January is Cervical Health Awareness Month: A New Perspective on Cervical Cancer
The number of new cases of cervical cancer in the United States have declined overall, unfortunately, more than 14,000 women are diagnosed each year. Most cases of cervical cancer are in white women but when statistics are adjusted for population size, Hispanic women are more likely to develop this form of cancer. Black women are the second most likely demographic to develop cervical cancer and are 80% more likely to die from this form of cancer. In this article we will discuss what is cervical cancer, how to prevent cervical cancer, why we see these differences in cervical cancer in women of color, and how can we improve outcomes.
What is Cervical Cancer and How Can It be Prevented?
Cervical cancer begins when healthy cells in the cervix, the part of the uterus that opens into the vagina, develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do.
Healthy cells grow and multiply at a set rate, eventually dying at a set time. The mutations tell the cells to grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body.
It isn't clear what causes cervical cancer, but it's certain that human papillomavirus (HPV) plays a role in cervical cancer. People can pass the virus through non-sexual skin-to-skin contact, during sexual intercourse, skin-to-genital contact, and oral sex. The Centers for Disease Control and Prevention report that at least half of sexually active people will have HPV during their lifetime, but few develop cancer. This means other factors — such as your environment or your lifestyle choices — also determine whether you'll develop cervical cancer.
Cervical cancer is highly preventable by regular screening and with the availability of the human papillomavirus (HPV) vaccine. Screening includes a Pap test alone or along with an HPV test to detect cancer in its early stage. When found early it is highly treatable and associated with long survival and good quality of life. Nearly all cervical cancer is caused by persistent infection with human papillomavirus (HPV). The greatest prevention is to vaccinate young women and girls before they become sexually active (recommended at 11 and 12 years of age). It is also recommended that young boys be vaccinated too.
Cervical Cancer Differences: Social Determinants of Health
Social determinants of health (SDOH) are defined as the conditions in the environments where people are born, live, learn, play, work, and age that affects their health, well-being, and quality of life. Some examples include safe housing, access to healthy food, language and literacy skills, and the neighborhood they live in. Differences in people’s health and inequality in care is quite complex but financial stability and access to care are two SDOH that can more easily explain these differences.
Financial Stability and Access to Care
Unfortunately, we know that someone’s wealth is tied to their health. Cancer treatment and medicines are very expensive. Having health insurance determines what kind of care you receive. Missing work for medical appointments may mean you don’t get paid. Cancer care is the number one cause of medical bankruptcy.
Access to care is determined by how close you live to a healthcare facility for cancer screening or for treatment, or if you can’t miss work for appointments. Having a car or living near public transportation also determines your ability to get to an appointment. Another consideration is how welcoming the medical institutions are to the communities they serve, and do they have staff that look like the community?
We can only improve outcomes if we begin by preventing cancer. We can reduce cervical cancer if women know that this type of cancer is treatable if caught early by regular screening and receiving HPV vaccine in a welcoming community healthcare center. The color of your skin and where you live shouldn’t increase your risk of cervical cancer.
To learn more about this topic:
Mayo Clinic Q & A: The Link Between Racial Disparities and Cervical Cancer
Podcast from Cancer.Net: What Are Social Determinants of Health and How Do They Affect People with Cancer?
Other Mayo Clinic Connect Groups to follow: