Editor’s note: Dr. Eloise Chapman-Davis is director of gynecologic oncology at NewYork-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine. Dr. Denise Howard is chief of obstetrics and gynecology at NewYork-Presbyterian Brooklyn Methodist Hospital and vice president of obstetrics and gynecology at Weill Cornell Medicine. The opinions expressed in this comment are my own. Read more opinions on CNN.
As physicians who specialize in women’s reproductive health, we are at the forefront of a preventable crisis. Imagine treating a woman with advanced cancer who has a 17% five-year survival rate, knowing that she should never have developed the deadly disease in the first place.
This is what we are dealing with with cervical cancer. However, we have the clinical tools to not only reduce, but also eliminate nearly all of the approximately 14,000 new cases and 4,300 deaths from cervical cancer each year.
We have effective screening tests: 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 from developing. Importantly, we have the HPV vaccine, which protects against the high-risk types of human papillomavirus (HPV) that cause most cases of cervical cancer and is nearly 100% effective, according to the Institute. Cancer National.
A report published earlier this month shows the tremendous impact of the vaccine. The US experienced a 65% drop in cervical cancer rates between 2012 and 2019 among women ages 20 to 24, the first to receive the vaccine. The vaccine, combined with screening, could end cervical cancer and make it a disease of the past.
But the percentage of women who are late getting screened for cervical cancer is growing, and alarmingly, late-stage cases are on the rise.
We have had the heartbreaking experience of watching mothers in the prime of life die from this preventable disease, leaving behind young children, even women who had an abnormal screening test but never received follow-up care. It is devastating to see a healthy person slowly die from a preventable cancer.
Simply put, cervical cancer should never happen. This Cervical Cancer Awareness Month, we must commit to making it happen. This is what must happen.
Eliminating cervical cancer requires commitment at multiple levels, from public awareness campaigns with culturally appropriate messages that convey the power of vaccines and screening tests to prevent cancer, to resources that ensure all women have easy access to routine health exams.
Timely screening reminders and systems to prioritize follow-up care are essential. Too 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 between 13% and 40% of cervical cancer diagnoses are due to lack of follow-up among women with an abnormal screening test.
Gynecology and primary care practices should be vigilant in reaching and monitoring patients with suspicious test findings. Large health systems can harness the power of the electronic health record to track abnormal tests and ensure these women receive appropriate follow-up.
Pediatricians should encourage parents of children older than 9 years to get the HPV vaccine and emphasize its safety. About 60% of teens are up to date on their HPV vaccines, according to the US Centers for Disease Control and Prevention. Doctors Not Recommending the Vaccine and Growing Parental Concerns About Its Safety , despite more than 15 years of evidence that it is safe and effective, have been cited as the main reasons why more children do not receive this life-saving vaccine.
College campuses should conduct large-scale catch-up vaccination campaigns. These students are at high risk for HPV, but only half report having received the full series of HPV vaccinations. This service must be provided at no cost to students.
Stark racial disparities must also be addressed. As black doctors, we are frustrated that black women are still more likely to die from the disease than any other race, according to the American Cancer Society. System failures contributing to this tragedy range from black women receiving less aggressive treatment to barriers around accessing affordable routine health care and the high-quality specialty treatment needed to treat cancer. Everyone deserves access to quality care.
Older patients should be told that the approval of the HPV vaccine has been extended to age 45 and to discuss with their doctor if it is right for them. Insurance providers must cover the cost of the vaccine for these older ages.
Women should see a gynecologist regularly well into old age. We see cervical cancer patients in their 60s and 70s who haven’t been screened in 20 years. Many people stop seeing a gynecologist after pregnancy or menopause, but this should not be the case. Getting quality gynecological examinations throughout a woman’s life is essential to preserve it.
We also need to empower women to be their own advocates through health education. Women should receive their assessment result with an explanation of what it means and clearly outlined next steps. No news after a screening is not good news. In an ideal world, women would see their HPV status as essential information with the power to save their lives.
Education makes the difference. At NewYork-Presbyterian and Weill Cornell Medicine, we produce a series of publicly available, easy-to-understand videos about cervical cancer and the HPV vaccine. We showed several of the vaccination videos to more than 100 parents at one of our pediatric practices that primarily serves low-income families as part of a pilot study. Their knowledge scores on a questionnaire about the vaccine and HPV that they completed before and after viewing the videos increased by nearly 80%, and approximately 40% of the unvaccinated children received the HPV vaccine within one month . Our goal is to expand this effort.
We have the tools to prevent cervical cancer, but we don’t use them effectively. It is unacceptable, and we can no longer ignore the problem. It is time for a full-scale offensive focused on all fronts to make cervical cancer a disease of the past.