After the diagnosis: Women of color receive poorer cervical cancer care

When people talk about access, typically the conversation revolves around screening and prevention and the political debates over Planned Parenthood funding. Assuring equal, quality treatment itself is just as important – particularly for women of color.

Women of color face unique barriers in receiving equitable health care for cervical cancer, in both prevention and after a diagnosis. According to the Wisconsin Department of Health Services, they are diagnosed with cervical cancer at higher rates than white women. () While cervical cancer is preventable, a person’s socioeconomic status may determine whether or not she is even able to access the care to avoid it.

Local organizations like the Wisconsin Well Woman Program (WWWP) for Dane and Rock Counties assist low-income women with better access to preventative care like cervical cancer screenings, with specific programs targeted toward women of color.

The WWWP is funded by the Centers for Disease Control and Prevention (CDC), and there are similar programs all over Wisconsin, said Kari Sievert, the regional coordinator. WWWP offers free statewide breast and cervical cancer screenings with services such as a PAP test, pelvic exam and colonoscopy.

The WWWP free programs go up to the point of diagnosis, Sievert said. Eligible women may then apply for Wisconsin Well Woman Medicaid that will provide medical treatment for women diagnosed with breast or cervical cancer.

However, the inequalities do not stop at the diagnosis. In addition to being diagnosed at higher rates, women of color also have much higher mortality rates than white women.

In a study conducted by Dr. Laurel Rice, chair of the Department of Obstetrics and Gynecology from the UW School of Medicine and Public Health, Rice looked at the treatment of women diagnosed with locally-advanced cervical cancer between 2004 and 2012 and tracked whether they received care adhering to the National Comprehensive Cancer Network guidelines.

The results found care for non-Hispanic white women met standard guidelines 58 percent of the time, non-Hispanic black women 53 percent of the time and Hispanic women 51 percent of the time.

This disparity matters, because patients who received care meeting guideline standards were more likely to survive.  This disparity was the widest in high-volume hospitals, Rice said.

“It’s a multi-pronged issue,” Rice said. “Identifying the problem is the first step. Now we have to figure out why and how.”

Health disparities historically and disproportionately affect people of color, and Madison was unprepared for the influx of families of color in the 70s, 80s and 90s, according to Erin Bailey, the project coordinator of the Dane County African American Cancer Outreach Project within the UW Carbone Cancer Center. Existing policies in place did not, and still do not, match up with the needs of people of color, she said

“Racism has played a long history in how these systems have been set up,” Bailey said.

The lower a person’s socioeconomic status, the less likely he or she is to be able to access equitable treatment. People of color are more likely to be uninsured, even after the Affordable Care Act, and are more likely to be poor. If a person has lower level of education, a lower level of health literacy or has children, those factors introduce a whole new set of barriers, said Bailey.

For the type of localized cervical cancer Rice’s study examined, treatment that meets National Comprehensive Cancer Network guidelines requires two different types of radiation as well as  weekly chemo. This is time consuming, and if a patient cannot make it to the treatment in the first place because she cannot afford to miss any work, she is not going to get standard care.

“Every single piece of your life that [relates to healthcare] forms a puzzle, and you don’t really know how well it fits together until you get sick. People with lower socioeconomic status, they don’t have a good puzzle,” Bailey said.

Another barrier preventing equitable care is obstructed communication between doctor and patient, whether through bias or differing levels of medical literacy.

Doctors might have already formed  assumptions when a patient of color walks into the office based on their work in particular populations, Bailey explained. 

Rice’s study found the treatment disparity widest in high-volume hospitals. The bigger the hospital, the more likely the hospital will be in a city and serve a higher volume of people of color, especially people of color who are underinsured or completely uninsured, Bailey said. Any barriers to equitable healthcare are multiplied in a setting like this, and physicians with biases in high-volume hospitals are more likely to continue their practices and mindset.

Inaccessible language also makes open communication between a patient and doctor difficult. Heavy medical language can be hard to navigate for patients of any education level. Working on how to open up lines of actual communication with their patients is vital, especially for black or brown patients that may already feel intimidated going into a doctor’s office, Bailey said.

According to Rice, to increase equitable treatment for every woman, research should follow individual cases that did not meet standard care and figure out what exactly went wrong.

Further, Bailey said healthcare systems and physicians need to acknowledge their own biases and work to correct them.

A combination of further research, communication and accountability will help to level the playing field for health care and allow women of color to access the treatment their disease demands.