Report Finds High Rates of Cervical Cancer Indicate Broader Problems in Access to Care
A new report released today by the National Cancer Institute, part of the
National Institutes of Health, finds that high rates of cervical cancer are
indicators of larger problems in access to health care. The report also finds
that cervical cancer mortality, which is higher in certain geographic areas and
populations, is a marker for other health disparities. The authors of the new
report, compiled by NCI's Center to Reduce Cancer Health Disparities (CRCHD)
and titled Excess Cervical Cancer Mortality: A Marker for Low Access to Health
Care in Poor Communities*, conclude that the nation's public health system must
improve its delivery of cervical cancer education, screening, and treatment and
related health care to women at risk.
Despite a consistent decline in cervical cancer deaths in the United States
overall, patterns of high cervical cancer mortality have existed for decades in
specific geographic areas and populations. Those groups with the highest
mortality rates include African American women in the South, Hispanic women
along the Texas-Mexico border, and white women in Appalachia, American Indians
of the Northern Plains, Vietnamese American women, and Alaska Natives.
The authors of this report hypothesize that cervical cancer is an indicator of
larger health system concerns, including medical care access, cultural issues,
and health communication and education issues. To examine the underlying causes
of this ongoing disparity, CRCHD embarked on a two-phase project, the Cervical
Cancer Mortality Project. In the first phase, researchers reviewed the
literature and analyzed both historical and current data on cervical cancer
incidence, screening, treatment and mortality in the United States. An analysis
of the literature showed that women suffering from high cervical cancer
mortality share several life conditions: they tend not to have a usual source
of health care; have lower rates of preventative health services, including
cancer screening; have low incomes and educational levels; and live in regions
with high rates of screenable and treatable diseases, such as breast cancer,
colorectal cancer, cerebrovascular disease, and infant mortality.
CRCHD Director Harold P. Freeman, M.D., emphasized the importance of efforts to
find a solution to this problem. "Effectively addressing cervical cancer
mortality can provide a model for action and an opportunity to address not only
the health problems facing women who are dying from cervical cancer, but also
the full set of human circumstances that lead to health disparities."
The authors of the report outline specific actions and targeted interventions
to eliminate cervical cancer mortality disparities. These actions fall into
four key strategy areas: access (services, outreach, and navigation);
information and communication; collaborations, partnerships, and advocacy; and
research.
The authors recommend that health care workers intensify outreach to women who
have rarely or never been screened for cervical, breast, or colon cancer and
other screenable diseases. To achieve this outreach, the report suggests that
it is very important for women at risk for cervical cancer and other cancers to
have a "medical home"-- a usual source of medical care where they can receive
screening and counseling, experience continuity of care, and build
relationships with the medical caregivers. The authors also recommend pairing
all women with patient navigators at local hospitals or primary health centers,
who can help at-risk women through the health system once an abnormality has
been detected. Increased patient navigator programs would help improve
communication between primary care, screening services, and follow-up/treatment
at hospitals.
The report also suggests strategies to remove cultural and economic barriers to
care. When only male physicians are available to conduct examinations, distrust
and cultural taboos may cause at-risk women to avoid screening. Increasing the
number of female providers, particularly those of the patient's race/ethnicity,
is an important step in breaking down resistance to screening. The report also
calls for improved coverage and reimbursement for cancer-related services.
Specifically, the report recommends that any uninsured woman with cervical or
other cancer should be considered eligible for Medicaid or Medicare for the
duration of her treatment and follow-up care.
Native-born populations in high cervical cancer mortality areas tend to reach
lower educational status and require materials written at a level that matches
their reading levels. The authors of the report recommend working with
community members to develop linguistically and culturally appropriate
information about this disease. Effective translation is an integral part of
reaching women in high-risk populations, and the report recommends improving
provider-patient communication through provider tools and availability of
language translation.
Additional research is needed to study the effects of numerous factors on
cervical cancer mortality, including insurance status, transportation, lack of
a medical home, human papillomavirus (HPV) prevalence, smoking, sexual
practices, and condom use. The authors emphasize the need to optimize HPV
testing and vaccine development to eliminate the cause of 90 percent to 95
percent of all cervical cancers. They also noted a need for additional research
to develop better and more affordable screening tests for all women.
The authors recommend that all government, state, and local programs with an
interest in women's health pursue collaborations which promote a "whole woman"
approach to health care. "The problem of cervical cancer mortality underscores
the urgent need to analyze our entire health care system," said Freeman.
"Change can occur if the will exists to make it happen. We need to courageously
craft the changes that will eliminate disparities and save lives."
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For more information about NCI's Center to Reduce Cancer Health Disparities,
visit http://crchd.nci.nih.gov/.
For more information about cancer, visit the NCI Web site at
http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4CANCER
(1-800-422-6237).
To order a copy of the report, visit NCI's Publications Locator Web site at https://cissecure.nci.nih.gov/ncipubs or download a PDF copy of the report at http://crchd.nci.nih.gov/meetings/Excess%20CervCanMort.pdf .
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*Freeman, HP, Wingrove BK, eds. Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities. Rockville, MD: National Cancer Institute, Center to Reduce Cancer Health Disparities, May 2005. NIH Pub. No. 05-5282.
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