Racial differences in expected versus actual costs of cervical cancer screening among low-income, under-screened women in North Carolina

Abstract

Background: Perceived financial barriers to cervical cancer screening in the US are well documented. However, few data compare perceived cost barriers to actual screening costs. Our objective was to compare individual's expected to actual screening costs. Additionally, we explore cost differences for Black and White participants to better understand how perceived financial barriers may contribute to screening disparities.

Methods: We utilized control arm (n=227) data from the MBMT-3 trial of low-income under-screened women in North Carolina. At baseline, participants were asked their expected screening and screening-associated costs (i.e., lost wages, transportation, child/dependent care). After in-clinic screening, participants reported their actual costs. We calculated differences between individuals' expected versus actual costs, overall and for Black and White participants. We examined socio-demographic predictors of expected costs and expected-actual cost difference.

Results: Participants expected screening to cost a median $200 (IQR: 100-300), primarily for appointments and lab tests. Black participants expected higher screening costs (median $265) than White participants ($205). Participants who completed screening overestimated expenses, with median expected costs of $215 compared to $5 for actual costs. Participants overestimated costs for every category: appointment and lab tests, lost wages, transportation, and child/dependent care. Actual costs were similar for Black and White participants.

Conclusions: Educational outreach about existing affordable screening services may reduce perceived financial barriers, particularly for historically marginalized populations.

Impact: Among an under-screened population perceiving high financial barriers, participants over-estimated screening costs, with Black participants expecting higher costs than White participants. High expected costs indicate low awareness of subsidized screening options.