Perceived Financial Barriers to Cervical Cancer Screening and Associated Cost Burden Among Low-Income, Under-Screened Women

Abstract

Background: Despite screening's effectiveness in reducing cervical cancer incidence and mortality, disparities in cervical cancer screening uptake remain, with lower rates documented among uninsured and low-income individuals. We examined perceived financial barriers to, and the perceived cost burden of, cervical cancer screening. Materials and Methods: We surveyed 702 low-income, uninsured or publicly insured women ages 25-64 years in North Carolina, U.S., who were not up to date on cervical cancer screening according to national guidelines.Participants were asked about perceived financial barriers to screening and how much they perceived screening would cost. We used multivariable logistic regression to assess the sociodemographic predictors of perceived financial barriers. Results: Seventy-two percent of participants perceived financial barriers to screening. Screening appointment costs (71%) and follow-up/future treatment costs (44%) were most commonly reported, followed by lost pay due to time missed from work (6%) and transportation costs (5%). In multivariable analysis, being uninsured (vs. publicly insured), younger (25-34 vs. 50-64 years), White (vs. Black), and not reporting income data were associated with perceiving screening costs and future treatment costs as barriers to screening. Participants reported wide-ranging estimates of the perceived out-of-pocket cost of screening

Factors responsible for healthcare avoidance among rural adults in the Eastern Region of North Carolina

“…Despite high rates of health insurance coverage in our overall sample, including those who avoided healthcare for a year or more, cost was the most frequently cited reason for healthcare avoidance, followed closely by complexity and lastly, privacy. These results are consistent with previous findings that suggest cost and time are frequently reported barriers to accessing medical care [ 2 , 4 , 13 , 15 , 25 ].…”

Racial and ethnic differences in cervical cancer screening barriers and intentions: The My Body My Test-3 HPV self-collection trial among under-screened, low-income women

“…major barriers to cervical cancer screening [14,15,22,37,38]. Our findings are consistent with results of a previous study using MBMT-3 data, which found that 72% of participants perceived financial barriers to screening and that uninsured women were more likely to perceive screening costs and follow-up treatment costs as barriers [39].…”

Current gaps and opportunities in screening, prevention, and treatment of cervical cancer

“…Although routine cervical cancer screening is recommended and covered under the Affordable Care Act, a recent survey of 702 low‐income women who were uninsured or publicly insured demonstrated multiple perceived barriers to engaging in this crucial preventive service—with 72% citing financial barriers 21 . Persons without health insurance are less likely to be screened or vaccinated against HPV 22 …”

“…20 Although routine cervical cancer screening is recommended and covered under the Affordable Care Act, a recent survey of 702 low-income women who were uninsured or publicly insured demonstrated multiple perceived barriers to engaging in this crucial preventive service-with 72% citing financial barriers. 21 Persons without health insurance are less likely to be screened or vaccinated against HPV. 22 Population characteristics, such as poverty and underinsurance or uninsurance, that place women at greater risk for cervical cancer are disproportionally concentrated in the less populated, rural areas of the United States.…”