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Geographic Disparities in Cancer Mortality
The chance of dying from breast or cervical cancer varies across the nation. Why is that?
Where a woman lives in the United States can be a major factor in her risk of dying from cervical and breast cancer. There is a cluster of states in the American South where women have the highest risk of dying from these cancers. These states also have the highest risks of women dying from childbirth and have the highest rates of dying from any form, for any reason, for young women aged 15 to 44.
Possible Causes: Environment, Population, and Policy
Is it the latitude? Is it too much sun? Is it too hot? It's been a hot summer. I'm sure that's part of it. Well, is it an environmental factor, or is it the people who live there? Or is it the health care policies in those states? It's actually all of these things and more. And it's a perfect issue to look at through the lens of the seven domains of women's health.
Racial Disparities in Cancer Mortality
Are there some people who are more likely to die from cervical or ovarian cancer? And the answer is yes. And the hard question is why. Women who are African American are more likely to die of cervical cancer and breast cancer than white women. African American women may be more likely to get some health care screening, like Pap smears and mammograms, and these are free under the Affordable Care Act if women have signed up for health care.
Health Insurance and Access to Care
Some states have not expanded Medicare to cover low-income women, so they may have no health insurance at all. In fact, the states that have the least amount of Medicare coverage have the highest rates of dying from breast and cervical cancer.
The mammogram, screening for breast cancer, and the Pap smear, screening for cervical cancer, might be available for free for low-income women in some health centers. The follow-up tests for abnormal screening tests, meaning the biopsy of the breast, extra imaging, or colposcopy looking at the cervix, and a biopsy of the abnormal areas, and treatment are not free. And many women don't follow up because they can't afford the next layer of tests in diagnosis and treatment.
Emotional and Social Barriers to Health Care
The effects of poverty and lower education, which may also cluster in the southern states, make this problem more acute. Women may not know where or how they can access the next step in treatment, and they might put off therapy. Some women may feel that they're not comfortable within the health care system. Cervical biopsies and breast biopsies feel invasive and hurt. And they are. These are reasons in the emotional and social domain that can add to women not seeking screening and following up on treatment.
The financial domain is clearly an issue for poor women in any ethnic or racial group. If states have not expanded Medicaid to cover more low-income women, then access to health care becomes limited.
Rural Health Care Access Challenges
In states with a large rural population, there may be fewer health care centers and hospitals available nearby, leaving women to have to travel for next-level care. Death rates from cervical cancer and breast cancer are seen as a marker of lower access by women to health care. This is a marker for all kinds of health care disparities for women. The same states in the South that have higher rates of death from cervical and breast cancer have higher rates of death in childbirth.
Strategies to Improve Health Outcomes
If deaths from cervical and breast cancer are a marker for health care disparities across the nation, what can be done? Well, improving health care access can be helped by ensuring that hospitals and health care centers stay open in rural areas. Access to Medicare is determined by state legislatures. To expanding access requires a focused effort by people in the state to improve Medicare access. Education about the importance of health care screening, and in the case of cervical cancer, helps assure that pre-teens have access to the HPV vaccine, which can decrease the risk of cervical cancer. A national discussion about the importance of access to women's reproductive health care is vital in this time of closing clinics. Focusing patient-centered education and resources on populations with the lowest rates of screening and follow-up is important.
Health care disparities across the nation should be addressed so that all women and their children and families can lead a life with the greatest potential. If you have a little more time or interest in the health care disparities, please check out our other podcasts on this topic. Wherever you live, help the women you love to get their reproductive health screening and follow-up if there's a problem. The answer lies with all of us, in our families, our communities, and our nation. And thanks for joining us on The Scope.