Effective screening and prevention have limited deaths from cervical cancer to about 4,000 each year. But a recent study of a dozen states over 10 years found experts may have underestimated the risk of dying from the disease.
Dr. Lakshmi Kannan is an oncologist with Methodist Charlton Medical Center.
What accounts for the underestimation: “The previous study had included all women, including people who had hysterectomies in the bottom number. Women who have had hysterectomies don’t have a cervix — therefore no cervical cancer. So, it only seems fair not to include them in the total pool of women who are at risk. And when you do a calculation of women who are getting cancer or who are dying of cancer to the total number at risk, the bottom number drops significantly. So the ratio went up.”
The study found black women were dying at a rate 77 percent higher than thought. White women, 47 percent: “There is actually a 40 percent disparity in African-American women dying comparing to white women dying. The reason for the disparity is many. One, access to screening is less for African-American women. Second is even if they have a positive test, a lot of African-American women don’t go back for the confirmative results and to take care of things. Number three, they feel that the disparity of care between African-American women and white women stage for stage exists. Those are the three major factors."
More reasons: "Apart from the fact that actually when you look at the number of African-American women who’ve had hysterectomies, the study found the number of African-American women who had hysterectomies is higher. So the bottom number dropped even further for African-American women as opposed to white women. The other reason is that the deadlier cervical cancer, which is called adenocarcinoma, the incidence keeps rising in African-American women after 35, meaning African American women are getting more of the adenocarcinomas as they age as opposed to white women, who hit a plateau at 35."
How to bridge the gap: “Maybe by increased awareness, maybe by promoting the HPV vaccination. If you go back and look at cervical cancers, the cervical cancers happen in women who have never had a screening test or who have missed it in the last five years.”
Recommendations for screening: “From the age of 21 to the age of 65, have Pap smears every three years. And once you hit the age of 30, meaning that the HPV becomes a bigger player after the age of 30, Pap smears and HPV testing every five years – assuming you’re at average risk. If you’re at high risk – say you’re immune-suppressed or a smoker or you have multiple sexual partners – you need to do the screening more often.”
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