Date of Award


Document Type

Open Access Thesis


Epidemiology and Biostatistics

First Advisor

Jan M. Eberth


INTRODUCTION: Late-stage cervical cancer diagnosis is an important contributing factor to the cervical cancer mortality rate. Screening for cervical cancer is a vital tool in reducing the number of late-stage cases, preventing incident cases and reducing mortality. Access to care is often a significant barrier to receiving these services. Women who have no usual source of care report significantly lower percentages of Pap tests than women who have a usual source. South Carolina ranks 13th in the US in cervical cancer incidence and 7th in cervical cancer mortality. South Carolina also struggles with a primary care physician shortage, ranking 39th in primary care physician density. This study aimed (1) To determine the demographic and geographic differences between early and late stage cases as well as the distribution of primary care physicians in South Carolina (2) To assess the relationship between primary care physician density and the risk of late-stage cervical cancer diagnosis. METHODS: Multivariate logistic regression models were used to assess the association of primary care physician density to late stage cervical cancer diagnosis. Both the main outcome and exposure were mapped. RESULTS: Out of 1,992 cervical cancer cases from 2000-2010 44.78% were diagnosed late-stage. Census tracts with greater than 0 primary care physicians per 100,000 persons had significantly lower odds of late-stage diagnosis than census tracts with 0 primary care physicians per 100,000 persons. African-American women, cases diagnosed after 2003, and older women all had significantly higher odds of late stage diagnosis.

CONCLUSION: Areas with low primary care physician density and high late stage diagnosis should be a focus of in cervical cancer screening interventions.


© 2014, Emily Haanschoten

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