Women with disabilities are less likely to receive critical annual cervical cancer screenings using human papillomavirus or HPV tests, as recommended by the American Cancer Society (ACS). Cervical cancer is the most common cancer associated with HPV, accounting for 90% of such cancers, according to data from the Centers for Disease Control.

A new cross-sectional study by University of Delaware epidemiology program Assistant Professor Tarang Parekh found that nationwide, just over 50% of women with disabilities adhered to ACS guidelines for HPV testing. Delaware fared slightly better than the national average, with nearly 56% of women with disabilities meeting annual cancer screening recommendations set by the ACS.

The data shows women with multiple disabilities or cognitive disabilities have an even higher likelihood of not adhering to the guidelines for cancer screening," Parekh said. "We need to address that."

The findings were recently published in the American Journal of Preventive Medicine.

Parekh and colleagues analyzed pooled data from 2018 and 2020 from the CDC's Behavioral Risk Factor and Surveillance System, including nearly 190,000 women aged 25 to 64.

The next question Parekh, who joined UD's College of Health Sciences this semester, seeks to answer is why cancer screening rates are lower among women with disabilities.

"We have the data, and we see the disparities; now we need to know what barriers are in place that perpetuate these disparities," Parekh said.

To answer that question, Parekh wants to conduct a pilot study and interview women with disabilities.

"I want to ask them whether they're getting screened regularly, and if not, what barriers they have in place and whether anyone has tried to address those barriers," Parekh said. "Once we know more about those barriers, it will guide us on where to focus our interventions."

Parekh suspects social determinants of health, including access to health insurance, play a role, but structural barriers perpetuate inequities and may be a primary reason for the lack of cancer screenings in people with disabilities.

"Structural barriers include limited access to care, whether the health care center is equipped to accommodate the needs of women with disabilities, whether women with disabilities have transportation," he said. "Negative attitudes from health care providers can also discourage women with disabilities from seeking regular, preventative care."

Parekh suspects that bias among health care providers may also play a role in the lack of cancer screenings conducted in women with disabilities.

"Evidence shows that health care providers have a bias towards women with cognitive disabilities, physical disabilities, or multiple disabilities," Parekh said. "By assuming they're not sexually active, providers may not convey the importance of routine screenings to this particular population."

Race is also a factor.

"Women of color have not been given priority when it comes to screening awareness," Parekh said. "For many racial minorities, it was never discussed in their families, so it's important to discuss that and family members' negative attitudes towards openly discussing reproductive health. If we can provide reproductive health education to this marginalized population, we can increase the prevalence of cancer screenings."

While health care providers must make a concentrated effort to better equip their facilities and ensure personnel are trained to treat women with disabilities, Parekh said a public health awareness campaign could also help raise the rates of cancer screenings in people with disabilities.

"We need to educate and have conversations with family members and caregivers of people with disabilities about whether their loved ones are getting their annual routine checkups," Parekh said. "A targeted education and awareness campaign about the importance of cancer screenings for this particular population may contribute to lower cancer screening rates."