Healthcare Inequities and Structural Racism as Determinants of Treatment and Survival among Individuals Recently Diagnosed with Cervical Cancer from Two Diverse Population-Based Cancer Registries: The ACHIEVE Study

Abstract

Abstract Persistent inequities in cervical cancer burden disproportionately impact marginalized communities and reflect social and structural barriers to high-quality care. Guided by socioecological models, the Assessing Cervical Cancer Healthcare Inequities in Diverse Populations (ACHIEVE) Study examines social and structural influences on cancer treatment among survivors (aged 21-79 years, diagnosed with any stage of cervical cancer between 2021 and 2025, who can complete study surveys in English, Spanish, Chinese, or Haitian Creole) identified through two population-based cancer registries: the New Jersey State Cancer Registry and the Los Angeles Cancer Surveillance Program. Participants were mailed a baseline survey, followed by a request for medical records access and a 12-month follow-up survey. Study activities were significantly halted by NIH’s termination of funding from March to July 2025. This analysis reflects baseline survey data collected prior to federal funding disruptions, which includes a socio-demographically diverse study sample of racial and ethnic minorities, immigrants, and individuals with varying insurance coverage and income levels. Treatment delays, experienced by nearly one-third of participants, were more common among survivors diagnosed before age 40, uninsured at diagnosis or having unstable insurance during diagnosis. Survivors with treatment delays more frequently reported difficulty accessing cancer services near home and timely specialist appointments. Participants reported food insecurity, underinsurance, and transportation challenges as barriers to care. Participants reporting discrimination in medical settings were also significantly more likely to experience treatment delays. Regional differences and intersecting social and structural barriers highlight the need for multilevel interventions addressing community-specific and systemic inequities in cervical cancer care. PUBLIC HEALTH SIGNIFICANCE Preliminary findings from baseline survey data collected from participants in the Assessing Cervical Cancer Healthcare Inequities in Diverse Populations (ACHIEVE) Study indicate regional differences in cervical cancer survivors’ characteristics and some reported structural and social barriers, signaling that multilevel interventions should respond to community-specific needs and systemic barriers.