Cervical cancer is largely preventable through the combination of human papillomavirus (HPV) vaccination and cytology (Pap smear) screening. However, not all women have received the HPV vaccine or undergo recommended Pap smear screening. The US Preventive Service Task Force recommends screening for cervical cancer in women aged 21 to 65 years with cytology every 3 years, or for women aged 30-65 who wish to lengthen the screening interval, screening with a combination of cytology and HPV testing every 5 years.
It has been widely publicized that when cervical cancer is detected early, it is highly treatable and associated with a long survival and overall good quality of life. The American Cancer Society estimates that in 2016, there were 12,990 new cases of cervical cancer in the United States and 4120 deaths due to cervical cancer. Although this death rate isn’t alarming, what is alarming is new data on cervical cancer death rates. The risk of dying from cervical cancer appears to be much higher than previously thought.
Accounting for Hysterectomy
Researchers at Johns Hopkins and George Washington University analyzed data on cervical cancer deaths in the United States from 2000 to 2012. They noted that previous estimates of cervical cancer death rates didn't account for women who had their cervixes removed when hysterectomies were performed, which eliminates the risk of developing cervical cancer. Consequently, data were collected from the Behavioral Risk Factor Surveillance System on the number of women in 2000 to 2012 aged 20 years and older who reported ever having a hysterectomy. Study authors then used that data to adjust the cervical cancer deaths rates.1
Before the adjustment, data indicated that cervical cancer caused the deaths of 5.7 per 100,000 black women and 3.2 deaths per 100,000 white women. After adjusting for hysterectomies, the rate was 10.1 per 100,000 black women and 4.7 per 100,000 white women. The researchers concluded that the racial disparity seen in cervical cancer death rates for black and white women was underestimated by 44% when hysterectomies were not taken into account. They advocate that this disparity be addressed with initiatives focusing on improved access to HPV vaccination and cervical cancer screening programs, as well as access and adherence to evidence-based cervical cancer treatment.
Looking at these new statistics another way, black women are dying from cervical cancer at a rate 77% higher than previously thought, and white women are dying at a rate 47% higher than previously thought. The media clamored to use these particular statistics, raising alarm and outrage among women’s health advocates.
The revised death rates highlight the importance of cervical cancer prevention and early detection. HPV vaccines are highly effective and safe, and a powerful prevention tool for reducing HPV infections and HPV-associated cancers, including cervical cancer. The Centers for Disease Control and Prevention (CDC) estimate that 50% of boys aged 13 to 17 received at least 1 of the recommended 3 HPV doses as of 2015 (the most recent year data are available), which is an 8% increase from 2014. Among girls, 63% had received at least 1 HPV dose, compared with 60% in 2014. Although the HPV vaccination rate is improving, it is still far from 100%.
The CDC’s Advisory Committee on Immunization Practices in December 2016 updated their HPV vaccine recommendations to a 2-dose schedule for girls and boys who initiate the vaccination series at 9 through 14 years. Three doses remain recommended for people who initiate the vaccination series at 15 through 26 years and for those who are immunocompromised.
Oncology nurses can help reduce cervical cancer’s mortality by asking women about their cervical cancer screening behaviors. We can also participate in community programs that inform the public about the benefits of HPV vaccination and cervical cancer screening. These new data on cervical cancer mortality demand that we take action to help reduce deaths from this disease.
Beavis AL, Gravitt PE, Rositch AF. (2017), Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States [published online ahead of print January 23, 2017]. Cancer. doi:10.1002/cncr.30507.
Lisa Schulmeister, MN, RN, ACNS-BC, FAAN, is an oncology nursing consultant and editor-in-chief of Oncology Nursing News.
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