Uncovering cervical cancer screening disparities among Asian American subgroups in California

Background: Cervical cancer is a highly preventable and treatable malignancy when detected early. Despite the availability of Pap test, clear racial/ethnic disparities in screening uptake exist, with Asian American women having significantly lower rates than Non-Hispanic White (NHW) women. To improve cervical cancer screening rates among Asian American women, it is important to understand which Asian subgroups are more inclined to be underscreened. However, research on this topic remains limited. Our study aims to examine recent Pap test rates and factors associated with screening uptake across disaggregated Asian subgroups. Methods: Using cross-sectional data from the 2016, 2018, and 2020 California Behavioral Risk Factor Surveillance System, we calculated the weighted prevalence of women ages 21-65 who reported being up-to-date with Pap test based on the most recent U.S. Preventive Services Tasks Force's recommendations (i.e., having been tested in the past three years) for the six largest Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and NHW women as a comparison group. Multivariable logistic regression was fitted with reporting being up-to-date with Pap test as the outcome, regressing on race/ethnicity and adjusting for sociodemographic (age, education, income, marital status, poverty status, metropolitan statistical area) and access to care factors (having a primary care provider, health insurance type). In addition, the weighted prevalence of Pap test uptake for each Asian subgroup was calculated for factors found to be statistically significant in the adjusted model. Results: Our analysis included 517 Asian American and 3,061 NHW women. While the percentage of NHW women who reported being up-to-date with Pap test was 83%, this percentage was lower for all Asian American subgroups (32% for Vietnamese, 54% for Asian Indian, 59% for Japanese, 66% for Korean, 67% for Chinese, 75% for Filipino). After adjusting for covariates, the Asian subgroups had 46-91% lower odds of reporting being up-to-date with Pap test, with the most notable disparities being among Vietnamese (OR=0.09, 95% CI 0.02-0.33) and Asian Indian women (OR=0.20, 95% CI 0.08-0.45). Interestingly, while all Asian subgroups with a primary care provider showed a prevalence of Pap test uptake of over 70%, this percentage was only 30% for Vietnamese women. Conclusions: Although all Asian American subgroups reported lower Pap test adherence to screening guidelines than NHW women, the disparities were particularly striking for Vietnamese and Asian Indian women. Our results also suggest further exploring the role of primary care providers in the context of cervical cancer screening, particularly among Vietnamese women. Furthermore, the ethnic-specific disparities noted in our analysis highlight the importance of disaggregated data so interventions can be appropriately tailored.