A critical overview that highlights ways to prevent invasive cervical cancer was recently published in Cancer Epidemiology, Biomarkers & Prevention.

Anna R. Giuliano, Ph.D., director of Moffitt’s Center for Infection Research in Cancer and senior member of the Cancer Epidemiology Department, explained:

“The good news is that over the past several decades, the incidence of invasive cervical cancer has declined dramatically. The bad news is that 60 percent of invasive cervical cancers occur in women who are members of underserved racial or ethnic minorities, in women residing in rural areas or living in poverty.”

The number of invasive cervical cancer cases has decreased 75% since the 1940s. Partly due to the increased extensive use of the Pap smear, a team from Moffitt Cancer Center, University of South Florida, and The Ohio State University, explained, rates have declined from 14.8 per 100,000 females in 1975, to 6.6 per 100,000 in 2008.

Today, the incidence of invasive cervical cancer differs by race geography, ethnicity and socioeconomic status. The highest rate is found among Hispanics (10.4 per 100,000). The number of cases is three times higher among blacks 85 and older than white females of the same ages.

Christine M. Pierce Campbell, Ph.D., leading author and a postdoctoral fellow within Moffitt’s Cancer Epidemiology Department, said: “In looking across the nation, there are geographic and socioeconomic disparities associated with invasive cervical cancer rates. Along the U.S.-Mexico border, in the deep South and in Appalachia, rates are higher than in other regions of the nation. Also, many studies have shown that socioeconomic status predicts who gets screened, diagnosed and treated for invasive cervical cancer, regardless of race and ethnicity.”

Federal and local funding of prevention programs, including the National Breast and Cervical Cancer Early Detection Program, the only nationwide screening program, has also contributed to the decrease in incidence.

Although the National Breast and Cervical Cancer Early Detection Program was executed to encourage high-risk and low-income women to get screened, only few of the women qualified have used the service.

The percentage of women utilizing the service differ by state, but just 8.7 percent of those qualified for screening received it between 2004 and 2006.

The experts pointed out that human papillomavirus (HPV) vaccination could also be playing a role in incidence reducing. The vaccination is now found in 2 forms:

  • GARDASIL– released in 2006 and was the first HPV vaccine, targeting females ages 9 to 26, to prevent invasive cervical cancer
  • CERVARIX– followed the gardasil shot and targets females ages 10 to 25

However, Giuliano said, HPV vaccine use is not as efficient as other adolescent vaccines.

Pierce Campbell said:

“Barriers to HPV vaccination include costs, perceived safety issues, and the perception that vaccination is unnecessary if the woman or child is not sexually active. Parental knowledge, attitudes and beliefs influence utilization, as well. Physician recommendation of the HPV vaccine is a key factor to its use, yet many primary care physicians have not been proactive in promoting it, especially to young adolescents in the target age groups.”

When males become infected with HPV, it contributes to females becoming infected and the subsequent development of invasive cervical cancer. Therefore, another technique that can decrease incidence is the HPV vaccination of males, the authors said.

Maximal disease reduction would be the outcome from gender-neutral HPV vaccination. Universal HPV vaccination can potentially decrease the incidence of invasive cervical cancer and its precancerous lesions by 91%.

“Invasive cervical cancer can be eliminated in the United States,” the scientists concluded. “To achieve this goal, we need to adopt a comprehensive national health care program that underscores accessible and equitable health care, one that delivers compassionate care to all. A future without invasive cervical cancer is possible, although we must be innovative and vigilant in our approach to reduce its burden, as well as reduce the disparities in access to screening and overcome the obstacles to vaccination.”

The research was supported by a grant from the National Cancer Institute. It is one of five manuscripts published as a special issue to emphasize what needs to be done to extinguish cervical cancer.

Written by Sarah Glynn