Abstract 4969: Ethnic disparities in breast and cervical cancer screening in Guam: a cross-sectional analysis (2012-2022)
Authors: Aurienne Cruz, Grazyna Badowski, Grace Garces Bordallo
Journal: Cancer Research (2025)

Background: In Guam, breast and cervical cancer late-stage diagnoses and mortality rates exceed U.S. averages. From 2013-2017, 30.7% of breast and 28.6% of cervical cancers were diagnosed late. Micronesians had the highest late-stage breast cancer rate (59.1%); Filipinos had the highest for cervical cancer (33.3%). Breast cancer mortality was 27.3 per 100,000 in Guam vs. 20.3 in the U.S., with Micronesians at 104.6. Cervical cancer mortality was 6.7 in Guam vs. 2.3 in the U.S., with Micronesians at 22.3. Methods: A cross-sectional study analyzed 6,625 female adults from Guam using Behavioral Risk Factors Surveillance System data from 2012 to 2022. We examined current mammogram screenings for women aged 40 and older and Pap tests for women aged 21 to 65. Binary logistic regression models assessed trends and associations, adjusting for age, education, income, and survey year. Results: Overall, 64.4% of women ≥40 were current with mammograms, and 67.7% of women aged 21 to 65 had recent Pap tests. White women had the highest screening rates (70.7% for mammograms; 79.7% for Pap tests), while Micronesian had the lowest (44.2% for mammograms; 49.1% for Pap tests). Mammogram rates increased by 1.4% bi-annually, with the highest increases among Filipino (2.9%) and White (1.3%) women, but declined among Micronesians (-0.8%). Pap test rates declined slightly (-0.3%), with CHamoru women having the biggest decrease (-2.1%). Despite Micronesian women having the largest increase in Pap test rates (3.7%), their screening rates (54.1%) remained significantly below the overall rate (68%). Adjusted odds ratios showed higher mammogram screening among Asians (OR = 1.3; 95% CI: 1.1-1.6) and lower among Micronesians (OR = 0.6; 95% CI: 0.6-0.8) compared to White women. Age groups 50-59 (OR = 2.2; 95% CI: 2.0-2.6), 60-69 (OR = 2.8; 95% CI: 2.6-3.0), and 70+ (OR = 2.0; 95% CI: 1.8-2.2) had higher odds than ages 40-49. Higher education and income levels were associated with increased screening. For Pap tests, Filipinos (OR = 0.6, 95% CI: 0.6-0.7), Asians (OR = 0.7, 95% CI: 0.6-0.8), and Micronesians (OR = 0.5, 95% CI: 0.5-0.6) had lower odds compared to White women. Age group 60-69 had lower odds (OR = 0.6; 95% CI: 0.5-0.7) compared to ages 18-29. Higher education and income were also associated with increased Pap test screening. Conclusion: Despite some improvements, Guam’s cancer screening rates remain below U.S. medians. Significant ethnic disparities exist, especially among Micronesian and CHamoru populations. Targeted interventions are needed to improve screening rates and reduce late-stage cancer diagnoses among these groups. Acknowledgement: This research was funded by the National Cancer Institute: The University of Guam/University of Hawaii Cancer Center Partnership to Advance Cancer Health Equity (PIPCHE), Grant U54CA143728 (University of Guam, YCP)/Grant U54CA143727 (University of Hawaii Cancer Center). Citation Format: Aurienne Cruz, Grazyna Badowski, Grace Garces Bordallo. Ethnic disparities in breast and cervical cancer screening in Guam: a cross-sectional analysis (2012-2022) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4969.