The last 50 years have witnessed a dramatic decline in the number of cervical cancer cases, according to the National Cancer Institute. This trend can be primarily attributed to the use of the Pap test, a screening tool that allows doctors to detect precancerous changes in cells of the cervix.
The American Cancer Society recommends yearly screening for all women about three years after they begin having intercourse, but no later than the age of twenty one. In addition, an HPV (human papilloma virus) DNA test has become available that can detect the virus responsible for most of the cell changes that lead to cancer. HPV DNA testing is most appropriate in women aged 30 and older, when risk of cervical cancer is highest.
Despite all the progress, certain minority groups have higher rates of invasive cervical cancer than other groups, according to statistics from Baylor College of Medicine’s Intercultural Cancer Council. The council found that Hispanic, Mexican-American and Puerto Rican women are all affected by cervical cancer more frequently than Caucasian women.
“In Latin American culture, it’s important for women in particular to have company with them when they go to the doctors,” Hugo Vilchis, M.D., director of New Mexico State University’s Border Epidemiology and Environmental Health Center, told the Las Cruces Sun News. “Family or extended family support is very important. But some women may have nobody to accompany them, so they won’t go to the doctor.”
In addition to the family or support factor, other issues cited for Hispanic, Mexican-American and Puerto Rican women not getting annual Pap tests include lack of access to health care, lack of insurance and lack of education within the community about the importance of check-ups.
The National Cancer Institute is trying to change this trend. It issued a grant earlier this year to New Mexico State University for programs to help promote educational programs to Hispanic women in border communities about the importance of Pap tests and help increase access to clinicians. In addition, the programs will attempt to assist women with abnormal Pap test results in follow-up tests.
In addition to increasing awareness about Pap testing, the cervical cancer vaccine may play a role in reducing the number of invasive cervical cancer cases among this population. “The hope is that the vaccine would help,” says Elin Cohen, M.D., director of Children’s Health Services in Weston, Conn.
The cervical cancer vaccine, approved by the FDA in 2006, offers protection from HPV and is the first vaccine designed to prevent a cancer. The vaccine is recommended for girls ages 11 to 12, although it can be used in girls as young as 9 and is approved for us in women though age 26. The vaccine is given in three injections over six months and women must have all three injections to receive the vaccine’s protection. All girls and women who receive the HPV vaccine should continue to receive regular cervical cancer screening, because the HPV vaccine does not replace routine cervical cancer screening.
To help at risk populations, the U.S. Centers for Disease Control and Prevention (CDC) operates the National Breast and Cervical Cancer Screening Program. It has a primary focus to make sure that low income women and immigrant women get access to timely screening and diagnostic services.
CDC, through its state partners, has many outreach initiatives to increase the number of immigrant women they screen. Women who are under-insured or have no insurance can contact the state health department to find out how to get a free or low cost Pap test. Women can also contact CDC’s National Breast and Cervical Cancer Early Detection Program at 1-800-CDC-INFO.
Jennifer Wider, M.D.
Society for Women’s Health Research