CIDRAP-Disabled women more likely to skip cervical cancer screening, new data show

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Disabled women more likely to skip cervical cancer screening, new data show

www.cidrap.umn.edu

Disabled women more likely to skip cervical cancer screening, new data show​

Meghan Holohan

50 minutes ago.
Human Papillomavirus (HPV)


Disabled women can struggle to find medical care, which means they often miss important health screenings such as those for breast or cervical cancer. A paper published today in JAMA Network Open today shows that women with physical disabilities are less likely to undergo routine cervical cancer screening than women without disabilities.

“What we found is that for every single category—by age, by race group, by ethnic group, and by whether or not they attended any kind of college—is that women with physical disabilities had significantly less cervical cancer screening than women without physical disabilities,” lead author Diane Harper, MD, MPH, professor of family medicine and obstetrics and gynecology at the University of Michigan Medical School, told CIDRAP News.

“They are, to be precise, 21% less likely to have cervical cancer screening than women without disabilities,” she added.

Connie Lam, MS, director of the NYU Langone Initiative for Women with Disabilities, said this paper provides much-needed information about women with disabilities and gaps in their medical care.

“There’s not a lot of research around people with disabilities, in general, especially in gynecology care,” said Lam, who was not involved in the research. “Educating the population, building awareness, having more statistics, this speaks for itself.”

First large-scale study of its kind​

Harper, whose research includes human papillomavirus (HPV) vaccination, cervical cancer, and disability, wondered whether disabled women receive cervical cancer screenings at the same rate as their peers without disabilities. Past survey data indicated women with disabilities were less likely to undergo such screening, but self-reported data can be inaccurate.

“Women believe that if they’ve taken their underwear off, that means they’ve gotten a cervical cancer screen, which is not true,” Harper said. “We were really looking for a way to get a much more rigorous idea of what was happening.”

Harper and her colleagues designed a study examining the medical records of 2.3 million women, which included 15,727 women with physical disabilities (0.7%), to understand rates of cervical cancer screening by age, race, ethnicity, disability, and education status.

“This is the first project that’s been published that can actually look at women with physical disabilities in large numbers and look at it from the standpoint of sociodemographic [identities] that are associated with cervical cancer screening in the United States,” Harper explained.

‘The power of some college education’​

The researchers examined women aged 20 to 60 in 2016 and who had medical records through 2022 to see whether they underwent cervical cancer testing. They found that 63.5% of disabled women were screened for cervical cancer, compared with 70.9% of women without disabilities. “It’s so striking,” Harper said.
They are, to be precise, 21% less likely to have cervical cancer screening than women without disabilities.
Diane Harper, MD, MPH
But for disabled women who attended at least some college, their chance of being screened for cervical cancer was the same as women without disabilities.

“The second thing that we saw that blew our minds away was the power of some college education,” Harper said. “Having some college education was so important for helping this group of people to actually understand that they need a screening.”

While the research didn’t uncover why there was a difference in screening rates between disabled women with some college education and those without it, Harper has a theory.

“There is more information about sexually transmitted infections on college campuses,” she said. “I think that many college campuses offer HPV vaccination to their incoming students who haven’t had it yet.”

One of the paper’s limitations is that it examined cervical cancer screening only in women with physical disabilities, so it does not include data on women with intellectual disabilities.

Role of self-screening​

At Lam’s clinic—one of only a handful in the United States that specifically offers gynecologic care to women with disabilities—the examination rooms have adjustable tables so they can be lowered or raised to help women in wheelchairs transfer.

The beds use stirrups like those in operating rooms, because they’re more comfortable for disabled women, and the clinic’s scales accommodate wheelchairs. Prior to arriving, the medical team knows all about the patient’s disability and accessibility needs so she does not need “to repeat herself.”

“We create a culture of dignity and respect,” Lam said. “Our goal is to make the patient feel that she is an active [participant] in her care rather than someone who has to continuously advocate for basic accommodations.”

Yet many disabled women do not have access to such a clinic. Self-sampling cervical testing can make undergoing screening more accessible and comfortable for women with disabilities.

“It completely eliminates the need for a speculum and the need for changing positions,” Harper said. “A woman can do it herself, or if she needs a caretaker to do it for her, she can have a caretaker do it for her.”

Harper hopes this study will increase awareness about the importance of cervical cancer screening for women with disabilities.

“Not all disabled women are the same,” she said. “I don’t believe that one message is going to work effectively for all. But we have to start with one message saying, ‘If you have a physical disability, you are at risk for cervical cancer, and you can get screened now.’”