In Chester County, 7.1 percent of the population is of Hispanic descent. That number increases to more than 50 percent in Kennett Square and Avondale, according to Chester County Hospital’s Community Health Needs Assessment. The Hispanic community is the fastest growing population in the United States, and their health needs are growing too: the Centers for Disease Control and Prevention’s (CDC) most recent reports show that Hispanic women have the highest incidence of cervical cancer than any other racial or ethnic group in the U.S. These women also tend to have more severe cases of cervical cancer and experience higher mortality rates compared to most other populations
“One of the major reasons for this prevalence is the lack of cervical cancer screenings,” explains Robert Giuntoli, II, MD
, an associate professor of Clinical Obstetrics and Gynecology at Penn Medicine and a gynecologic oncologist at Chester County Hospital (CCH). “Though these women are not more likely to get cervical cancer than any other race/ethnicity, Hispanic women, especially migrant populations, are less likely to get Pap smears.”
Cervical cancer is easily treated when caught early
. Cervical cancer screenings are used to find changes in the cells of the cervix that could lead to cancer. Pelvic exams, Pap test screenings, and human papilloma virus (HPV) testing can detect cervical cancer in its earliest stages.
“Though simple screening tests allowing for the early detection of cervical cancer are essential to every woman’s health, access and financial barriers can make it difficult for many women to access the care they need,” explains Carmen Guerra, MD, MSCE, FACP
, an associate professor of Medicine at Penn Medicine and associate chief of staff at Penn’s Abramson Cancer Center. Low income, language barriers, and not knowing where to go for care are just some of the things that prevent Hispanic women from getting screened. Because of these barriers, some women don’t seek medical treatment unless there is an obvious problem.”
“Insurance is the number one barrier to these women getting regular screenings,” Giuntoli says. “Not having insurance, or even having insurance that won’t cover these tests leads to us seeing women with advanced stage cancer. Had these patients had the appropriate screenings, we would have been able to detect the cancer in its early stages for a more favorable outcome.”
Chester County Hospital’s Ob/Gyn Clinic and the hospital’s partnership with La Comunidad Hispana (LCH) are working to eliminate these barriers in Chester County so more women have access to regular gynecological exams and cervical cancer screenings. The clinic serves more than 2,000 Hispanic women annually at their West Chester and Kennett Square locations. These visits account for more than 46 percent of their total census. To address language, insurance, and low income barriers, the Ob/Gyn Clinic’s bilingual staff offers gynecological care, including cervical cancer screenings, at a reduced rate. If the cost is still too high, the clinic will work with patients to ensure they get the care they need without the financial burden.
Beyond routine exams, the staff also ensures patients receive proper follow-up care when screening results are abnormal. Follow-up Pap and colposcopy tests are scheduled when a Pap smear is irregular. A colposcopy is a procedure that allows providers to more closely examine the cervix for abnormalities or disease. If the tests reveal something that requires surgery, the clinic will address that with the patient and set up the procedure in the hospital, regardless of insurance coverage. The clinic also helps women who require surgery to apply for financial assistance if needed.
La Comunidad Hispana, a Kennett Square-based organization that provides comprehensive health care services to low-income residents of southern Chester County, is also working to remove barriers to preventative screenings for Hispanic women. Currently, LCH is the only location in Chester County that offers the HealthyWoman program, a free breast and cervical cancer early detection program funded by the Pennsylvania Department of Health and through a grant from the CDC for low-income women who are uninsured or under-insured. Penn Medicine hospitals also serve women through this program in the Philadelphia region. Through this initiative, LCH offers free “well woman” exams, which include a gynecological visit, Pap smear, and mammograms. If there is an abnormal Pap, LCH arranges follow up care. Chester County Hospital works with LCH on this program by providing free Pap smear readings in their lab.
Penn Medicine also partners with the American Cancer Society and WUVP Univision 65 each year to offer free mammograms to uninsured women in the Philadelphia region – another way to reach Hispanic women. In May 2017, for the first time, the annual “Amate a ti Misma
,” or “Love Yourself,” event also provided cervical cancer screenings at no cost.
“Events like Amate a ti Misma promote early detection and preventive care, ultimately leading to improved outcomes and saved lives,” Guerra says. The event had Spanish-English translators available at all three sites where the services were offered.
The work the Ob/Gyn Clinic and La Comunidad Hispana are doing to reduce the barriers for Chester County women to access routine screenings are helping to decrease the prevalence of cervical cancer in the Hispanic community. Hispanic women can also take an active role themselves to reduce this high incidence.
“The take home message is: screenings,” Giuntoli explains. “Get regular Pap smears, the HPV vaccine and co-testing – a combination of a Pap smear and HPV test – when appropriate.”