January is Cervical Cancer Awareness Month: Here’s What You Should Know
By Asm. Jessica Gonzalez-Rojas (NY), NHCSL East Region Chair
By Asm. Jessica Gonzalez-Rojas (NY), NHCSL East Region Chair
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Cervical cancer —once the leading cause of cancer deaths among women in the United States— is caused in 90% of cases by certain types of Human Papillomavirus (HPV), the most common sexually-transmitted infection. In most cases, HPV is harmless and goes away on its own, but there are 12 high-risk HPVs that can lead to different types of cancer, and HPV 16 and HPV 18 are responsible for most HPV-related cancers. While there is no cure for HPV, Gardasil, an FDA-approved vaccine can help protect against several high-risk types.
Since 1980, cervical cancer rates and related deaths have decreased significantly. However, this stride in our country’s public health has not been experienced equally across all communities. Latinas are still 36% more likely to be diagnosed with cervical cancer and 30% more likely to die from it compared to non-Hispanic white women, according to the American Cancer Society and the U.S. Department of Health and Human Services.
Furthermore, a 2019 report from the National Institutes of Health highlighted that more than half of women diagnosed with cervical cancer each year are not up to date on their screenings, making cancer much more difficult to treat.
The disproportionate impact of cervical cancer on Latinas is linked to factors such as limited access to resources —money, transportation, and time— that prevent many women from seeking care, lack of health insurance, shortages of healthcare providers in underserved areas, immigration status, and cultural or language barriers that complicate access to necessary care.
Despite all this, there are two tangible actions we can take to further improve cervical cancer rates, and even possibly eradicate it: improving access to screenings and awareness around them, and HPV vaccines requirements and access to those vaccines for all individuals, including those who are uninsured and underinsured.
Improving Awareness and Access to Screening
For generations, the most important screening tool for cervical cancer was the pap test, or pap smear. This test retrieves cells from the cervix with a swab to detect any cancerous or precancerous abnormalities. It was, and still is, an effective tool for those who got screened during their annual OBGYN check-ups.
However, in the past few years, the testing guidance has been updated to reflect two different possibilities: primary HPV testing, or co-testing. The former phases out Pap tests in favor of screening that detects HPV, and the latter adds these tests instead of relying solely on Pap. The current testing frequency and guidelines from the CDC reflect these two possibilities and take into consideration access to care and availability. The frequency of getting tested depends on each person’s age, medical history, and previous tests results, but in general, the CDC recommends:
Between 21–29 years old: screening should begin at 21, and providers can recommend a Pap test every 3 years.
Between 30–65 years old: people should discuss with their provider which testing option is right for them:
- An HPV test only (primary HPV testing): If results are normal, provider may tell their patient they can wait five years until next screening test.
- An HPV test along with a Pap test (co-testing): If both results are normal, provider may tell their patient they can wait five years until next screening test.
- Pap test only: If results are normal, provider may tell their patient they can wait three years until next screening test.
The Anti-Cancer Vaccine to End Cervical Cancer
The HPV vaccine has shown an almost 100% efficacy in preventing the HPV types responsible for cervical cancer. People can get it until age 45, but it’s at its most effective when applied at 11–12 years, per the CDC.
Almost two decades ago, NHCSL adopted Res. 2006-05 End Cervical Cancer in Our Lifetime. This visionary policy proposal supported the development by all states and U.S. territories of legislation to “require that all young women, prior to entry into middle school, be educated regarding HPV and vaccinated against cervical cancer and the most common types of HPV.” It also supported, before the existence of the Affordable Care Act, legislation requiring broad access to then-newly emerging preventive technologies, like the HPV vaccine, for low-income and Medicaid-eligible young adult women.
Since then, only Hawaii, Delaware, Rhode Island, Virginia, Puerto Rico and the District of Columbia have HPV vaccine requirements for secondary school.
A study assessing stakeholders’ recommendations around these policies in Puerto Rico suggested that even though vaccine requirements have been successful at increasing vaccination rates, the current politicization of discourse around the COVID-19 vaccine has altered the way in which the public sees these policies (…) potentially hindering the implementation of current, and the adoption and implementation of future, vaccine requirements.” To curtail misinformation and improve access, the stakeholders recommended the importance of raising awareness and providing education about the HPV vaccine prior to the requirement, incorporating real stories, and making the problem relevant by using local data.
The study also highlighted the importance of considering local culture, unique government bureaucracies and the promotion of multisectoral collaborations when resources are limited. The findings also highlight “the need to understand the contextual distinctions of the communities where vaccination requirements may be adopted and implemented to anticipate barriers and leverage existing resources. Consideration of the politico-cultural context may be important as political beliefs have become entrenched with vaccine policy.”
This assessment of Puerto Rico’s policies can inform us when we address this at a state level to make our policies more culturally competent and relevant for our communities. In the upcoming 2025 legislative session, let’s take a bold step and advance legislation to end cervical cancer in our lifetime.