A Closer Look: Cervical Cancer Death Rates and Racial Disparities
As modern medicine progresses, we increasingly hear stories about new medications, treatments, and research for the diseases and conditions we all face. Sometimes the news is optimistic, with improved survival rates and outcomes reported.
A January article in the medical journal Cancer did not bring such good news, however, with researchers reporting significantly higher rates of cervical cancer than previously thought, and substantial racial disparities in disease incidence.
Scientists adjusted nationwide cervical cancer mortality rates after accounting for women who eliminated their risk of cervical cancer after having hysterectomies. They found that cervical cancer among African American women was especially underestimated, with the original rate of 5.7 cases per 100,000 jumping to 10.1 with the corrected rate, much higher than the estimate of a jump from 3.2 per 100,000 to 4.7 among Caucasian women.
Heather Bartos, M.D., an OB/GYN and physician on the medical staff at Texas Health Denton, said the sad truth is that cervical cancer is still prevalent, and that she sees at least one case annually, even in her solo practice.
“This issue definitely has to do with access to and education about care, and I do feel minority women are at a disadvantage in both areas,” she says. “Health care providers need to educate young women about the Pap smear schedule, and should have nurses call them for their next pap smear.
“After childbearing, many women never see another doctor. Or if they do, it’s a primary care doctor who doesn’t do speculum exams with the Pap included. There is already a shortage of OB/GYNs in this country, and many primary care physicians don’t keep up with the latest guidelines on Pap testing, either because it’s not their priority or their favorite thing to treat.”
While a lack of access to and education about care are widespread issues, Bartos also cites Southern cultural norms as contributing to the problem.
“I have moms denying their daughters the human papillomavirus (HPV) vaccine for different reasons, possibly because of the anti-vaccine movement or because they are afraid to admit their daughters could be sexually active someday,” she explained. “HPV causes cervical, mouth and throat, anal and other cancers, and these rates are going up.
“Strict Southern culture, especially among minorities, contributes to a hesitancy to discuss teen sexual behavior, abstinence and how to protect young girls who do choose to participate in it. However, we know the vaccine works best before they become sexually active.”
The American Cancer Society estimates that 12,820 new cases of invasive cervical cancer will be diagnosed in the U.S. this year, with 4,120 deaths, including 1,300 new cases and 370 deaths in Texas. Additionally, while the incidence rates of cervical cancer between 2009 and 2013 for Hispanic, non-Hispanic black and American Indian/Alaska Native women were very similar (9.9 cases, 9.8 cases and 9.7 cases per 100,000 respectively), the mortality rate for black women was much higher at 3.9 cases per 100,000, followed by American Indian/Alaska Natives at 2.8 and Hispanics at 2.6.
The article in Cancer reported that with the corrected cervical cancer death rates, the disparity in mortality between the races was underestimated by 44 percent, with black women ages 85 and older seeing the highest corrected rate of 37.2 deaths per 100,000.
Bartos says there are often practical reasons why women of all ages don’t seek out the care that could be lifesaving to them.
“The Gardasil HPV vaccine is very, very expensive, around $350 per shot with a patient needing three shots,” she says. “For a low-income family, they don’t see the value in that. Additionally, I will often have women come to me without a checkup since the birth of their last child, regardless of their race. Their biggest concern is always their weight or sex drive, not their cervixes.
“The problem is that these older women are the most in danger of a cervical cancer diagnosis, with the risk peaking in their 60s. At that point in their lives, many minority women aren’t thinking about their own health anymore, instead sacrificing their health for their kids, grandkids and great grandkids instead.”
Read more about the American Cancer Society’s guidelines for the prevention and early detection of cervical cancer or search for a Texas Health OB/GYN near you to schedule a women’s wellness checkup.
Bartos recommends the nonfiction book “The Immortal Life of Henrietta Lacks” by Rebecca Skloot.
“This amazing book is about a black woman who died of cervical cancer at the age of 30 in 1951, back when there were different wards for black and white patients. Her cells were cultured and actually were used to help create the polio vaccine, cancer studies and, ironically, the Gardasil HPV vaccine. The cells were named HeLa cells after her and are still used today.”