title: Access of Black, Hispanic, and nonprivately insured women to liquid-based cytology, human papillomavirus DNA testing, and on-site colposcopy in the United States.
abstract: OBJECTIVE
  To determine whether patient race, ethnicity, or insurance status was associated with access to cervical cancer screening with liquid-based cytology (LBC) and with human papillomavirus (HPV) DNA testing and with access to on-site colposcopy at the provider's principal practice site.
  
  
  METHODS
  We conducted a nationally representative survey of clinicians in specialties that provide cervical cancer screening. Adjusted odds ratios (OR) were estimated for the associations between race, ethnicity, and insurance status of patients and provider use of LBC, HPV DNA testing, and on-site colposcopy.
  
  
  RESULTS
  Providers who cared for >or=20% Hispanic patients were less likely to use LBC (OR 0.60, 95% CI=0.42-0.84). Providers who cared for >or=25% black women (OR 0.71, 95% CI=0.51-0.98) and providers who cared for <75% privately insured patients (OR 0.66, 95% CI=0.46-0.95) were less likely to use HPV DNA testing. Providers who cared for <75% privately insured patients were less likely to have on-site colposcopy (OR 0.57, 95% CI=0.37-0.89), but those who cared for >or=20% Medicaid patients were more likely to have on-site colposcopy (OR 1.86, 95% CI=1.26-2.73).
  
  
  CONCLUSIONS
  Given the high rates of cervical cancer in minority women, access to cervical cancer screening and diagnostic follow-up must be ensured. It may also be beneficial to ensure affordable access to technologies such HPV DNA testing that increases the sensitivity of disease detection and to on-site colposcopy that facilitates follow-up of abnormal cytology.
authors.affiliation: Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. khoover@cdc.gov
authors.forename: Karen
authors.initials: K
authors.lastname: Hoover
authors.forename: Emilia H
authors.initials: EH
authors.lastname: Koumans
authors.forename: Daniel
authors.initials: D
authors.lastname: Montaño
authors.forename: Danuta
authors.initials: D
authors.lastname: Kasprzyk
authors.forename: Crystal
authors.initials: C
authors.lastname: Freeman
authors.forename: April
authors.initials: A
authors.lastname: Greek
authors.forename: Nidhi
authors.initials: N
authors.lastname: Jain
authors.forename: Kathleen
authors.initials: K
authors.lastname: Irwin
mesh_terms: D001741:Black or African American; D003585:Cell Biology; D003127:Colposcopy; D004267:DNA Viruses / Q000302:isolation & purification*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis*; D014481:United States; D014626:Vaginal Smears