Cervical Cancer and Black Women: When to Get Screened, Signs and Symptoms to Look Out For

Joelle Y. Jean, FNP-C, BSN, RN
Updated April 8, 2022
    Despite cervical cancer being treatable, Black women are more likely to die from late-stage cervical cancer than any other racial or ethnic group in the United States. This guide discusses when to get screened and symptoms to look for.
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    Black patients are 1.5 times more likely to die from cervical cancer than white patients.

    Black women dying from cervical cancer at disproportionate rates to white women isn’t biological or genetic. Historically marginalized women, women of color, women from lower socioeconomic status, and women without health insurance continue to face structural barriers which impact their abilities to live happy, healthy lives.

    According to the World Health Organization (WHO), cervical cancer is the fourth most common cancer among individuals with a cervix globally. Cervical cancer is not only preventable if caught early, but it can be cured and managed.

    Despite this, Black individuals with a cervix are more likely to die from late-stage cervical cancer than any other racial or ethnic group in the United States. Factors like barriers to healthcare, racial discrimination, and distrust of the medical field prevent individuals from seeking care that could save their life.

    This can lead to patients being diagnosed too late, leaving fewer options for treatment of this disease.

    Where Are Black Women Dying From Cervical Cancer?

    Statistically, where you live is an alarming factor in higher cervical cancer incidences and mortality among Black patients. These areas in the U.S. include:

    • Appalachia
    • South Atlantic
    • Lower Mississippi

    For example, in Georgia, though cervical cancer diagnosis rates are nearly the same for both white and Black individuals with a cervix, data shows that Black patients are 1.5 times more likely to die from cervical cancer than white patients. Furthermore, Black individuals with a cervix over 70 are three times more likely to die from cervical cancer.

    Black individuals with a cervix in Georgia are more likely to never have been screened for cervical cancer. Also, they are more likely to:

    • Live in poverty
    • Have a lower socioeconomic status
    • Lack health insurance
    • Have less or no access to healthcare
    • Lack access to reliable transportation

    According to some studies, Black women with the same median household income as white women continue to die at higher rates. This is linked to:

    • Discrimination
    • Racism
    • Distrust in the medical system
    • Cultural background
    • Lack of sexual education
    • Vaccine hesitancy

    In some cases, Black patients will see their provider, but they do not return for a follow-up. With cervical cancer being largely preventable, missing follow-ups can greatly impact prognosis. But gaps in education, misinformation, inaccessibility, and fear contribute to patients not returning.

    Risk Factors Associated With Cervical Cancer

    Genital human papillomavirus (HPV) infection is the leading cause of cervical cancer. For about half of cervixes with HPV infection, the immune system can clear the HPV virus within six months, and in up to 90% of women within two years. But a persistent infection from high-risk human papillomavirus (hrHPV) infection causes cervical cancer.

    Other risk factors include:

    • Smoking
    • Childbirth
    • Oral contraception
    • Diet

    Because cervical cancer is largely preventable if addressed early, knowing the signs and symptoms is essential.

    Signs and Symptoms of Cervical Cancer

    Tamika Felder is the chief visionary at Cervivor, a national nonprofit dedicated to cervical cancer advocacy and support. In 2001, at the age of 25, she was diagnosed with stage 2A cervical cancer.

    “I lost my fertility after a radical hysterectomy, chemo, and radiation therapy,” Felder says. Although devastating, cervical cancer can be managed by medical interventions when diagnosed early.

    Felder is active in educating on the signs and symptoms of cervical cancer. Signs and symptoms include:

    • Abnormal bleeding, which includes heavy bleeding and/or spotting
    • Pain during and/or after intercourse
    • Pelvic pain
    • Unusual vaginal discharge

    Being proactive with screening is also extremely important.

    “The body doesn’t always whisper or give warnings,” Felder says.

    So, while there are symptoms like bleeding during or after intercourse, the best way to identify signs of cervical cancer is to get screened by your healthcare provider.

    Screening for Cervical Cancer

    Kecia Gaither is a double board-certified physician in obstetrics and gynecology (OB/GYN) and maternal fetal medicine. She uses guidelines from the American College of Obstetricians and Gynecologists (ACOG) when screening her patients.

    “Screenings are predicated on age and underlying comorbidities,” Gaither says.

    ACOG recommends the following regarding screening:

    ACOG Screening Recommendations by Age
    Less than the age of 21No screening
    Ages 21-29Cytology every three years
    Ages 30-65Cytology alone every three years or Food and Drug Administration-approved hrHPV testing alone every five years, or cotesting (hrHPV testing and cytology) every five years
    Ages 65+No screening after adequate negative prior screening results
    Hysterectomy with removal of the cervixNo screening in individuals who do not have a history of high-grade cervical precancerous lesions or cervical cancer

    “Patients with prior abnormal Paps, those with AIDS/HIV or other high-risk factors may require more frequent evaluation,” Gaither says.

    Forming a relationship with your primary care physician (PCP) can be beneficial in identifying these underlying health conditions, so you and your PCP are aware of the increased risk of cervical cancer.

    Nurses’ Role in Cervical Screening and Treatment

    The additional role of nurses and nurse practitioners is to educate and provide information on prevention, screening, and treatment options.

    “Nurses are trusted messengers,” Yolanda Lawson, MD, says. “Often their families, communities, and patients look to them for advice and guidance.”

    Nurses and nurse practitioners are first-line providers for patients. Specifically for women’s health, the process of Pap tests and gynecological exams should be explained beforehand to the patient, so there are no surprises.

    The processes should be reinforced by the provider performing the exam.

    “The patient should understand the ‘when’s, what’s, how’s, and whys’ of the procedure,” Gaither says.

    Lawson and Gaither suggest other ways nurses can advocate for their patients. They can:

    • Ensure a respectful care environment
    • Reinforce communication
    • Engage to alleviate patient anxiety and fear
    • Explain triaging the patient
    • Provide education verbally and/or in writing

    The Importance of Diversity in Healthcare

    There is already anxiety and fear surrounding a gynecological visit. Historically, minority populations also distrust the healthcare establishment.

    “Increasing diversity in the healthcare workforce is an important factor to improve trust and communication,” Lawson says.

    Nurses and nurse practitioners can also provide culturally competent nursing care while easing anxiety and fear. Culturally competent care can also improve outcomes, Lawson points out.

    Nurses can provide culturally competent care in several ways:

    • Understanding your own culture
    • Using culturally sensitive language
    • Using open and sensitive communication
    • Collaborating with your patients and family members

    Patients express anxiety as a reason to forego gynecological appointments. Nurses and nurse practitioners can help patients to follow-through with follow-up visits by:

    • Suggesting patients come to appointments with a friend, significant other, and/or partner
    • Understanding why patients are scared and/or nervous
    • Knowing your patient’s rights
    • Encouraging patients to ask the provider to explain what they are doing
    • Letting patients listen to music or use distractions to relax

    Preventing and Eliminating Cervical Cancer

    To prevent cervical cancer, regular OB/GYN appointments and Pap tests are necessary. Three doses of the HPV vaccine are also recommended for individuals ages 15-45 years. The vaccine is given at 0, 2, and 6 months.

    Researchers are also developing self-collected sampling as an option. It would serve in prevention and screening, especially for underscreened patients with a cervix.

    The WHO created a plan on how to eradicate cervical cancer. By 2030, each country must achieve the following global points:

    • Vaccination: 90% of patients with a cervix are fully vaccinated with the HPV vaccine by the age of 15
    • Screening: 70% of patients with a cervix are screened using high-performance tests by age 35 and again by age 45
    • Treatment: 90% of patients with a cervix with precancer are treated and 90% of patients with a cervix with invasive cancer is managed

    The deaths of 4,290 patients with a cervix in 2021, including disproportionately high numbers of Black individuals with a cervix, could have been prevented. These preventable deaths highlight the need for the federal, state, and local governments to support and guarantee that the human rights of future individuals are honored and protected.

    Meet Our Contributors

    Portrait of Kecia Gaither, MD, MPH, FACOG

    Kecia Gaither, MD, MPH, FACOG

    Kecia Gaither, MD, MPH, FACOG, is a double board-certified physician in OB/GYN and maternal fetal medicine and holds a master’s degree in public health. Dr. Gaither is director of perinatal services at NYC Health + Hospitals/Lincoln and an associate professor of clinical obstetrics and gynecology at Weill Cornell Medicine. She received her bachelor’s in biology from Barnard College and her medical degree from SUNY Health Sciences Center in Syracuse. Dr. Gaither earned her master’s in health policy and management at Columbia University.

    Portrait of Yolanda Lawson, MD, FACOG

    Yolanda Lawson, MD, FACOG

    Yolanda Lawson, MD, is a board-certified OB/GYN and an associate attending at Baylor University Medical Center. She earned her MD at the University of Arkansas for Medical Sciences and performed her internship at Morehouse School of Medicine. She completed her residency at St. John’s Hospital & Medical Center. Dr. Lawson is a member of the American Medical Association, National Medical Association, American College of Obstetricians and Gynecologists, and Dallas County Medical Society.


    Portrait of Tamika Felder

    Tamika Felder

    Tamika Felder is a high-energy inspirational speaker, facilitator, author, educator, mobilizer, and award-winning health advocate. A cervical cancer survivor diagnosed in her early 20s, Felder serves as chief visionary at Cervivor, a national nonprofit dedicated to cervical cancer advocacy and support. She has been featured on television and print including Good Morning America, Dr. Oz, The Washington Post, Essence, and SELF. She is the author of “Seriously, What Are You Waiting For? 13 Actions to Ignite Your Life & Achieve The Ultimate Comeback” and hosts the “Cervivor Podcast.”