Racial and Ethnic Disparities in Cervical and Breast Cancer Screening Utilization By Nativity and Length of U.S. Residence

Background/Purpose: Although increased participation in cervical and breast cancer screenings has substantially reduced the incidence of and mortality from these cancers, significant racial and ethnic disparities remain. The proportion of Hispanic (60%) and Asian women (55%) meeting mammogram screening guidelines is lower than that of non-Hispanic Black (66%) and non-Hispanic White (64%) women. Research shows a similar pattern regarding the odds of Pap test utilization.

Previous studies identified major access barriers to screenings that may be associated with immigration such as insurance coverage, language barriers, length of residence, and lack of knowledge about cancer screenings. However, insufficient sample sizes have posed a challenge to testing this relationship. Our study examined the impact of potential drivers on screening utilization, based on nativity and length of U.S. residence, for Hispanic and Asian women relative to non-Hispanic White and non-Hispanic Black women.

Methods: We pooled six years of data (2005, 2008, 2010, 2013, 2015, and 2018) from the National Health Interview Survey (NHIS) for a total sample of 13,725 women ages 21-64. Within this sample, there were 13,725 women ages 21-64 without a hysterectomy who provided data for Pap test results. Of them, 8,677 women aged 40-64 reported mammogram data. Using separately stratified analyses for each racial/immigrant group, we used logistic regression to compute odds ratios of Pap test and mammogram utilization according to race/ethnicity, nativity and immigrant length of stay (for Asian and Hispanic women), with demographic characteristics (age, marital status), socioeconomic status (education, employment history, family income), and health insurance as covariates.

Results: We observed significant racial/ethnic disparities in Pap test and mammogram utilization. In the adjusted models, compared to White women, Black (O.R.=1.66, CI=1.46-1.88), long-term Hispanic immigrant (O.R.=1.37, CI=1.16-1.61), and U.S.-born Hispanic (O.R.=1.19, CI=1.02-1.39) women had higher odds of Pap test utilization. In contrast, recent Asian immigrant (O.R.=0.32, CI=0.26-0.41) and U.S.-born Asians/long-term Asian immigrant (O.R.=0.70, CI=0.58-0.85) women had lower odds of Pap test use than White women. Regarding mammograms, Black (O.R.=1.50, CI=1.25, 1.81), U.S.-born Hispanic (O.R.=1.37, CI=1.05, 1.77), and long-term Hispanic immigrant(O.R.=2.47, CI=1.93, 3.15) women had higher odds of mammogram utilization than Whites.

Low socioeconomic status was an important indicator of screening underutilization among White women and Hispanic immigrant women regardless of length of U.S. residence. Never being married was associated with lower odds of Pap test utilization among long-term Hispanic immigrants, U.S. born Asians/long-term Asian immigrants, and White women. Lower education was a significant predictor of Pap test underutilization among Black and White women. Not having insurance coverage was a significant driver of lower Pap-test and mammogram screening utilization across all groups.

Conclusions and Implications:

We found that immigration status plays a significant role in disparities in both Pap test and mammogram screening, but its effects, and those of other sociodemographic factors, varied across and within racial/ethnic groups. Researchers should examine whether outreach efforts and prevention messages that address these differences in nativity, length of residence, and other factors increase screening utilization. Increased access to health insurance is likely to increase utilization.