Unveiling inequities in cervical cancer outcomes

According to the World Health Organization, cervical cancer is among the most preventable and treatable gynecological cancers. Human papillomavirus (HPV) vaccination and longitudinal screening are highly effective modes of prevention and detection, respectively. While statistics on the efficacy of vaccination and screening are promising, the realities surrounding cervical cancer outcomes are anything but. A closer look at the diagnosis and mortality rates paints quite a bleak picture.

The United States’ cervical health outcomes speak to stark racial disparities. Although Black women and white women receive diagnoses at similar rates, Black women are more likely to die of cervical cancer. Worse, Black women have the highest mortality rate of any other racial group. January is Cervical Health Awareness Month. In honoring the lives of those affected, we must acknowledge harsh truths about the health conditions in our nation and take steps to improve. More importantly, we must sit with the truth of our health establishment’s entanglement with anti-Black racism and misogynoir.

There are gaps in care, and these gaps reveal the pernicious effects of structural racism on Black women’s livelihoods and bodies. Evaluating the manifestations of structural racism is a key step in changing these outcomes.

One such manifestation is inadequate gynecological care access. Compared to other neighbourhoods, Black neighborhoods are 67 percent more likely to lack a local primary care physician. The key to prevention and survival is appropriate and timely screening. With the inaccessibility of a local gynecologist comes limited access to this resource, which makes it difficult to treat precancers before the condition progresses. Ultimately, this arrangement divests Black women of their right to take necessary preventive measures.

The negative implications of this shortage do not end with the shortage of gynecologists in Black neighbourhoods. Pre-existing conditions, such as a weakened immune system, greatly impact the progression of the disease. Unfortunately, this means that once Black women receive a diagnosis, they are likely to come in untreated for other chronic illnesses that may exacerbate the condition.

While cervical health disparities persist along racial lines at every economic level, it is important to note who these care shortages impact the most. Geographical factors, in addition to class, have implications for the health care of Black women.

These care gaps leave low-income Black women in regions like the rural South especially vulnerable. The issue of constant hospital closures in the regions that fall outside of our nation’s urban centers creates maternity care deserts. In these counties, obstetrical and gynecological health care services are limited—or virtually absent. Unfortunately, this issue is worsening with time. According to a 2022 March of Dimes report, more than 1 in 3 US counties are maternity care deserts.

Structural racism also manifests as unconscious bias in gynecological care. Physicians have great discretion in their practice and recommendation of cervical cancer screening. This can prove fatal for Black women and birthing people. Notions of Black women’s exceptional strength and imperviousness to pain may lead physicians to 1) dismiss the complaints of Black patients and 2) prolong the time before a doctor recommends a patient for screening. Because the efficacy of treatment correlates with the speed of detection, time is of the essence.

In addition to screening and diagnosis, this implicit bias shapes the ensuing treatment options for Black birthing patients. Studies show that Black women are more likely to receive no treatment after a diagnosis—a reality that may be tied to both implicit bias and comorbid conditions.

Another manifestation of structural racism within the medical establishment is its erasure of Black women and birthing people. Despite growing knowledge of the significance of screening and early detection, nascent policy decisions have done away with annual pap smears. The reason for this change seems scientifically sound. According to health professionals, the expansion of time between the screening tests acknowledges the time it takes for cervical cancer to develop.

While health professionals are deeming annual pap smears unnecessary, the current state of Black women’s cervical health renders routine screening absolutely necessary. Black women are more likely to present with advanced cervical cancer. Even in the absence of interpersonal experiences, these policy decisions manage to undermine Black women and birthing people to reproduce negative health outcomes.

We cannot change what we refuse to acknowledge. The state of cervical health is a fragment of a larger picture—one of a system that routinely fails Black women and birthing people. Racial disparities in survival warrant further investigation if we are to undo the systemic racism that contributes to poor outcomes.

Bintou Diarra is a pre-medical student.


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