While we have made tremendous strides with the Affordable Care Act, black women in the United States are dying from cervical cancer, also known as “the silent killer,” at more than two times the rate of white women.
Moreover, black women are more likely to be diagnosed at later stages with more aggressive forms of cervical cancer than any other racial group. This is why access to the HPV vaccine as well as effective, affordable screening is imperative in ensuring the early detection and treatment of cervical cancer in black women.
USPSTF decided not to include co-testing — combining the HPV test and Pap test — as the preferred screening option in its recent recommendations although it is considered today’s standard of care.
By not including co-testing, women over the age of 30 would be limited to either a Pap test or an HPV test. This is a significant departure from established current clinical practice and could not only risk reversing nearly 75 years of advances against cervical cancer diagnoses and deaths, but also widen the racial disparity gap for cervical cancer.
What’s even more troubling, the USPSTF made this recommendation based largely on evidence acquired from international studies that did not include a sufficient number of women of color.
Not only would these draft recommendations be dangerous for women’s health, if implemented they would also have serious implications for health insurance coverage, as health plans would no longer be required to cover co-testing because it did not receive an A or B grade. A disruption in coverage and the subsequent confusion would only result in even less women, particularly women of color, getting the lifesaving screenings they need.
Co-testing has helped to save millions of women’s lives in the United States over the past several decades. Several large domestic studies have found that co-testing identifies more cervical cancer and pre-cancerous lesions than either test alone. And a recent study in Cancer Cytopathology found that the use of an HPV-only test could miss a cancer diagnosis in 20 percent of women. The fact that the draft USPSTF recommendations didn’t consider the merits of co-testing is concerning for all women – especially women of color.
Screenings are a proven public health tool that can save lives. And in this case, cervical cancer screenings can detect the disease at an early stage, which can save Black women from the morbidity and mortality that occurs when screenings are delayed or skipped. And it is not as if all Black women choose to forgo or delay screenings; oftentimes, it is an inevitable decision due to cost and/or lack of health care coverage.
Policymakers must understand that health care outcomes differ greatly across the races and genders. In understanding these differences they must recognize that health care recommendations and guidelines must be based on the lived experiences of individuals from different communities. In order for these needs to be met, they must be based on evidence from clinical trials which are inclusive of all racial and ethnic backgrounds.
At a time when we are fighting for everyone to have the ability to fully exercise their right to quality, comprehensive health care, we must remember care is not universal nor comprehensive unless it takes into consideration the health care needs of the individual. And because we are not all the same, we can't use a "one size fits all" approach to health care and coverage.
USPSTF must reinstate an A grade for co-testing and allow cervical cancer screening decisions to remain, first and foremost, between a woman and her physician. It is only then that we will start to see the disparity reduced and less Black women dying silently and unnecessarily from this disease.
Christy M. Gamble, JD, DrPH, MPH is the Director of Health Policy and Legislative Affairs at the Black Women's Health Imperative and an Allies Reaching for Community Health Equity Public Voices fellow at The OpEd Project.