Take aim at lowering cervical cancer rates
A study of cervical cancer incidence and mortality in North Carolina has revealed areas where rates are unusually high, prompting public health officials to call for education, screening, and vaccination programs in impacted areas.1
The N.C. Cervical Cancer Resource Directory, www.ccresourcedirectory.org, has been developed as an online resource to help uninsured or underinsured women find screening services, as well as obtain information on human papillomavirus (HPV) vaccination.
Available in English and Spanish, the directory was developed by Cervical Cancer-Free NC Initiative, based at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill (UNC). The program is working to eliminate or substantially reduce cervical cancer in North Carolina. Each year, more than 12,000 women are diagnosed with cervical cancer, and more than 4,000 die from the disease in the United States.2 In 2011, almost 400 women in North Carolina received cervical cancer diagnoses, and more than 100 died.3 Healthcare experts say most of these deaths could have been avoided through regular cervical cancer screenings and timely HPV vaccination.
Promoters of the directory are getting the word out about the new resource by sharing it with members of the North Carolina Cervical Cancer Coalition, as well as other key partners throughout the state, including county health departments, gynecologists, and reproductive health specialists, says Noel Brewer, PhD, director of Cervical Cancer-Free NC and associate professor of health behavior at UNC's public health school.
"The response has been phenomenal," notes Brewer. "It is our hope that the directory helps women get the screening and vaccination they deserve to help protect them from cervical cancer."
Who is most at risk?
To perform the North Carolina study, analysts gathered data on all reported invasive cervical cancer cases from 1998 to 2007 from the North Carolina Central Cancer Registry. Age-adjusted incidence and mortality rates were estimated using population data from the National Center for Health Statistics.
The analysis indicates that cervical cancer incidence and mortality rates varied greatly by county and were inversely associated with county prosperity. Hispanic women had the highest incidence rate, with African American women at the highest mortality rate and white women accounting for most cases.
Incidence rates remained fairly steady above age 35, and mortality rates steadily increased with age, the analysis reflects. A later stage at diagnosis was more common for older women and for women without private insurance.1 Women with private insurance were more likely to be diagnosed at earlier, more treatable stages than women with no insurance or with government-sponsored insurance, such as Medicare, Medicaid, or military benefits, the analysis shows.
10 counties stand out
Ten counties — Anson, Chowan, Duplin, Halifax, Hoke, Lincoln, Randolph, Robeson, Sampson, and Scotland — had both high incidence rates (more than 11 cases per 100,000 women) and mortality rates (more than 3 deaths per 100,000 women) of cervical cancer. Compare these incident rates to national statistics: In 2012, an estimated 12,170 cases of invasive cervical cancer will be diagnosed in the United States, and an estimated 4,220 women will die.4
"This indepth, registry-based assessment provides us with a clearer picture of which women in North Carolina are being diagnosed with cervical cancer, and it identifies gaps in our state's cervical cancer prevention health network," says Jennifer Smith, PhD, associate professor of epidemiology at the UNC public health school and an author of the study. "The cancer registry data will help us, as a state, initiate targeted and appropriate interventions."
Smith, a member of the UNC Lineberger Comprehensive Cancer Center, also serves as director of the Cervical Cancer-Free America Initiative (www.cervicalcancerfreeamerica.org), which is guiding states to develop cervical cancer prevention programs aimed at eliminating cervical cancer through education, vaccination, screening, and early treatment.
What prompted the initiative?
"We began the Cervical Cancer-Free America Initiative to decrease unnecessary death among women in the United States," says Smith. "In North Carolina, Alabama, California, Indiana, Kentucky, and Texas, we have built state-level coalitions and focused intervention activities to do more to prevent cervical cancer with available sensitive screening and vaccination prevention tools."
The initiative is based on the Carolina Framework, developed at the UNC Gillings School of Global Public Health. The Carolina Framework identifies four key challenges to eradication of cervical cancer:
- HPV infection. HPV vaccination can offer protection against the two HPV types (HPV 16 and 18), which are responsible for more than 70% of cervical cancers.
- Lack of screening. Although cervical cancer screening is highly effective for reducing cervical cancer mortality, between 30% and 50% of women in the United States have not been screened in the last three years.5
- Screening errors. About one-third of cervical cancer deaths are due to Pap screening errors.6 Combining more sensitive HPV testing with Pap testing might increase detection of precancerous lesions.
- Not receiving follow-up care. One in six cervical cancer deaths are due to lack of follow up for abnormal Pap smear results.7 This problem particularly affects women from minority groups and from rural areas.
The cancer registry data gathered in the current analysis will help NC public health officials initiate targeted and appropriate interventions, an important step toward eradicating cervical cancer in North Carolina, says Smith.
"The analysis also can serve as a model for other states as they bolster the efforts to reduce or end this cancer across the nation," she states.
References
- Denslow SA, Knop G, Klaus C, et al. Burden of invasive cervical cancer in North Carolina. Prev Med 2012; 54:270-276.
- American Cancer Society. Cancer Facts & Figures 2011. Atlanta: American Cancer Society; 2011.
- North Carolina Central Cancer Registry. Projected New Cancer Cases and Deaths for All Sites, 2011. Accessed at http://bit.ly/IunK7d.
- Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012; 62:10-29.
- U.S. Preventive Services Task Force. Screening for Cervical Cancer. Accessed at http://bit.ly/cyDcWj.
- Leyden WA, Manos MM, Geiger AM, et al. Cervical cancer in women with comprehensive health care access: attributable factors in the screening process. J Natl Cancer Inst 2005; 97(9):675-683.
- Janerich DT, Hadjimichael O, Schwartz PE, et al. The screening histories of women with invasive cervical cancer, Connecticut. Am J Public Health1995; 85:791-794.
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