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
9 affiliations
- 1Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- 2University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
- 3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- 4Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
- 5Los Angeles Cancer Surveillance Program, University of Southern California, Los Angeles, CA, USA
- 6New Jersey State Cancer Registry, Rutgers Cancer Institute, New Brunswick, NJ, USA
- 7Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- 8Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California
- 9Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
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.
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BibTeX
@article{tsui2026healthcare,
title = {{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}},
author = {Jennifer Tsui and Heather Wurtz and Amber Rockson and Emily Dang and Zirui Zhang and Min Qian and Andy Yang and Ruijie Li and Mila Cordero and Junrui Lyu and Lisa E. Paddock and Jie Li and Antoinette M. Stroup and Lihua Liu and Jason D. Wright and X. Mona Guo and Goleen Samari and Chanita Hughes-Halbert and Adana A. M. Llanos},
journal = {Behavioral medicine (Washington, D.C.)},
year = {2026},
month = oct,
doi = {10.1080/08964289.2026.2627895},
url = {https://doi.org/10.1080/08964289.2026.2627895},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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
AU - Jennifer Tsui
AU - Heather Wurtz
AU - Amber Rockson
AU - Emily Dang
AU - Zirui Zhang
AU - Min Qian
AU - Andy Yang
AU - Ruijie Li
AU - Mila Cordero
AU - Junrui Lyu
AU - Lisa E. Paddock
AU - Jie Li
AU - Antoinette M. Stroup
AU - Lihua Liu
AU - Jason D. Wright
AU - X. Mona Guo
AU - Goleen Samari
AU - Chanita Hughes-Halbert
AU - Adana A. M. Llanos
PY - 2026
DA - 2026/10/21
JO - Behavioral medicine (Washington, D.C.)
DO - 10.1080/08964289.2026.2627895
UR - https://doi.org/10.1080/08964289.2026.2627895
AB - 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.
SN - 0896-4289
SN - 1940-4026
ER -