Sometimes it is cultural, other times it is out of fear. Minority women are less likely to get screened for breast and cervical cancer than their white counterparts.
In some cases, they do not have health insurance or lack childcare. Transportation can be an issue.
Medical experts as well as volunteers are working to turn this dilemma around and, in the process, save lives. Routine screening for breast and cervical cancer is already known to save lives. So, the emphasis is on getting more women screened so abnormal cells in their bodies do not become cancerous.
Edelmira Pacheco, who goes by the nickname Reina, put off getting a mammogram. But at age 46, she finally made and kept the appointment. Her diagnosis of stage 2 breast cancer required a double mastectomy and four rounds of chemotherapy. She credits the diagnosis and follow-up treatment with saving her life.
Becoming an advocate
For the past 20 years, Pacheco has worked to bring other minority women into the light, teaching them breast self-examination and the importance of early screening.
“At the time, I knew nothing about cancer and thought at any time I could die,” the Orlando woman says.
That very first mammogram revealed her breast cancer.
Today, she spends much of her time on the advocacy and educational program Creando Conciencia Por Reina, going to churches, airports, women’s groups, and other gathering spots to preach early screening.
In some of those groups, Pacheco finds Hispanic women who don’t even know what a mammogram is, she says. In other cases, they don’t get them because they have no insurance, or they are afraid of getting bad results.
The same can be said for early cervical cancer screening.
Dr. Matthew Anderson, a gynecologic oncologist with the University of South Florida, is involved in developing cervical cancer screening programs that reach more women. While mobile units now spread out to entice more women to get mammograms, Anderson and his colleagues are working on mail-in Human Papillomavirus, or HPV, test kits to reach more women.
Cervical cancer “has really become a disease that reflects healthcare disparities due to the problem with access to care,” he says.
“The most vulnerable people are the ones that don’t get screened," Anderson adds.
Because cervical cancer sometimes takes years to develop, it offers a window of opportunity to patients and healthcare providers to catch it at the pre-cancerous stage.
Transforming care
Before World War II, Anderson says, cervical cancer was the leading cause of death among women in the U.S. The development of the Pap smear – in-office vaginal testing for cervical cancer – transformed healthcare for women by catching it early, so there was no longer a need for invasive treatment.
Where Pap smears are available, the incidence of cervical cancer has dropped dramatically, Anderson said. And with the HPV vaccine readily available in metropolitan areas, many lives are saved.
Still, Black women are more susceptible to getting cervical cancer because they are less likely to get screened. Relatively recent data collected in the past few years also shows the incidence of this cancer increasing in rural Caucasian women because they are not getting screened, Anderson says.
“In Florida, cancer mortality in rural counties is 40% higher than in urban population areas like Tampa, St. Pete, Orlando, and Miami,” he says.
A Pap smear alone will not fix that.
“You have to come back if anything shows up,” Anderson says.
And for some women, a Pap smear is unacceptable because it is considered invasive, or women have experienced sexual trauma, or are just less comfortable with the procedure.
Enter self-testing for cervical cancer. Already, Anderson says, self-testing is being used by some doctors. They can simply hand their patients the test kit so they can privately test themselves.
“We just published a paper where we were able to show that if you take this population that has not been screened, and you mail them a self-test...You can almost triple the rates of testing,” he says.
Right now, the self-testing is only FDA-approved to be done in a doctor’s office, Anderson says, but eventually, that test will come through the mail.
“It is making screening work for people in their daily lives,” he says.
An article on self-testing, recently published in JAMA Internal Medicine, includes a link for those wishing to participate in a clinical trial. Contact
Trials.gov Identifier: NCT03898167.
Clinicians still see disparity in cervical cancer data, says Dr. Susan Vadaparampil, Associate Center Director for Community Outreach and Engagement at Moffitt Cancer Center.
“In 2023 data, all groups combined, about 76% of women, or three out of four, were up to date with cervical cancer screening,” she says.
Looking at race and ethnicity, screening rates are about 80 percent for white women, 74 percent for Black women, and 67 percent for Hispanic women, Vadaparampil says.
As for breast cancer in Hillsborough County, data from the National Health Interview Survey shows that Black and Hispanic women are close in terms of screening rates, compared to other racial and ethnic groups, Vadaparampil says.
“We have seen it improve over time, not only locally, but across the nation,” she says.
She attributes the improvement to community outreach, including mobile mammogram units that provide more access.
“It is the intersection of learning more about how people want to receive education, and logistics, like bringing screening to where women are or where a mammography center may be of service,” Vadaparampil says.
“We are always trying to balance,” she says. “Mobile mammography takes away the barrier of transportation and time, and the ability to do it when childcare is not an issue. It is an important game changer.”
That is the good news, she says. More challenging, she says, is that screening should be done annually with women following up on any abnormal results.
“This is where we start to see a potential contributor to the death rates when looking at Black women and the general population…That is one of the reasons there is still a disparity,” Vadaparampil says.
“At Moffitt, we are fortunate in that we have an entire team of researchers focused on screening and early detection,” she says. “We’ve been able to readily identify what some of those barriers are. And as an institution, we make sure women get screened through financial assistance and are also linked to a navigator that can help them with those in between steps.”
Funding for Florida's Breast and Cervical Cancer Early Detection Program is administered through the Florida Department of Health State Health Office, and includes Hillsborough and Pinellas counties.
For more information, go to Breast and Cervical Cancer Early Detection