USA. madina_agenor@brown.edu.
⁵ Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
⁶ Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
⁷ Larner College of Medicine, University of Vermont, Burlington, VT, USA.
⁸ The Fenway Institute, Fenway Health, Boston, MA, USA.
⁹ Department of Sociology, Northeastern University, Boston, MA, USA.
¹⁰ Teachers College, Columbia University, New York, NY, USA.
¹¹ Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
¹² Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹³ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹⁴ Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁵ Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
¹⁶ Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

PMID: 38907205
PMCID: PMC11191319
DOI: 10.1186/s12905-024-03151-7

Erratum in

Correction: Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States.
Agénor M, Noh M, Eiduson R, LeBlanc M, Line EC, Goldman RE, Potter J, Austin SB. Agénor M, et al. BMC Womens Health. 2024 Jul 29;24(1):433. doi: 10.1186/s12905-024-03276-9. BMC Womens Health. 2024. PMID: 39075501 Free PMC article. No abstract available.

Abstract

Background: In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism.

Methods: We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development.

Results: Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct.

Conclusions: Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.

Keywords: Cervical cancer; Clinical guidelines; Health care providers; Health equity; Racism; Screening.

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Conflict of interest statement

The authors declare no competing interests.

References

1. Buskwofie A, David-West G, Clare CA. A review of Cervical Cancer: incidence and disparities. J Natl Med Assoc. 2020;112(2):229–32. - PubMed
1. Yoo W, Kim S, Huh WK, Dilley S, Coughlin SS, Partridge EE, et al. Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States. Chang JS, editor. PLoS One. 2017;12(2):e0172548. - PMC - PubMed
1. American Cancer Society. American Cancer Society. 2023 [cited 2023 Mar 23]. Key Statistics for Cervical Cancer. https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html.
1. Yang DX, Soulos PR, Davis B, Gross CP, Yu JB. Impact of widespread cervical cancer screening: number of cancers prevented and changes in race-specific incidence. Am J Clin Oncol. 2018;41(3):289–94. - PMC - PubMed
1. Cohen CM, Wentzensen N, Castle PE, Schiffman M, Zuna R, Arend RC, et al. Racial and ethnic disparities in Cervical cancer incidence, survival, and mortality by histologic subtype. J Clin Oncol. 2023;41(5):1059–68. - PMC - PubMed

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Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States

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Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States

Authors

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Erratum in

Abstract

Conflict of interest statement

References

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