Abstract C124: Racial and ethnic disparities in follow-up of abnormal cervical cancer screening results

Abstract

Abstract Background: Despite well-defined practice guidelines for management of abnormal cervical cancer (CC) screening results, the incidence of CC is disproportionately higher in Black and Hispanic women compared to White women. Black women experience the highest overall CC mortality rates, irrespective of subtype or stage. Disparities in CC prevention may be related to differential follow-up of abnormal CC screening and delays in CC diagnosis. In a cohort of primarily Black and Hispanic patients, we investigated racial and ethnic disparities in factors associated with colposcopy attendance following abnormal CC screening. Methods: In a large urban OB/GYN clinic in Connecticut, clinical and demographic medical record data was collected for patients with abnormal CC screening results from 2/2021 to 1/2022. Factors related to colposcopy completion were examined for colposcopy indicated patients. In univariate and multivariate analysis (SAS 9.4), we analyzed the relationship between clinical and demographic characteristics and key junctures in the colposcopy referral and completion cascade. Colposcopy scheduling outcomes were compared by race/ethnicity using the Mann-Whitney U test. Analyses of race/ethnicity were stratified by primary language spoken (non-Hispanic Black, Hispanic English-speaking, Hispanic Spanish-speaking, and White/Other). Results: Of the 248 patients indicated for colposcopy, 44% identified as Black, 39% identified as Hispanic, and 18% identified as White/Other. Among Hispanic patients, 62% spoke English and 38% spoke Spanish as their primary language. The majority of colposcopy indicated patients were publicly insured by Medicare or Medicaid. Colposcopy appointments were attended by 86.7% (215) of indicated patients, with 63.3% (157) attending within the guideline recommended interval of 8 weeks from CC screening for high-grade cytology and 90 days for low-grade cytology. In univariate analysis, colposcopy attendance was significantly lower in Black vs. White/Other patients (p<0.05). Multivariate analysis also showed that Black patients experienced the greatest disparity in colposcopy attendance, followed by Hispanic English-speaking patients (p<0.01). Although rates of guideline-concordant colposcopy attendance were lowest in Black and Hispanic English-speaking patients, these differences were not significant as guideline-concordant completion rates decreased across all groups. No significant relationships were found between race/ethnicity and the number of cancellations, no shows, or reschedules of colposcopy appointments. Conclusions: Although we identified significant differences in colposcopy attendance across race/ethnicity, there were no significant differences in guideline-concordant colposcopy attendance or appointment scheduling outcomes related to delays in colposcopy (i.e. cancellation, no show, or reschedule). Future studies on colposcopy delays will focus on multi-level factors that may disproportionately burden racial/ethnic minority groups and lead to disparities in follow-up of abnormal CC screening results. Citation Format: Anisha V. Patel, Guangyu Tong, Beth A. Jones, Raul U. Hernandez-Ramirez, Wanyi Tang, Sarah Megiel, Abigail Girgis, Jamie Foster, Donna Spiegelman, Sangini S. Sheth. Racial and ethnic disparities in follow-up of abnormal cervical cancer screening results [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C124.