In partnership with the Michigan Department of Health & Human Services and the Michigan Public Health Institute, MiCHWA compiled resources that illustrate the vital role CHWs play in cancer control and prevention. This page is specific to Cervical Cancer. For other health conditions that are covered by MiCHWA, refer to the sidebar to the right.
Health Disparities in Cervical Cancer
Since the introduction of the Papanicolaou (Pap) test, incidence and mortality rates for cervical cancer have declined. However, disparities across racial and ethnic groups persist in the United States and in Michigan. The following table highlights major cervical cancer disparities.
|African-American and Hispanic women are more likely than White women to be diagnosed with cervical cancer (2 and 1.5 times, respectively)1||Older black women (age 50+) have higher cervical cancer incidence rates than White women2|
|Black women are twice as likely to die of cervical cancer than White women (4.4 deaths per 100,000 vs. 2.2 deaths per 100,000, respectively)2||Black women are more likely to die of cervical cancer than White women (3.4 deaths per 100,000 vs. 1.8 deaths per 100,000, respectively)2|
|Vietnamese women have the highest cervical cancer incidence rate (14 cases per 100,000)1||Cervical cancer screening rates are lower among Asian Americans than among white women3|
|Asian American, Hispanic, or uninsured women and women with no more than a high school diploma or GED are less likely to have had a Pap test in the last three years4||Asian American, Arab American, Hispanic , lower income and less educated women report significantly lower rates of cervical cancer screening.5|
Community Health Worker (CHW) Interventions
Promotora-led workshops with Hispanic community members have been shown to significantly increase cervical cancer understanding and Pap smear screening. Following one such intervention, screening rates increased 29% (from 36% to 65%), cervical cancer knowledge increased from 3.5 to 5.4 (out of 6) and self-efficacy increased from 4.0 to 4.7 (out of 5).6
Screening and Vaccination
An economic evaluation found that although CHW-led education programs targeting Korean-American women are more expensive than traditional methods ($444 vs. $269 per enrollee), the cost per screening in the CHW-led program was significantly cheaper ($1,002 vs. $1,766), and the incremental cost-effectiveness ratio (ICER) was calculated to be $236.7.7 For Hispanic communities, interventions that demonstrate the most significant increases in screening consist of one-on-one or small group educational sessions led by lay health advisors (LHAs). In effective interventions, LHAs carry out multiple sessions or implement ongoing activities in the community.8 In South Texas, a promotora-led program called Entre Madre e Hija (EMH) provides mothers and their daughters with culturally relevant cancer prevention education and support. This group was compared to another group given just an HPV vaccine education brochure. Eighty-four percent of participants in both groups started the HPV vaccine series, but the EMH group was over 30% more likely to complete the vaccine series (72.2% vs. 42.5%).9
Health System Navigation
Individuals from disadvantaged neighborhoods with lower socioeconomic statuses are less likely to receive timely cancer care.10 Patient navigators can decrease the time it takes to resolve abnormal cervical cancer screening tests. One study found that women with a patient navigator were more than twice as likely to have reached diagnostic resolution in 60 days (52.4% vs. 24.9%) and at 365 days were nearly 20% more likely to have their diagnosis resolved (88.5% vs. 70.3%).11
Article abstracts available by clicking the hyperlinked article titles above; full citations are located in the References category.
Fact Sheet: CHWs & Cervical Cancer
Click To View All External Links & References
1. Downs LS, Smith JS, Scarinci I, Flowers L, Parham G. The disparity of cervical cancer in diverse populations. Gynecol Oncol 2008;109(2 Suppl):S22-S30. doi:10.1016/j.ygyno.2008.01.003.
2. Michigan Public Health Institute and Michigan Department of Community Health. The Cancer Burden In Michigan: Selected Statistics 1993-2011. Report. https://www.michigan.gov/documents/mdch/Ca_burden_MI_select_stats_1993-2011_371092_7.pdf. Accessed July 13, 2015.
3. Wu T-Y. Reducing Health Disparities in Asian American: Michigan Experience. Heal Asian Am Proj. http://www.michiganmhc.com/Documents/Tsu Yin Wu Presentation.pdf. Accessed August 17, 2015.
4. Cancer Prevention & Early Detection Facts & Figures 2015-2016. http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-045101.pdf. Accessed August 17, 2015.
5. Michigan Public Health Institute and the Michigan Department of Community. Special Cancer Behavioral Risk Factor Survey, 2008.; 2010. http://www.michigancancer.org/PDFs/Publications_Products/MCCSpecialRpt/SCBRFS_2008-042910.pdf. Accessed July 13, 2015.
6. O’Brien MJ, Halbert CH, Bixby R, Pimentel S, Shea JA. Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med. 2010;25(11):1186-1192. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2947642&tool=pmcentrez&rendertype=abstract. Accessed May 18, 2015.
7. Schuster AL, Frick KD, Huh B-Y, Kim KB, Kim M, Han H-R. Economic evaluation of a community health worker-led health literacy intervention to promote cancer screening among Korean american women. J Health Care Poor Underserved. 2015;26(2):431-440. doi:10.1353/hpu.2015.0050.
8. Mann L, Foley KL, Tanner AE, Sun CJ, Rhodes SD. Increasing Cervical Cancer Screening Among US Hispanics/Latinas: A Qualitative Systematic Review. J Cancer Educ. 2015;30(2):374- 387. doi:10.1007/s13187-014-0716-9.
9. Parra-Medina D, Morales-Campos DY, Mojica C, Ramirez AG. Promotora Outreach, Education and Navigation Support for HPV Vaccination to Hispanic Women with Unvaccinated Daughters. J Cancer Educ. 2015;30(2):353-359. doi:10.1007/s13187-014-0680-4.
10. Barrett RE, Cho YI, Weaver KE, et al. Neighborhood change and distant metastasis at diagnosis of breast cancer. Ann Epidemiol. 2008;18(1):43-47. doi:10.1016/j.annepidem.2007.07.001.
11. Markossian TW, Darnell JS, Calhoun EA. Follow-up and timeliness after an abnormal cancer screening among underserved, urban women in a patient navigation program. Cancer Epidemiol Biomarkers Prev. 2012;21(10):1691-1700. http://cebp.aacrjournals.org/content/21/10/1691.short. Accessed May 18, 2015.