Q+A: Why Are So Many Black Women Dying From Cervical Cancer?

A stained photomicrograph reveals cancerous vaginal tissue in a teenage girl. (CDC)

Thanks to Pap tests and vaccinations, cervical cancer is highly preventable.

“Essentially no woman should get cervical cancer,” according to Kymberlee Montgomery, DrNP, an associate clinical professor in the College of Nursing and Health Professions and the College of Medicine.

Yet, a new study (unaffiliated with Drexel) found that the death rate from cervical cancer in the United States is much higher than previously estimated. Moreover, the disparity in death rates between black and white women is significantly wider.

According to the new report, the mortality rate for black women was 10.1 per 100,000. That’s 77 percent higher than previously thought. For white women, it was 4.7 per 100,000.

The new rates do not reflect a rise in the number of deaths, which the Centers for Disease Control and Prevention estimates is about 4,000 per year in the United States. Instead, the new study’s figures adjust the existing data, accounting for women who had their cervixes removed in hysterectomy procedures.

“A correction for hysterectomy has revealed that cervical cancer mortality rates are underestimated, particularly in black women,” the study authors write.

Why are women still dying from cervical cancer? And why are black women at much higher risk?

Montgomery, a nurse practitioner who studies HPV and cervical cancer prevention, said unequal access to screening, as well as a lack of insurance coverage and health education all play a role — and repeal of the Affordable Care Act could worsen the disparity.

Human papillomavirus (HPV) is a common sexually transmitted infection. What should women know about the connection between HPV and cervical cancer?
Women should know that HPV can cause cervical cancer. In fact, over 99.7 percent of cervical cancer cases are related to the HPV virus. There are many different strains of the HPV virus, which can be divided into two groups: low risk and high risk. The low-risk HPV types — commonly strains 6 and 11 — cause approximately 90 percent of genital warts and are usually not cancer-causing. Women who get cervical cancer have one of the 13 high-risk strains that cause cancer. Strains 16 and 18 are responsible for over 70 percent of cervical cancer and precancerous lesions.

Were you surprised to learn that the rate at which black American women are dying from the disease is comparable to that of women in many developing nations?Unfortunately, I am not surprised. I am disappointed, because if a woman has her appropriate cervical cancer screening (typically a pap test), then she should not get cervical cancer.

Health care providers have been aware for years that this is a significant health disparity. Women who do not have adequate access to health services, who live in lower socio-economic areas, who smoke, who have inadequate education, and are inflicted with diseases which lower their immune system, such as HIV, are at higher risk of acquiring and dying from cervical cancer.

Why is there a connection between poverty and cervical cancer?
As former National Cancer Institute Director Samuel Broder once said, “poverty is a carcinogen.” Similar to underdeveloped countries, African-American women are more likely to live in poverty and have little or no access to health care and health care education. In addition, women who also have untreated serious medical conditions are at higher risk for HIV, which lowers the ability of their immune system to fight off other diseases. Lastly, studies show that black women are less likely to receive the HPV vaccine, thus their cervical cancer incidence will be higher. This is also similar to women in developing countries where there is no ability to vaccinate or no access to vaccination.

 How can HPV and cervical cancer be prevented?
HPV is easily transmitted from skin-to-skin during intimate sexual contact, including vaginal, anal and oral sex. Women who do not engage in sexual activity usually do not become infected with HPV, thus abstinence significantly reduces the risk of acquiring the virus. Correct and consistent condom usage reduces the risk of HPV exposure but it does not eliminate it, because areas that not covered by the condom may be infected by HPV and can transmit it. Many men and women who have HPV are asymptomatic and have no idea they are infected.

HPV vaccinations are available and provide high protection against the HPV virus, however, these vaccines do not treat existing HPV infections. The vaccines are also only effective for girls and boys up to age 26, before they have been exposed to strains of HPV.

Cervical cancer can be detected in women through age-appropriate routine cervical cancer screening through a test called the Pap test. The Pap test can identify abnormal cells or precancerous lesions on a woman’s cervix early, before cervical cancer develops, allowing for appropriate treatment and follow up. Sometimes, the abnormal cell changes will heal on their own. If not, the abnormal areas can be removed with a cone biopsy, laser therapy or other options.

In addition, an HPV DNA test may be completed to detect high-risk HPV strains. It is crucial that women consult their health care provider to discuss appropriate cervical cancer screening, disease prevention and health promotion.

If a woman receives an abnormal Pap test result, HPV can be detected, and cancer can be avoided.

How might changes to the Affordable Care Act or the elimination of health clinics for women affect the rate at which women contract or die from cervical cancer?
The Affordable Care Act mandated the availability of cervical cancer screening for women without having to pay a copayment. Depending on the changes made, women who cannot afford their co-pay or no longer have insurance will not continue appropriate cervical cancer screening. Without preventative education, diagnosis, treatment, and follow up, cervical cancer mortality will undoubtedly and unfortunately rise. No woman should die from cervical cancer today!