Editor’s note: dr Eloise Chapman-Davis is Director of Gynecologic Oncology at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine. dr Denise Howard is chief of obstetrics and gynecology at New York-Presbyterian Brooklyn Methodist Hospital and vice chair of obstetrics and gynecology at Weill Cornell Medicine. The views expressed in this comment are their own. Read more opinion on CNN.
As physicians specializing in women’s reproductive health, we are on the front lines of a preventable crisis. Imagine treating a woman with advanced cancer who has a 17% five-year survival rate, knowing that she should not have developed the deadly disease in the first place.
This is what we face with cervical cancer. Nonetheless, we have the clinical tools to not only reduce but also eliminate the approximately 14,000 new cases and 4,300 deaths from cervical cancer each year.
We have effective screenings: the traditional pap smear and the HPV test. If these screening tests are abnormal, additional tests can determine who needs further treatment to prevent cancer from developing. Importantly, we have the HPV vaccine, which protects against high-risk types of human papillomavirus (HPV), which cause most cases of cervical cancer, and is almost 100% effective, according to the National Cancer Institute.
A report published earlier this month shows the huge impact of the vaccine. The US saw a 65% drop in cervical cancer rates from 2012 to 2019 in women ages 20 to 24 who were first to receive the vaccine. The vaccine, combined with screening, could wipe out cervical cancer and make it a disease of the past.
But the percentage of women who are overdue for their cervical cancer screening is growing, and alarmingly, late-stage cases are increasing.
We’ve had the heartbreaking experience of seeing mothers die from this preventable disease in the prime of their lives, leaving young children behind — even women who had abnormal screening but never received follow-up care. It is devastating to see an otherwise healthy person slowly dying of a preventable cancer.
Simply put, cervical cancer should never happen. During this Cervical Cancer Awareness Month, let’s commit to making it a reality. Here’s what needs to happen.
Eliminating cervical cancer requires commitment at multiple levels, from public awareness campaigns with culturally appropriate messages that spread the power of vaccines and screening to prevent cancer, to resources that ensure all women have easy access to routine health screening.
Timely screening reminders and follow-up prioritization systems are essential. Too many women with abnormal screenings don’t get their results, reminders, or follow-up instructions they understand, and therefore don’t get the right treatment. Obstacles also include logistical challenges such as transportation and language issues. Studies suggest that 13% to 40% of cervical cancer diagnoses are due to a lack of follow-up in women with an abnormal screening test.
OB/GYN and GP practices should be vigilant when it comes to reaching out and monitoring patients with suspicious test results. Large healthcare systems can harness the power of the electronic health record to track abnormal tests and ensure these women receive the proper follow-up care.
Pediatricians should encourage parents of children as young as 9 to get the HPV vaccine and emphasize its safety. About 60% of teens are up to date with their HPV vaccines, according to the US Centers for Disease Control and Prevention. Doctors not recommending the vaccine and increasing parental concerns about its safety, despite more than 15 years of evidence evidence that it is safe and effective have been cited as the main reasons why more children are not receiving this life-saving vaccine.
College campuses should conduct large-scale, catch-up vaccination campaigns. These students are at high risk of contracting HPV, but only half report having received the full HPV vaccine series. This service should be made available to students free of charge.
Strong racial differences also need to be addressed. As black physicians, we are frustrated that black women continue to die from the disease at higher rates than any other race, according to the American Cancer Society. The system failures contributing to this tragedy range from black women receiving less aggressive treatment to barriers to accessing affordable routine health care and the high-quality, specialized care needed to treat cancer. Everyone deserves access to quality care.
Elderly patients should be informed that HPV vaccine approval has been extended to age 45 and discuss with their doctor whether it is suitable for them. Insurance providers should cover the cost of the vaccine for these older age groups.
Women should go to the gynecologist regularly into old age. We see cervical cancer patients in their 60s and 70s who have not been screened for 20 years. Many people stop seeing their gynecologist after childbirth or menopause, but that shouldn’t be the case. Getting quality pelvic exams throughout a woman’s life is crucial to get it.
We must also empower women to be their own advocates through health education. Women should receive their screening result with an explanation of what it means and any next steps will be clearly outlined. No news after a screening is not good news. In an ideal world, women would see their HPV status as essential information with the power to save their lives.
Education makes a difference. At NewYork-Presbyterian and Weill Cornell Medicine, we have produced a series of easy-to-understand, public-access videos about cervical cancer and the HPV vaccine. As part of a pilot study, we showed some of the vaccination videos to more than 100 parents in one of our pediatric practices, which mainly looks after low-income families. Their knowledge scores on a questionnaire about the vaccine and HPV they filled out before and after watching the videos increased by nearly 80%, and approximately 40% of the unvaccinated children received the HPV vaccine within a month. We want to expand these efforts.
We have the tools to prevent cervical cancer, but we don’t use them effectively. This is unacceptable and we can no longer ignore the problem. It’s time for a comprehensive offensive that focuses on all fronts to make cervical cancer a disease of the past.