Women with disabilities face lower odds of receiving cervical cancer screening

Nov 17, 2023

Parekh T, et al. Am J Prev Med. 2023;doi:10.1016/j.amepre.2023.08.010.

Parekh T, et al. Am J Prev Med. 2023;doi:10.1016/j.amepre.2023.08.010.

Women with disabilities, especially those with multiple and physical disabilities, had a lower likelihood of receiving the recommended cervical cancer screening using HPV testing, according to researchers.

These findings are “crucial,” Tarang Parekh, PhD, MBBS, an associate professor at the University of Delaware, told Healio, because they reveal “a sizable gap in health care access” and highlight “the urgency of addressing these disparities.”

Parekh and colleagues wrote in the American Journal of Preventive Medicine that disparities in cervical cancer screening have not yet been extensively studied despite a slow but progressive decline in mortality from cervical cancer, which is largely because of greater use of screening, including HPV and Pap tests. So, they conducted a study to examine the likelihood of screening for cervical cancer using HPV tests among women with disabilities.

The researchers used pooled data from the 2018 and 2020 Behavioral Risk Factor and Surveillance System, including 189,795 women aged 25 to 64 years. They also used descriptive analyses to calculate the proportion of HPV tests based on the American Cancer Society’s (ACS’) 2020 guidelines, which recommend testing all women aged 25 to 65 years within 5 years.

Parekh said he and his colleagues found “a distinct link between the type of disability and the adherence to cervical cancer screening guidelines” — findings that have “significant clinical implications for the medical community.”

Just over half — 53.8% — of women overall met the recommended ACS guidelines. Compared with those who did not have disabilities (54.8%), the proportion of HPV tests was lower in women who had multiple (47.8%), physical (48.2%) and sensory (49.7%) disabilities, and higher in women with a cognitive disability (55.9%).

Adjusted analyses revealed that, compared with women who did not have disabilities, women with multiple disabilities (adjusted OR = 0.88; 95% CI, 0.78-0.97), physical disability (aOR = 0.96, 95% CI, 0.8-0.98) or any disability at all (aOR = 0.95; 95% CI, 0.88-0.97) had lower chances of being screened for cervical cancer with HPV tests.

Parekh said the findings underscore “a potential deficiency in equitable access to essential health care services based on disability type” and physicians must “recognize the multifaceted challenges faced by individuals with these specific disabilities and develop targeted interventions that consider their unique needs, ensuring they receive appropriate information, support and access to screening.”

“Addressing the identified disparities demands a concerted effort involving health care professionals, policymakers and advocacy groups to create awareness campaigns, accessible information resources and adapted screening procedures that accommodate various disabilities,” he said.

Parekh said there are several factors that may be contributing to the disparities. For example, women who have disabilities face barriers limiting their access to health care services.

“Structural barriers such as limited physical access and negative attitudes from health care providers can discourage women with disabilities from seeking regular screenings,” he said. “Additionally, a lack of targeted education and awareness about the importance of screenings among this population may contribute to the lower rates.”

To tackle these disparities, Parekh said that “personalized communication is vital, considering unique challenges of each disability type.”

“Facilities should be made accessible, accommodating ramps, elevators and adjustable tables to enhance the screening experience. Tailored care plans should be devised collaboratively to address specific mobility and comfort needs,” he said. “By raising awareness about these disparities and advocating for change, we can create a health care system that prioritizes the needs of all individuals, regardless of their abilities. Addressing disparities in cervical cancer screenings is just one step toward a more inclusive and equitable health care landscape.”

LeeAnn Tanaka, DO

This article truly underscores our difficulty in identifying and addressing disparities in health and health care access for our patients. In patients with disabilities, whether physical, sensory or cognitive, just getting to appointments can be more difficult, which impacts screening rates. We as health care providers should consider if we are not offering patients the same recommended options across the board based on our evaluation of patients’ identified disabilities or other identities.

Additionally, there is a concern for limited access to primary HPV testing in rural or under-resourced communities, which may be complicating the access to such testing for patients with disabilities. Until this testing is widely available for all patients, we should continue to use cytology and HPV co-testing in patients aged 30 to 64 years and cytology alone in patients aged 21 to 30 years. Regardless of type of testing, this study shows, as previous studies have as well, that we are not appropriately screening patients with disabilities for cervical cancer. We should consider how we can better get appropriate care and screening to these patient populations, whether that is through outreach, provider education or improving patient access.