Reducing Cervical Cancer Deaths

Cervical cancer is in the spotlight during January, designated as Cervical Health Awareness Month to draw attention to a deadly disease that claims the life of one woman every two minutes worldwide and, according to the American Cancer Association, is growing in the U.S. at a pace of 13,240 new cases each year. And while the increased use of Pap tests means earlier identification of cancer, the loss of life remains high.

According to an article in the December 2018 issue of Gynecologic Oncology, little has changed in cervical cancer treatment the last 15 years. Nor has there been any improvement in survival rates over that same timeframe, due in part to subpar prevention, screening and care. That could change, however, thanks to “increased knowledge of the disease and greater worldwide resources including prevention, screening, and improved therapeutics,” wrote the authors, adding that “there is significant promise for fewer women to die from this virally induced cancer.”

The study focused on the major problems in prevention, screening, and delivery of care for cervical cancer. These include:

  • Screening: Between 2012 and 2015, the number of women in the U.S. not screened for cervical cancer increased dramatically, from 8 million to 14 million. Screening was particularly low among the uninsured, immigrants, and women without a usual source of healthcare. Pap testing among women aged 21–65 from 2000 to 2015 also dropped by nearly 6 percent.
  • Vaccination: More than half of all cancers for women worldwide that are attributed to infection are caused by HPV. For more than a decade, the HPV vaccine has proven effective at protecting against several types of HPV infection that cause most HPV-related cancers. However, its use continues to be highest in countries where incidence and mortality are the lowest, with just one percent of individuals targeted by HPV vaccination programs coming from low- and lower- to middle-income countries.
  • Care Disparities:S. mortality rates are higher among women in rural areas vs. more urban settings and among black women compared to white women, suggesting disparities in care for cervical cancer patients.
  • Radiation Therapy Delivery: High rates of local control for large tumors are achieved with a combination of external beam radiotherapy (EBRT) and brachytherapy (BT) in cancer of the cervix. Yet a study in Gynecologic Oncology using data from the National Cancer Database found that just 44 percent of patients with advanced cervix cancer received the standard of care modalities: EBRT, BT and chemotherapy.
  • Chemotherapy and Precision Medicine/Current Global Trials: Several ongoing clinical trials are focused on identifying the optimal timing, schedule, and dose of chemotherapy, as well as maintenance chemotherapy or immunotherapy in patients with advanced disease. So far, however, there have been few advances in the use of systemic treatment cervical cancer, particularly for advanced or metastatic disease, and no validated treatment options exist beyond first-line treatment regimens.
  • Global Medicine: Cervical cancer is the fourth most common cancer in women worldwide, and more than 85 percent of deaths occur in less-developed regions. Yet, much of the global population has little or no access to cervical cancer care. Further, middle-low income countries face numerous significant issues, including manpower, training, funding, facilities, and outreach. For example, radiotherapy resources are vastly deficient in Africa, South and Central America, large parts of Asia and much of the Caribbean.

The study included viable solutions to each of these areas, solutions designed to quickly drive significant improvements in survival rates. Most fell into five buckets, including 1) patient education and expansion of nontraditional screening programs for unscreened and under-screened populations, 2) implementing cost reductions, government health programs, and school based programs for vaccinations, 3) adhering to guidelines, ensuring access to healthcare, and establishing an ethnically similar physician workforce for all patients, 4) improving training, work efficiencies, payment reform, and quality metrics, and 5) ensuring widespread use of chemoradiation, identifying targets, and developing mutation-specific trials.

Wrote the study’s authors: “There is significant promise to turn the tide against the high incidence and mortality of cervix cancer. Optimistically, great change can be affected with a united effort…The primary challenge is wide implementation. Together we need to promote health systems that will provide high quality gynecologic care for all women.”

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