Breast cancer is the second leading cause of cancer death in the US for women. The American Cancer Society estimates that over 40,000 women will die from breast cancer in 2025. On top of that, according to the Centers for Disease Control and Prevention, there are around 11,500 new cases of cervical cancer, and about 4,000 women die from cervical cancer each year. Luckily, there’s an easy way to reduce these deaths, through cancer screening.
Together, breast cancer and cervical screenings have prevented an estimated 1,160,000 deaths from 1975 to 2020. As a result of all the hardship breast cancer causes and the benefits that screening offers, the US Preventative Services Task Force recommends screening for breast cancer every other year starting at age 40 and screening for cervical cancer every three years beginning at age 21. The current standard for breast cancer screening is mammograms. The standard for cervical cancer is pap smears and Human Papillomavirus (HPV) testing.
Disparities in Mortality
Overall mortality rates have been declining in recent years for breast cancer. Yet, it is still the second leading cause of cancer death in women. Of course, cancer mortality risks aren’t evenly distributed. Non-Hispanic Black women have the highest rate of mortality from breast cancer when compared to other ethnic groups. Black women are at higher risk of more aggressive forms of breast cancer at younger ages than White women. Also, women in rural areas are at higher risk of being diagnosed with late-stage breast cancer and thus higher risk of death. Mortality rates for breast cancer in rural areas have remained the same or increased in recent years. This is inconsistent with the decreasing national declining mortality rate.
As a whole, cervical cancer mortality has been declining in recent years from pap testing and HPV vaccination. However, Black women, compared to White women and rural women compared to metropolitan women, have higher rates of death from cervical cancer. This is shown by adjusted rates of mortality for Black women over double the rate compared to White women. The majority of cervical cancer is caused by HPV infection, meaning most cervical cancer is preventable through HPV vaccination and regular screening, according to the National Cancer Institute.
Disparities in Access to Care
The disparity in mortality for breast cancer in non-Hispanic Black women is associated with late-stage diagnosis, barriers to screening, and unequal access to treatment. Rural women, including Black, Hispanic, and White women, were found to have less access to mammograms and cervical cancer screening compared to urban populations. 35% of US counties were deemed “maternal care deserts” without a single obstetric provider. The immediate result of this has been seen in increasing rates of preterm births and maternal mortality, disproportionately affecting Native American, Black, and rural women. However, these obstetrics providers also provide women with preventative cancer screening in addition to maternal care.
The ramifications of limited access to women’s cancer screening in these maternal care deserts have yet to be seen. Still, restricted access to screening is associated with later-stage diagnosis and higher mortality rates. Amy, highlighted in the CDC’s Cancer Survivor Stories, put off cervical cancer screening because she was uninsured and did not seek care until she experienced symptoms and was diagnosed with adenocarcinoma, an aggressive form of cervical cancer. Creating bridges to these gaps in care is essential to timely and effective treatment.
HPV and Cervical Cancer
The majority of cervical cancer is caused by HPV infection and is preventable with the HPV vaccine. The vaccine is recommended for women between the ages of 11 and 26, requiring 2-3 doses to be effective. HPV vaccination rates in the United States are around 60%, but these rates vary by state. In 2022, the highest vaccine coverage for adolescents was in Rhode Island (84%), and the lowest was in Mississippi (38%). Those living in more rural areas and those who are uninsured were less likely to be vaccinated against HPV. These same populations are less likely to receive cervical cancer screening, putting them at higher risk of late-stage diagnosis and death from a mostly preventable cancer.
Factors for Care
Addressing disparities in breast cancer and cervical cancer screening can be challenging. This is because of the underlying and complex issues resulting in racial, geographic, and economic inequalities in access to care. Small-scale solutions explored include mobile mammography clinics. One study found that mobile clinics saw more Black, Hispanic, and uninsured women, who typically have lower rates of screening. However, they also found that those using the mobile clinic were less likely to follow up after initial screening. A meta-analysis by Han et al. found that interventions focused on increasing access to care had the most significant effect on regular pap screening. Knowledge of HPV risks and strong provider recommendations are associated with HPV vaccination initiation too.
Threats to Care and Steps Moving Forward
And once again, the Affordable Care Act (ACA) is back in the news. Passed in 2010, the new law decreased the percentage of uninsured Americans by over half, from 16% uninsured in 2010 before the act to 7.7% in 2023. In addition, just ten years ago, Medicare began publicly financing and subsidizing the prescription drug program for seniors known as Part D. In doing so, it may have saved thousands of lives. One study found mammograms increased by 2.4% for privately insured non-Hispanic Black women after the ACA was implemented. In addition to providing more people with insurance, the ACA requires health insurance providers to cover preventative screening. This includes mammograms and cervical cancer screening at no additional cost to the patient getting a screening. The preventative services covered cannot charge patient’s deductibles, copayments, or coinsurance. All forms of insurance, including public and private, must follow these regulations.
However, the requirement to include preventative services at no additional cost is under review by the Supreme Court on April 21, 2025. It is imperative that these services remain covered by insurance. Otherwise, it could exacerbate already present, persistent health disparities in breast and cervical cancer mortality. This has potential to undo some or all of the progress fomented by the ACA and creating further barriers to receiving care. Also, policymakers, payers, and providers should explore accessible screening service programs to reach high-risk groups and decrease disparities in mortality.
Olivia Jones
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