Ethnic disparities in cervical cancer illness burden and subsequent care: a prospective view in managed care

Costs associated with cervical neoplasia and cancer impose a significant burden on managed care. More than 50,000 cases are diagnosed annually in the United States, accumulating approximately $4.6 billion in costs per year. The apparent disparity of care related to screening and treatment among specific ethnic groups and economically disadvantaged subpopulations results in elevated cervical cancer mortality rates and adds to managed care's burden. This is likely the result of several factors, including differences in the stage of cervical cancer at diagnosis, cultural barriers to undergoing regular cervical screening, and impaired access to follow-up care after receiving abnormal Papanicolaou smear test results. To overcome socioeconomic and cultural barriers to providing adequate care for patients with cervical cancer, the implementation and effectiveness of secondary prevention methods should be revisited and options for primary prevention, such as human papillomavirus vaccination, should be explored. Vaccines have the potential to reduce disparities in care, particularly if they are provided to economically disadvantaged women or those whose culture serves as an obstacle to obtaining appropriate care. If action is not taken to broaden access to vaccines, it is likely that managed care will continue to bear the burden of increased costs due to poor outcomes.