Poorer Black Women Going Without Pap Smears

Underserved neighborhoods may have fewer health resources, experts say

TUESDAY, Dec. 27, 2005 (HealthDay News) -- Black women who live in poor neighborhoods are less likely to be screened for cervical cancer than women living in more affluent areas, researchers find.

The reason for the lower rate of screening isn't clear, and the researchers note that other factors linked to lower screening rates, such as older age or lower education, didn't seem to play a role.

"Even among women who were professionals or who were educated, they, too, had decreased screening if they lived in neighborhoods with high poverty," said study author Geetanjali Dabral Datta, a postgraduate fellow at the Harvard School of Public Health.

The report appears in the Feb. 1 issue of Cancer.

In their study, Datta and her colleagues focused on the connection between socioeconomic factors and how they affected cervical cancer screening, most notably the Pap smear. They collected data on more than 40,000 black women from across the United States. These women all participated in the Black Women's Health Study of Boston University and Howard University.

Women living in communities where at least 20 percent of families lived below the poverty level were significantly less likely to be get regular Pap tests, compared with women living in areas where only 5 percent of the population lived below the poverty line.

The reason for the trend remains unclear. "We can speculate that deprived neighborhoods are just that, deprived," Datta said. "It might be that women do not have access to transportation, or perhaps they can't get day care. But all of that is just speculation at this point," she said.

She believes the same phenomenon might be true for other types of screening, such as mammography and cardiovascular testing.

To ensure that women in these communities get Pap tests, there has to be a concentrated effort to reach them, Datta said. "There needs to be a focus on high poverty neighborhoods," she said. "We need to think of people's socioeconomic context when it comes to health behaviors."

One expert thinks that access to medical care may be the reason for these findings, and the reason that more black women die from cervical cancer than white women.

"African-American women have twice the mortality rate from cervical cancer as white women," noted Elizabeth Ward, the director of cancer surveillance at the American Cancer Society. "Researchers need to investigate how those differences are related to socioeconomic status."

"One of the big factors that may account for this finding is access to high-quality medical care," Ward said. "Often communities that have high poverty rates either lack access to good quality care, or people have to travel longer distances to obtain high-quality care."

Another expert said this screening "gap" is costing lives unnecessarily.

"While this finding is not surprising, it is noteworthy just the same," said Dr. David L. Katz, an associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine.

"No one should die of cervical cancer, because a simple screening test reliably finds the condition in its earliest stages when cure is almost universally achievable," Katz said. "Yet, several thousand deaths from this cancer occur each year in the U.S."

Identifying disparities and the toll they exact is the easy part, Katz noted. "Eliminating such disparities is the hard part," he said. "But it's a job that must be done, for lives are very clearly on the line."

More information

For more on cervical cancer, head to the American Cancer Society.

SOURCES: Geetanjali Dabral Datta, Sc.D., M.P.H., postgraduate fellow, Harvard School of Public Health, Boston; Elizabeth Ward, Ph.D., director, cancer surveillance, American Cancer Society, Atlanta; David L. Katz, M.D., M.P.H., associate professor, public health, and director, Prevention Research Center Yale University School of Medicine, New Haven, Conn.; Feb. 1, 2006, Cancer
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