editor’s Note: Dr. Eloise Chapman-Davis is director of gynecologic oncology at New York-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 commentary are his own. Read more opinions on CNN.
As doctors 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 are facing with cervical cancer. Yet we have the clinical tools to not only reduce but eliminate almost all of 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 growth. Importantly, we have the HPV vaccine, which protects against the high-risk human papillomavirus (HPV) types that cause most cases of cervical cancer and is nearly 100% effective, according to the National Cancer Institute.
A report published earlier this month showed the tremendous effectiveness of the vaccine. The US saw a 65% drop in cervical cancer rates from 2012 to 2019 among women aged 20-24 who were among the 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 overdue for cervical cancer screening is rising, and alarmingly, late-stage cases are on the rise.
We have had the heartbreaking experience of seeing mothers die of this avoidable disease in the prime of life, leaving behind young children – even women who had abnormal tests but never received follow-up care . It is devastating to watch an otherwise healthy person slowly die of preventable cancer.
Simply put, cervical cancer should never happen. This Cervical Cancer Awareness Month, let us commit to making it a reality. What should happen here?
Eliminating cervical cancer requires commitment on many levels, from public awareness campaigns with culturally appropriate messaging that convey the power of vaccines and screening to prevent cancer, to resources that ensure That all women have easy access to regular health examinations.
Timely screening reminders and systems for prioritizing follow-up care are essential. Many women with abnormal screenings do not receive their results, reminders or follow-up instructions that they understand and therefore do not receive appropriate treatment. Barriers also include logistical challenges such as transportation and language issues. Studies suggest that 13% to 40% of cervical cancer diagnoses in women with abnormal screening tests are due to lack of follow-up.
Gynecology and primary care practices should be vigilant about accessing and monitoring patients with questionable test findings. Large health systems can leverage the power of electronic health records to track abnormal tests and ensure these women receive appropriate follow-up.
Pediatricians should encourage parents of children age 9 and older to get the HPV vaccine and emphasize its safety. According to the US Centers for Disease Control and Prevention, about 60% of teens are up to date on their HPV vaccines. Doctors not recommending the vaccine and parents’ growing concerns about its safety, despite more than 15 years of evidence that it is safe and effective, are cited as the top reasons why more children get it. Life saving vaccine is not available.
College campuses should conduct massive catch-up vaccination outreach. These students are at high risk for contracting HPV, yet only about half report receiving the full HPV vaccine series. This service should be provided free of cost to the students.
Stark racial disparities must also be addressed. As Black women physicians, we are dismayed that according to the American Cancer Society, Black women are more likely to die from the disease than any other race. From Black women receiving less aggressive treatment to affordable routine health care and barriers to access to the high-quality, specialized treatments needed to treat cancer, there is a system failure in this tragedy. Everyone deserves access to quality care.
Older patients should be told that approval of the HPV vaccine has been extended up to age 45 and to discuss with their doctor whether this is right for them. Insurance providers should cover the cost of the vaccine for these older adults.
Women should see a gynecologist regularly in their older years. We see patients with cervical cancer in their 60s and 70s who haven’t been screened in 20 years. Many people stop visiting the gynecologist after childbirth or menopause, but this should not be the case. Getting quality gynecological exams throughout a woman’s life is key to preserving it.
We also need to 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 clearly delineated. No news after screening is not good news. In an ideal world, women would view their HPV status as essential information with the power to save their lives.
Education makes a difference. At New York-Presbyterian and Weill Cornell Medicine, we produced a series of easy-to-understand, publicly available videos on cervical cancer and the HPV vaccine. We showed several vaccine videos to more than 100 parents in one of our pediatric practices, which serves mostly low-income families, as part of a pilot study. Their knowledge scores on a questionnaire about the vaccine and HPV, which they completed before and after watching the video, increased by about 80%, and about 40% of non-vaccinated children received the HPV vaccine within a month. We want to expand this effort.
We have tools to prevent cervical cancer but fail to use them effectively. This is unacceptable, and we can no longer ignore the problem. The time has come to focus wholeheartedly on all fronts to make cervical cancer a disease of the past.