Gynecologic cancer among the socioeconomically disadvantaged.

It is difficult to discern the true dimensions of the relationship between poverty and gynecologic cancer. In well designed studies of patients with gynecologic cancers, demographic stratification usually is performed based on race/ethnicity, age, or geographic locale, but not on economic class. The unstated assumption of many of these reports is that women of color, inhabitants of rural communities, and older women are all poor. Although it is true that these populations are overrepresented among the poor, unless the variable of economic class is specifically evaluated, the broad nature of the problem may go unappreciated: the status of gynecologic cancers among the poor is primarily a reflection of a deeply rooted structural problem in the U.S. economy, the reverberations of which are experienced by all women who cannot afford regular health care. When women are poor and have gynecologic cancers, they often seek orthodox health care only after the symptoms have become unbearable. Explanations of this phenomenon include underlying feelings of pessimism, fatalism, or low self-esteem; faith in a belief system that does not regard the physician as the person to whom one goes for prevention or treatment of diseases; inaccessibility of health care facilities; experiences interpreted as degrading once health care facilities are accessed; high risk behavior and inability to pay. Programs that find effective ways around structural and functional problems of daily life and that respect and understand cultural norms have the best chance of finding temporary solutions to this national problem.