More than 12,000 women in the United States get cervical cancer each year, and about one-third of that number succumb to the disease. That's according to the CDC's November Vital Signs report, "Cervical Cancer is Preventable."(www.cdc.gov)
Based, in part, on data from a Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) issued on Nov. 5, the Vital Signs report notes that death rates from cervical cancer dropped for most years from 1975 to 2007, but have plateaued since 2008. The report goes on to say that 93 percent of cervical cancers are preventable through screening and vaccination against HPV.
Yet despite clear recommendations from both the U.S. Preventive Services Task Force(www.uspreventiveservicestaskforce.org) and the AAFP to screen women ages 21-65 for cervical cancer, a 2012 CDC survey(www.cdc.gov) found that in the previous five years, 8 million U.S. women in this age group reported they had not been screened for the disease. Given that about seven out of 10 of these women had a regular doctor and health insurance, family physicians are in the unique position to change this trend.
How Can Family Physicians Help?
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that cervical cancer screening has had a dramatic effect on cancer rates, but said family physicians can do better in this area.
- The CDC's November Vital Signs report, "Cervical Cancer is Preventable," addressed shortfalls in screening for the disease, including missed opportunities during acute-care visits.
- The report notes that death rates from cervical cancer dropped for most years from 1975 to 2007, but have plateaued since 2008.
- The AAFP recommends routine cervical cancer screening and HPV vaccination to battle the disease.
"The cancer rate can be reduced further by increasing the uptake of HPV vaccination and expanding cervical cancer screening," she said. "There are a significant number of women who have not been screened who have had several visits with their physician. Family physicians need to consider every visit as an opportunity for preventive care rather than waiting for the patient to schedule a well-woman exam."
Frost said cervical cancer screening with Pap smear should start at age 21 and continue at three-year intervals until age 65. Alternately, a combination of testing for HPV infection and Pap smear very five years is appropriate for women age 30 or older who wish to extend the interval between screens.
The HPV vaccine also plays an important role in preventing cervical cancer, yet its uptake is still suboptimal, said Frost. HPV vaccination is recommended for all adolescent girls at ages 11-12, but the three-dose series may be started in girls as young as 9 and include young women up to age 26 who have not been vaccinated.
"If family physicians strongly recommend the vaccine and focus on its role in cancer prevention, patients are far more likely to get the vaccine," Frost said. "Unfortunately, many physicians continue to treat HPV differently than other recommended vaccines, recommending it less strongly and presenting it as a vaccine against sexually transmitted infection."
What Else Can Be Done to Improve Rates?
According to the MMWR report, older women, Asians/Pacific Islanders and American Indians/Alaska Natives were more likely than other groups to be inadequately screened. Also, Southern states had the highest percentage of women who had not been screened, as well as the highest mortality rates from cervical cancer.
Current Vaccination, Screening Recommendations from CDC, AAFP
Both girls and boys ages 11-12 should be vaccinated against HPV. Girls and boys derive the best protection when they receive all three HPV doses as recommended before they are exposed to the virus.
Adolescent girls and young women ages 13-26 and adolescent boys and young men ages 13-21 should be given the vaccine if they have not received it already.
Conduct Pap testing every three years in women beginning at age 21. Starting at age 30, women can choose one of two screening options. Doctor and patient should decide together which screening approach is preferred:
- Pap test every three years or
- Pap test plus HPV testing every five years.
Frost noted that expansion of insurance coverage through the Patient Protection and Affordable Care Act and connecting women with a medical home should go a long way toward improving screening rates.
Ensuring that uninsured and underinsured women receive appropriate screening, which is the focus of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP),(www.cdc.gov) is key to turning the tide of cervical cancer, she said.
"Because the greatest number of unscreened women are in this group, this is potentially where the greatest impact can be made," Frost explained. "Expanding insurance coverage is essential, but as we do not have universal coverage in this country, there will still be women who do not have access to this service.
"The NBCCEDP provides education about the importance of screening as well as assisting women in getting access to this service."
Related AAFP News Coverage
Despite Gains, Number of Teens Receiving HPV Vaccine Still 'Unacceptably Low'
CDC Survey Outlines Sketchy Progress Made in Vaccination Effort
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American Family Physician: AFP by Topic: Cervical Cancer