Cervical cancer a major concern for Black women

Twice as likely to die as Whites

Dr. Anisa Shomo NNPA Columnist | 2/28/2019, midnight

Many people may believe that cervical cancer is a problem of the past. Prior to the 1940s, it was a major cause of death in women of childbearing age. According to the National Institute of Health, invasive cervical cancer is now considered to be the 14th leading cause of cancer deaths in women in the US. That accounts for approximately 4,000 deaths of women each year.

African American women are twice as likely as White women to be diagnosed with invasive cervical cancer and two to three times more likely to die from this diagnosis. Before we examine why this health disparity exists, let’s explore the historical gains that lead to the reduction of invasive cervical cancer diagnosis and deaths.

Before the 1940s, it was difficult to diagnose cervical cancer unless accompanied by significant symptoms such as bleeding, pain, and nausea were occurring, which caused women to present in the later stages. In 1943, Dr. George Papanicolau published a paper on his work to identify cervical changes as normal or cancerous via a microscope before invasive cancer occurred in an article titled “Diagnosis of Uterine Cancer on Vaginal Smear.”

In 1954, Dr. Papanicolau published his atlas for labs to learn how to identify cervical cancer using his method and this is now called a Papanicolau test or “Pap” smear. We now use this to screen for cervical cancer and catch it in its early stages. Cervical cancer caught in the early stages can be removed with very minor surgeries and in many cases, hysterectomy can be avoided.

In the 1970s, the HPV virus was being extensively researched as a possible link to cervical cancer. In 1984 Dr. Harald zur Hausen discovered that HPV 16 and 18 were major causes of cervical cancer. He later won a Nobel Prize in Science for this discovery. In the 1990s, Dr. Lowy and Schiller began working to create an HPV vaccine that could help prevent cervical cancer altogether. In 2006 the FDA approved the first HPV vaccines.

We now use the HPV vaccine to help prevent cervical cancer in the first place. This is especially important internationally since currently 500,000 women are diagnosed with cervical cancer each year and 275,000 of them will die of their disease due to low access to screening and treatment.

Cervical cancer has had such great advancements in treatment and diagnosis in the United States that even one death from this disease could be considered a failure of the system. But an estimated 700 African American women still die of cervical cancer each year. The three main reasons are: Later stage at diagnosis, less aggressive treatment, and more barriers to care once diagnosed.

One reason cited for lack of timely screening is confusion of Pap smear with a pelvic exam causing a person to think that they have already been screened, although they may have had this exam for a different reason. Many African American women do not receive treatment due to comorbid conditions, advanced cancer, or refusal to be treated. In 2016, Nardi et al detailed some of the findings of multiple studies that indicate that lack of knowledge about cervical cancer may be the largest barrier to screening and treatment of cervical cancer in African American women.