Racial Differences in Expected Versus Actual Costs of Cervical Cancer Screening among Low-Income, Underscreened Women...

Perceived financial barriers to cervical cancer screening in the United States are well documented. However, few data compare perceived cost barriers with actual screening costs. Our objective was to compare individuals' expected screening costs with actual screening costs. Additionally, we explore cost differences for Black and White participants to better understand how perceived financial barriers may contribute to screening disparities.

We utilized control arm (n = 227) data from the MBMT-3 trial of low-income underscreened women in North Carolina. At baseline, participants were asked their expected screening and screening-associated costs (i.e., lost wages, transportation, child/dependent care, etc.). After in-clinic screening, participants reported their actual costs. We calculated differences between individuals' expected versus actual costs, overall and for Black and White participants. We examined sociodemographic predictors of expected costs and expected-actual cost difference.

Participants expected screening to cost a median $200 (IQR: 100-300), primarily for appointments and laboratory tests. Black participants expected higher screening costs (median $265) than White participants ($205). Participants who completed screening overestimated expenses, with median expected costs of $215 compared with $5 for actual costs. Participants overestimated costs for every category: appointment and laboratory tests, lost wages, transportation, and child/dependent care. Actual costs were similar for Black and White participants.

Educational outreach about existing affordable screening services may reduce perceived financial barriers, particularly for historically marginalized populations.

Among an underscreened population perceiving high financial barriers, participants overestimated screening costs, with Black participants expecting higher costs than White participants. High expected costs indicate low awareness of subsidized screening options. See related In the Spotlight, p. 1061.