Cervical cancer could be eliminated soon. So why are American women losing ground?
It's an entirely preventable disease, but the American Cancer Society estimates 14,480 women will be diagnosed with invasive cervical cancer and 4,290 will die from it this year.
Instead of working with more urgency to prevent the unnecessary deaths of thousands of American women every year, the U.S. is moving in the wrong direction, particularly in the lack of effort to improve rates of cervical cancer screening.
In 2018, the director of the World Health Organization announced an ambitious goal — to eliminate cervical cancer as a public health problem. The World Health Assembly, including representation from the U.S., approved this goal and the strategy for accomplishing the goal globally in 2020.
Australia, Canada and the United Kingdom have taken up the charge with fervor, developing strategies tailored to their countries, racing each other to see which can be the first to achieve cervical cancer elimination.
U.S. lowers its screening goal
Why hasn’t the U.S. developed a national strategy or goal? Instead, we have lowered standards that could lead us to achieve the goal quickly.
The fastest way for the U.S. to eliminate cervical cancer is to increase cervical cancer screening. Yet the recent release of the Healthy People 2030 report lowered the objective for cervical cancer screening by nearly 10% from the prior report. This change could result in up to 2,100 additional cases of cervical cancer every year.
Healthy People sets objectives for national public health initiatives for the next 10 years. It serves as a guide that directs resources to state and local public health departments, as well as non-profit organizations to achieve the objectives.
Healthy People has included a cervical cancer screening objective every decade since its launch in 1979, setting a bar in the 2020 report with a goal of 93% of American women ages 21 to 65 screened for cervical cancer. In 2018, 80.5% were screened, with a trend toward decreasing rather than increasing percentages screened per year.
In a surprising turn, Healthy People 2030 lowered the objective for cervical cancer screening to 84.3%. The explanation for this reverse is “the trend was moving away from the desired direction… the Healthy People 2030 Workgroup Subject Matter Experts expected the overall percentage to continue to be difficult to change.”
An objective, necessary to achieve its intended outcome, requires additional effort, not a target reduction.
How are we to ever eliminate a completely preventable cancer if we accept our failure to reach all women with screening equitably as fait accompli? Which women have we failed by accepting that nearly 20% of women will not be screened? What kind of an example does the U.S. set for other countries by reducing the cervical cancer screening target, effectively delaying progress toward cancer elimination?
Uninsured less likely to be screened
Women who are uninsured are significantly less likely to be up to date on screening. In the U.S., lack of screening is the primary reason women are diagnosed with cervical cancer. Uninsured women may delay care or miss lifesaving appointments due to a lack of resources. The disparities are profoundly felt among minorities and low-income patients in access to screening, management of abnormal results to prevent cancer, and cancer care.
Today, as we mark International HPV Awareness Day, it is imperative that the U.S. take a firm stance by creating goals, objectives and strategies that propel us as a nation to eliminate cervical cancer, the first cancer ever to be eliminated in any country.
Decades of groundbreaking research have provided the tools to eliminate cervical cancer. Yet, every two hours a woman in the U.S. dies of this preventable cancer.
It is time to stop leaving women behind and work collectively to get every woman, regardless of race, ethnicity, and socioeconomic status, up to date with cervical cancer screening. Let’s create a national goal to achieve cervical cancer elimination, a strategy for the U.S. to accomplish this goal, and a revision of the Healthy People 2030 objectives.
Anna Giuliano, Ph.D., is founding director of the Center for Immunization and Infection Research In Cancer at Moffitt Cancer Center. Tamika Felder, a cervical cancer survivor, is the Founder and Chief Visionary Officer of Cervivor, a nonprofit organization dedicated to cervical cancer awareness and support.
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This article originally appeared on USA TODAY: Cervical cancer can be eliminated, but America needs more testing
