COMMENTARY

Cervical Cancer Is Preventable--Too Many Missed Opportunities

Ileana Arias, PhD

Disclosures

January 05, 2015

Editorial Collaboration

Medscape &

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Hello. I am Dr. Ileana Arias, the Centers for Disease Control and Prevention's (CDC's) principal deputy director. I am pleased to speak with you today about CDC's recent Vital Signs[1] report on cervical cancer prevention.

Every year, 12,000 women get cervical cancer and 4000 women die of it. But women don't have to die of cervical cancer. We have seen incredible reductions in cervical cancer cases and deaths with the Pap test, and now have additional screening and prevention tools, including testing for the human papillomavirus (HPV) and the HPV vaccine. Together, cervical cancer screening and the HPV vaccine could prevent as many as 93% of all cervical cancers.

Despite these important cancer prevention tools, in 2012, more than 8 million women between the ages of 21 and 65 years reported not having cervical cancer screening in the previous 5 years. We also know that 7 in 10 of these women had a regular healthcare provider and health insurance. In 2013, only 1 in 3 girls and 1 in 7 boys received the recommended three doses of the HPV vaccine. We can do better with both screening and vaccination by using any visit to a healthcare provider as an opportunity to discuss cervical cancer prevention and check patients' vaccination and screening status.

As of 2012, the US Preventive Services Task Force,[2] the American Cancer Society,[3] and the American College of Obstetricians and Gynecologists[4] all agreed on when and how often to screen for cervical cancer. Routine screening should begin at age 21 years, even if the woman has had the HPV vaccine. Women aged 21-29 years should be screened with the Pap test every 3 years. Women aged 30-65 years have the option of either having a Pap test every 3 years, or having a Pap test plus an HPV test every 5 years. Screening more frequently than this does not provide more protection, and routine screening is not recommended after the age of 65 years, given a history of normal screenings. Screening is not recommended for women who have had a hysterectomy with removal of the cervix and who do not have a history of high-grade precancerous lesions.

It is important to remember that these recommendations are for routine screening. Some women may need a different screening schedule because of their health history or previous screening results.

HPV vaccination is recommended for both boys and girls aged 11 to 12.[5] Protection is greatest when they receive all doses as recommended before they are exposed to HPV. Girls aged 13 to 26 years and boys aged 13 to 21 years should get the vaccine if they did not receive it earlier. Preteens and teens are not getting HPV vaccination as often as other recommended vaccines, even though it is safe and effective.

Fewer missed opportunities for vaccination against and screening for cervical cancer can help reduce the number of women suffering and dying of this highly preventable disease. Doctors, nurses, and other healthcare providers can:

Help women understand which screening tests are best for them and when to get them;

Use any visit to check whether patients are up to date with HPV vaccination and cervical cancer screening;

Screen or refer all women as recommended at any visit;

Make sure patients get their screening results and the right follow-up care quickly;

Use reminder-recall systems to help providers and patients remember when screening and HPV vaccination are due; and

Strongly recommend that preteens and teens get vaccinated against HPV when they receive their other adolescent vaccinations. The "HPV vaccine is cancer prevention" message resonates very strongly with parents. In addition, studies show that a strong recommendation from a healthcare provider is the single best predictor of vaccination.

The bottom line: No woman should ever die of cervical cancer. Every visit to a provider is an opportunity to screen or make sure that women are getting screened, and that preteens and teens are getting vaccinated.

Ileana Arias, PhD, serves as Principal Deputy Director for CDC and the Agency for Toxic Substances and Disease Registry (ATSDR). In this role, she serves as the principal advisor to the director on all scientific and programmatic activities of CDC/ATSDR. Dr Arias is responsible for advising the director in all executive responsibilities, and shaping the policies and plans for CDC/ATSDR.

Before becoming Principal Deputy Director, Dr Arias was the Director of the National Center for Injury Prevention and Control (NCIPC) since July 2005, where she has worked to prevent injuries and violence and reduce their consequences. She began her career as a research associate at the State University of New York at Stony Brook and then joined the University of Georgia in Athens as an assistant professor. Before joining CDC in 2000, Dr Arias was the director of clinical training and professor of clinical psychology at the University of Georgia.

Dr Arias holds a BA from Barnard College and a MA and PhD, both in psychology, from the State University of New York at Stony Brook. She speaks fluent Spanish.

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