Roland Matthews, MD

No woman should ever die of a highly preventable and treatable disease like cervical cancer. Yet, Black women are more likely to die from the disease than any other racial or ethnic group. In fact, they are twice as likely to die from cervical cancer compared to white women in the US.

 Despite advancements in cervical cancer screening and vaccination against high-risk human papilloma virus (HPV) that have contributed to an overall disease reduction, long-time racial, ethnic, and socioeconomic disparities are still prevalent within health care, specifically cervical cancer, and have not yet been addressed.

 Of concern, the American Cancer Society (ACS) recently released new cervical cancer screening guidelines that openly acknowledge Black and Latinx women have higher rates of cervical cancer, yet these guidelines will limit screening options and potentially cause the racial disparity gap to grow even further.

 It is imperative for the OB/GYN community to fully acknowledge this gap and work together to advance healthcare equity for all women.

Racial, Ethnic, and Socioeconomic Cervical Cancer Disparities are Prevalent


Cervical cancer incidence and mortality rates demonstrate troubling disparities when analyzed by race and ethnicity. In 2017, the cervical cancer incidence rate per 100,000 US women was:


8.3 for Black women (14% higher than white women)

8.9 for Hispanic women (22% higher than white women and 7% higher than Black women)

The age-adjusted cervical cancer mortality rate per 100,000 US women also demonstrated increased mortality among Black and Hispanic women when compared to white women.

These disparities are the result of significant socioeconomic barriers that lead to differences in screening rates.

 Studies show that both Black and Hispanic women are diagnosed at a later stage and have higher resultant mortality.

 Black women with cervical cancer also receive less aggressive treatment and have less access to health care.

 A substantial widening of the racial disparities in incidence and mortality occurs with advancing age, particularly in Black women.

The incidence of cervical cancer also is higher in rural versus metropolitan communities in the US, which may reflect differences in screening rates, socioeconomic status, and access to quality health care.

 In fact, more than 60% of US cases occur in areas of underserved and under screened women, many of which are rural settings.16 These screening disparities in rural communities show up at a particularly high rate in the southern region of the US,

 where many women lack adequate health insurance.

Although the lack of health insurance in the US is a socioeconomic barrier contributing to inadequate access to routine cervical cancer screening,

 a study showed that more than half of women (56%) with long-term health insurance and access to health care were not screened for at least three years prior to their cervical cancer diagnosis.18 Additionally, there was failure to follow up on the testing results in an additional 13%.

 Poor screening frequency due to access issues was the primary factor for development of cervical cancer in a meta-analysis of 42 studies. Approximately 54% of the women with cervical cancer had inadequate screening histories and 42% had never been screened prior to their diagnosis.

 The main factors for explaining racial, ethnic, and socioeconomic disparities include: lack of screening, access to screening services, and follow-up of abnormal tests which can affect the overall cervical cancer incidence and stage at diagnosis.

Along with imbalances in cervical cancer screening rates, disparities in the uptake of the HPV vaccine and completion of the vaccine series by geographic region and by race or ethnicity may also contribute to continued health disparities within cervical cancer.

 The CDC found that less than half of adolescents in the US have completed the HPV vaccination series, including only 53% of Black adolescents and 57% of Hispanic adolescents. The HPV vaccination rates in high-risk adolescent populations need to improve to prevent a greater future increase in cervical cancer disparities.

 A blanket assumption of vaccine uptake across the US is detrimental to ensuring prevention and should not lead to decisions of limiting cervical cancer screening choices for women, especially in at-risk populations.

Recent Cervical Cancer Screening Guidelines May Widen the Disparities Gap


The American Cancer Society recently updated their cervical cancer screening guidelines for women at average risk.

 Among the notable changes was the recommendation to begin screening at 25 years of age rather than 21 years, as well as to remove the proven Pap test from frontline screening and rely on HPV-alone screening.

These new guidelines represent a significant departure from current practice and have generated responses from several professional societies. The American College of Obstetrics and Gynecologists (ACOG) released a statement about the new guidelines and reinforced their position on cotesting. Several other groups also continue to support the use of cotesting and cytology for optimal cervical cancer screening including, The American Society of Cytopathology (ASC), the College of American Pathologists (CAP), and the American Society for Clinical Pathology (ASCP).

 The ASCP and ASC specifically warn that if Pap testing is no longer covered by insurance companies, existing screening disparities will increase further. Additionally, cases will be missed if only high-risk HPV tests are used for screening. Up to 10% of invasive cervical cancers test negative for HPV, and up to 14% may be negative for high-risk HPV types covered by the tests. Additionally, 8.3%-14% of high grade squamous intraepithelial lesion (HSIL) cases may also be negative for high-risk HPV.

 The CAP recommends cytology and cotesting be retained given that there is no longitudinal data applicable to US screening populations supporting the change.

Advocacy groups and women’s health advocates are also concerned about the harmful implications of the new ACS guidelines. The Black Women’s Health Imperative released a statement saying that the new ACS guidelines “fail to preserve access to the most accurate and effective cervical cancer screening options and threatens to put lives at risk.”

 They emphasize that Black women are already more likely to be diagnosed with advanced cervical cancer and more likely to die from the disease. Additionally, there are concerns that adjusting the screening interval will make women visit their healthcare provider less frequently, thus missing opportunities to counsel patients on a variety of health issues. Limiting the screening options and testing fewer women at a decreased frequency will widen the disparity gaps even further.

It’s important to note that the ACS based their guidelines strategy on data modeling that is not representative of the US screening population. In fact, the guidelines acknowledge this limitation stating, “There is disparity in the cervical cancer disease burden in the United States, with higher rates of disease among Black and Hispanic women and women of lower socioeconomic status: populations not optimally represented in the RCTs.” While the ACS acknowledges that disparities exist, they seemingly do not adequately account for these concerns within their recommendations.

The ACS guidelines suggest that clinical evidence supports the effectiveness of HPV-alone screening, a claim that directly conflicts with findings from several studies reflecting real-world data.

 The national Quest Diagnostic database analysis confirmed the value of cotesting results. Their data retrospectively analyzed women over a nine-year period and found that cotesting identified cervical cancer and cervical precancers more often than cytology or HPV tests alone. HPV testing alone failed to detect twice as many cases of cervical cancer than co-testing; in fact, HPV alone missed 23% of all cervical cancer cases.

 Given the greater sensitivity associated with cotesting, women who receive a negative cotesting result are at lower risk for disease than women who receive a negative HPV test result.

We Must Reduce Screening Disparities by Protecting All Screening Options


Cervical cancer prevention relies heavily on adequate screening, but despite recommendations for regular cervical cancer screening, many women are inadequately screened or not screened at all. A significant driver in the disproportionate burden of cervical cancer among Black and Hispanic women is related to this lack of screening. Recommendations like those from the ACS that further limit screening options could inadvertently undermine efforts to promote preventive measures in already underserved populations. These health disparities within cervical cancer are briefly recognized but not adequately addressed in the new ACS guidelines. Their recommendations are not tailored to the current US health care system and could increase disparities rather than remove barriers to routine cervical cancer screening. Any new cervical cancer screening guidelines must adequately account for a diverse screening population and the wide range of recognized socioeconomic barriers. Additionally, the guidelines state that Pap testing is less effective in HPV-vaccinated populations; however, significant disparities in vaccine uptake also remain unaddressed. The ACS guidelines should be reconsidered for its lack of applicability to a diverse screening population and the unfortunate likelihood that they will expand pervasive cervical cancer health disparities among women across the US.

OB/GYNs and other healthcare providers must continue to advocate for all cervical cancer screening options to remain available for patients. Providing sufficient, regular preventive care is challenging enough. Any attempt to limit cervical cancer screening options will make it even more challenging to ensure women with different racial and socioeconomic backgrounds get the protection they need to prevent unnecessary disease.

is professor and chairman of the Department of Obstetrics and Gynecology at the Morehouse School of Medicine, and a board-certified gynecologic oncologist and attending physician at Grady Memorial Hospital in Atlanta. He graduated from Columbia College, and earned his M.D. degree, with a distinction in research, from the State University of New York at Stony Brook. Dr. Matthews completed his residency in Obstetrics and Gynecology, then completed a fellowship in Gynecologic Oncology at the State University of New York, Downstate Medical Center. Dr. Matthews is a Georgia Cancer Coalition (GCC) Distinguished Cancer Scholar and is currently the Director of the Georgia Cancer Center for Excellence at Grady. He is Vice President of the Georgia Center for Oncology Research and Education (CORE) board, and serves on the executive committee of the Obstetrics and Gynecology Section of the National Medical Association. Throughout his career, Dr. Matthews’ research, education and clinical activities have focused on reducing disparities in underserved communities.

Beavis AL, Gravitt PE. Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States. 

Yu L, Sabatino SA, White MC. Rural–urban and racial/ethnic disparities in invasive cervical cancer incidence in the United States, 2010–2014. 

. 2019;16:E70. doi: 10.5888/pcd16.180447.

Yoo W, Kim S, Huh WK, et al. Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States. 

Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. 

Centers for Disease Control and Prevention. US Cancer Statistics. Demographics. Rate of new cancers. Cervix, US, 2017. Accessed 10-30-2020 at 

https://gis.cdc.gov/Cancer/USCS/DataViz.html

Centers for Disease Control and Prevention. US Cancer Statistics. Demographics. Number of cancer deaths. Cervix, US, 2017. Accessed 10-30-2020 at 

Downs LS, Smith JS, Scarinci I, Flowers L, Groesbeck P. The disparity of cervical cancer in diverse populations. 

Akinlotan M, Bolin JN, Helduser J, Ojinnaka C, Lichorad A, McClellan D. Cervical cancer screening barriers and risk factor knowledge among uninsured women. 

Nardi C, Sandhu P, Selix N. Cervical cancer screening among minorities in the United States. 

MacLaughlin KL, Jacobson RM, et al. J Womens Health (Larchmt). 2019 Feb;28(2):244-249. 

Olusola P, Banerjee HN, Philley JV, Dasgupta S. Human papilloma virus-associated cervical cancer and health disparities. 

. 2019;8(6):622. doi: 10.3390/cells8060622.

Arvizo C, Madhi H. Disparities in cervical cancer in African American women: What primary care physicians can do. 

Gaffney DK, Hashibe M, Kepka D, Maurer KA, Werner TL. Too many women are dying from cervix cancer: Problems and solutions. 

Brookfield KF, Cheung MC, Lucci J, Fleming LE, Koniaris LG. Disparities in survival among women with invasive cervical cancer. 

Musselwhite LW, Oliveira CM, Kwaramba T, et al. Racial/ethnic disparities in cervical cancer screening and outcomes. 

Scarinci IC, Garcia FAR, Kobetz E, et al. Cervical cancer prevention: New tools and old barriers. 

Benard VB, Thomas CC, King J, et al. Vital signs: Cervical cancer incidence, mortality, and screening—United States, 2007–2012.

Leyden WA, Manos MM, Geiger AM, et al. Cervical cancer in women with comprehensive health care access: Attributable factors in the screening process. 

Spence AR, Goggin P, Franco EL. Process of care failures in invasive cervical cancer: Systematic review and meta-analysis. 

Hirth J. Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature. 

Jeudin P, Liveright E, del Carmen MG, Perkins RB. Race, ethnicity and income as factors for HPV vaccine acceptance and use. 

American College of Obstetrics and Gynecologists. ACOG Statement on Cervical Cancer Screening Guidelines Accessed 10-30-2020 at 

https://www.acog.org/news/news-releases/2020/07/acog-statement-on-cervical-cancer-screening-guidelines 

American Society for Clinical Pathology. Release of the 2020 American Cancer Society cervical cancer screening guidelines. Accessed 10-30-2020 at 

https://www.ascp.org/content/docs/default-source/get-involved-pdfs/istp_clinical_practice_guidelines_and_resources/cetc-society-posting---acs-cervical-cancer-screening-guidelines---final-8-20-20.pdf?sfvrsn=2 

American Society of Cytopathology. Release of the 2020 American Cancer Society cervical cancer screening guidelines. Accessed 10-30-2020 at 

https://cdn.ymaws.com/cytopathology.org/resource/collection/75A4FB3E-BE73-4755-84EA-54214443AE0E/ACS_Cervical_Cancer_Screening_Guidelines_%e2%80%93_ASC_Response.pdf

College of American Pathologists. Letter to the Director of Guideline Development Process at the American Cancer Society. October 15, 2020. Accessed 11-5-2020 at 

https://documents.cap.org/documents/cap-response-to-acs-letter.pdf

Ge Y, Mody RR, Olsen RJ, et al. HPV status in women with high-grade dysplasia on cervical biopsy and preceding negative HPV tests. 

. 2019;8(3):149-156. doi:10.1016/j.jasc.2019.01.001 

McCarthy E, Ye C, Smith M, Kurtycz DFI. Molecular testing and cervical screening: will one test fit all? J

 2016;5(6):331-338. doi:10.1016/j.jasc.2016.08.001 

Black Women’s Health Imperative. Black Women’s Health Imperative responds to American Cancer Society cervical cancer screening guidelines. August 18, 2020. Accessed 10-30-2020 at 

https://bwhi.org/2020/08/18/black-womens-health-imperative-responds-to-american-cancer-society-cervical-cancer-screening-guidelines/

Kaufman HW, Alagia DP, Chen Z, Onisko A, Austin RM. Contributions of liquid-based (Papanicolaou) cytology and human papillomavirus testing in cotesting for detection of cervical cancer and precancer in the United States. 

Austin RM, Onisko A, Zhao C. Enhanced detection of cervical cancer and precancer through use of imaged liquid-based cytology in routine cytology and HPV cotesting. 

Vasilyeva D, et al. Negative Roche cobas HPV testing in cases of biopsy-proven invasive cervical carcinoma, compared with Hybrid Capture 2 and liquid-based cytology. 

Articles

Addressing the Cervical Cancer Screening Disparities Gap 

Major organizations currently recommend screening for endometrial cancer (EC) only for women with an inherited mismatch repair defect, commonly known as 

 (hereditary non-polyposis colorectal cancer) and Lynch syndrome. For women with HNPCC-which typically is identified 

 diagnosis of EC-endometrial biopsy is recommended annually or less frequently, starting at age 35. The precise definition and diagnostic criteria for Lynch and HNPCC syndromes vary. Genetic proof of these inherited disorders is not always available. In these circumstances, clinical criteria such as Amsterdam Criteria or a high index of suspicion should be sufficient to consider EC screening at some arbitrary interval and starting age.

The homogeneity of opinions about EC screening, however, may be ending. The Centers for Disease Control and Prevention (

) publicly announced that it is looking into EC screening, an initiative spurred by an unrelated, highly publicized case of morcellation.

 An incidentally discovered sarcoma is being used by at least one legislator to justify a request to the CDC to examine mandating endometrial biopsy before all hysterectomies. Many surgeons already perform biopsies before all hysterectomies and ovarian surgeries in at-risk women. In essence, these practitioners are screening for EC in an at-risk population: women about to undergo pelvic surgery.
	 


	Routine screening for EC was studied during the initial experience with selective estrogen receptor modulators (

 The attention was due to an increase in EC in patients with breast cancer who use SERMS to prevent recurrence. The conclusion of most opinions at that time was that screening was not warranted due to a low incidence and positive predictive value of the then-favored screening modality, ultrasonography. Only ultrasonography was considered because of a perceived increased risk of office endometrial biopsy. Based on these assumptions, screening was not adopted by most practitioners because of the poor specificity of ultrasonography and the low prevalence of EC. In retrospect, that decision still seems appropriate, given the information available at that time.

Data on complications of endometrial biopsy (perforation, bleeding, pain, infection) are derived from reports of a population with a strong indication for sampling (i.e., symptoms and presumed cancer until proven otherwise). In triage of this patient group, sampling attempts persist until successful, thus adding additional risks to the overall goal of sampling the endometrium.

On the other hand, sampling asymptomatic patients, or screening, would exclude women at increased risk of complications from the procedure. In other words, patients at increased risk of complications from a screening biopsy would not be put through additional invasive procedures or attempts. For instance, a woman considered for screening who has cervical stenosis or severe comorbidities would not be subjected to dilatation and curettage in the operating room. Instead such as a patient could be triaged to serial pelvic ultrasonography or other safer office maneuvers, such as cervical “ripening,” before biopsy.

 Thus, risk associated with biopsy for EC screening could be adjusted and lower than previously reported for endometrial sampling for other indications. In general, in-office sampling for screening should have little to no risk, as there are alternatives for difficult patients and procedures.


	Once risk of screening with biopsy is potentially acceptable, then disease prevalence becomes the next important area to consider. Currently some populations are at higher risk than the originally proposed group of patients using SERMs for breast cancer prevention. In those women, prospective cohort data suggest an endometrial cancer incidence of approximately 1/1000 to 1/2000.

 However, more recently reported data on community-based and risk-adjusted population incidence reveal much higher rates. For instance, in communities with high non-communicable disease (NCD) rates, EC incidence has been reported to be as high as 6/1000.

 In other populations, high-risk cohorts can be identified on the basis of risk factors such as age and weight. Using these risk modifiers, a subpopulation at even higher risk can be identified with rates theoretically approaching 1/100 for 50-year-olds with body mass indices (BMI) of 40 or more.

This prevalence approximates and compares favorably to that in patients with symptoms. In those women, who have the traditional indication for endometrial biopsy, the rate of diagnosed cancers is higher, but that should not be the sole criterion for deciding when to biopsy.

 Using the current standard, EC outcome is not optimal because overall survival can be as low as 80% in communities suffering from disparities. In theory, screening could eliminate all EC-related deaths in these and other populations.


	To justify screening, several other conditions must be met, including existence of a premalignant condition, availability of a realistic intervention, and likelihood that patients will adhere to treatment. EC screening is conceivable based on all of these parameters, including existence of a premalignant condition that can be treated to prevent progression to cancer. 

Hyperplasia in its various forms does respond to medical treatments and likely even lifestyle changes, including weight loss. Medical therapies such as a progesterone-delivering intrauterine device can be both effective for premalignant conditions and less morbid than surgical treatment for EC. The increased safety of medical treatment for a premalignant condition versus surgery for frank EC is a given. That benefit may be magnified because premalignant conditions occur years before development of EC and may have an earlier peak occurrence in women who are younger, and presumably healthier, than patients destined to be diagnosed with EC. Certainly for any patient contemplating surgery, whether for EC or a precursor, doing so at the youngest age possible may be an advantage. 

Most promising of all is evidence to suggest that lifestyle changes such as exercise and weight loss and interventions such as metformin that are aimed at underlying causes may have additional health benefits beyond interrupting progression to EC.

 Even if screening only leads to EC diagnosis at an earlier stage, it is theoretically possible that less invasive surgery, such as simple vaginal hysterectomy, can replace more extensive procedures involving lymph node removal and staging. 


	Finally, compared with other cancers for which screening is done, EC is an attractive target. Its incidence and other characteristics are similar to those of breast, prostate, colon, and lung cancer. To be clear, incidence is lower for endometrial than for breast and prostate cancer, but the latter diseases have an indolent counterpart, which EC does not. Given the potential for overtreatment of breast and prostate cancer, controversy exists regarding the risk/benefit equation for their respective screening programs. There is no way to screen for “indolent” EC, so the watchful waiting, active surveillance, and other treatment algorithms evolving for breast and prostate cancer do not exist for EC. Screening and triage for EC is relatively simple compared with the techniques used for colon and lung cancer. Incidence of the latter two diseases is slightly higher than for EC, but the complexity, expense, and risk of work-up for EC makes screening for it potentially comparable.

Other screening programs have been tailored to specific segments of the population, such as smokers and patients with chronic hepatitis, who are at risk of lung and liver cancer, respectively. EC screening could be further refined by known risk factors, such as age and BMI, until a consensus is agreed upon that the adjusted risk warrants screening.  This risk adjustment could be extended nearly universally in communities that share high-risk factors. For instance, in a community with high reported NCD rates, EC was 2.5, 3.5, 8 and 10.7 times more likely to be diagnosed than breast, colon, cervical and ovarian cancers, respectively.

 All of those other benchmark cancers are either being screened for or are the subjects of intense investigations for improved screening. EC is not currently experiencing the same focus, but the relative incidence of it suggests that it should be. Further, the high mortality associated with some cancers for which effective screening is being sought-such as ovarian and cervical cancer-is the rationale for that screening. In high-risk communities, however, EC, however, may actually be a more common cause of death than those diseases.

In-office versus hospital-based screening


	Screening can take many forms and may need to be community- or hospital-based, depending on the anticipated impact on compliance. Hospital-based screening, however, might be effective, given the association between EC and comorbid conditions and NCDs that lead to frequent hospital visits. For instance, at our safety net hospital, approximately 96% of women with EC had been seen an average of 1.7 years before their diagnosis, suggesting that earlier detection at screening may have been possible.

Many of these patients had prior Pap smears, imaging, and biopsies for other diagnoses, which suggests that a hospital-based screening program would be possible. Women at risk for EC who have intermittent, unpredictable, and uncertain access to healthcare may benefit even more from hospital-based screening for the disease because it may be effective even at long intervals between screening. This is based on the well-established relationship of EC with hyperplasia and the long latency period between EC and its premalignant precursors.


	Relative incidence of EC is higher than that for many cancers for which we already screen, including cervical cancer and other cancers with active screening research programs, such as ovarian cancer. EC does not have the same controversies that exist around prostate and breast cancer screening.  (Screening may do more harm than good in the subsets of patients with those cancers whose disease has a long indolent natural history.) Overall, as risks factors for EC become more prevalent, and the affected population grows older with increasing related comorbidities, the need becomes more urgent for a thorough, rigorous, and scientific approach to determining who, when and how to screen. It will also be important to consider relative costs and benefits associated with these strategies. Changes in the overall health of our society have now made it imperative for all stakeholders to reconsider screening for EC. 

The authors report no potential conflicts of interest with regard to this article.

Del Priore G. Endometrial Sampling Procedures. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2019.

Levitz J, McKay B. CDC eyes review of gynecological cancer screens. Wall Street Journal. May 2, 2018. Available at https://www.wsj.com/articles/cdc-eyes-review-of-gynecological-cancer-screens-1525318834 Accessed June 7, 2019.

van Leeuwen FE, Benraadt J, Coebergh JW, et al. Risk of endometrial cancer after tamoxifen treatment of breast cancer. Lancet. 1994 Feb 19;343(8895):448-452.

Del Priore G. Sonographic Follow-up in tamoxifen patients. Gynecol Oncol. 2000;76:423.

Gordon SJ, Westgate J. The incidence and management of failed Pipelle sampling in a general outpatient clinic. Aust N Z J Obstet Gynaecol. 1999; 39:115.

Elsandabesee D, Greenwood P. The performance of Pipelle endometrial sampling in a dedicated postmenopausal bleeding clinic. J Obstet Gynaecol. 2005;25:32.

GÃ¼ney M, Oral B, Mungan T. Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy. Int J Gynaecol Obstet. 2007; 97:125.

de Leon MC, Wu HH, Lennon AE, Del Priore G. Novel approach to outpatient endometrial biopsy to detect endometrial cancer. J Reprod Med. 2016 May-Jun;61(5-6):243-248.

Sierecki AR, Gudipudi DK, Montomarano N, Del Priore G. Comparison of endometrial aspiration biopsy techniques: specimen adequacy. J Repro Med. 2008;53(10):760-764.

Timoteo-Liaina I Khozaim K Buenconsejo-Lum LE, Del Priore G. Screening for endometrial cancer should be considered in special population. Available at 

https://www.sgo.org/wp-content/uploads/2017/03/Saturday-March-11-2017-SGO-Annual-Meeting-International-Session-Abstracts.pdf

Scott OW, Tin Tin S, Bigby SM, Elwood JM. Rapid increase in endometrial cancer incidence and ethnic differences in New Zealand. Cancer Causes Control. 2019 Feb;30(2):121-127.

Arthur R, Brasky TM, Crane TE, Felix AS, et al. Associations of a healthy lifestyle index with the risks of endometrial and ovarian cancer among women in the Women’s Health Initiative Study. Am J Epidemiol. 2019 Feb 1;188(2):261-273.

Luo J, Chlebowski RT, Hendryx M, et al. Intentional weight loss and endometrial cancer risk. J Clin Oncol. 2017 Apr 10;35(11):1189-1193.

Del Priore G, MD, Hamed KK, Chen, YJ, Timoteo-Liaina I, Matthews RPW, Buenconsejo-Lum, L. Is screening for uterine cancers an opportunity to reduce cancer’s burden among populations with disparities? Obstet Gynecol. May 2019; 133: 84S

A rigorous assessment of who, when, and how to screen may lead to regular testing in a broader population.

Roland Matthews, MD

Articles

Addressing the Cervical Cancer Screening Disparities Gap

Will screening for endometrial cancer soon be routine?