Cervical Cancer Awareness Month: Challenges of Reaching At-Risk Populations

Dennis Scribner, Jr, MD, FACOG, FACS, CPE, chief of gynecologic oncology at Cancer Treatment Centers of America (CTCA) Phoenix, discusses the challenges for reaching patients who are at the greatest risk of developing cervical cancer.

While new therapies can treat advanced-stage cervical cancer, Scribner emphasizes that from a public health perspective, women who do not receive a human papilloma virus (HPV) vaccine or get screened with a Pap smear are still at risk. Furthermore, the population that does not get vaccinated is also more likely to not get Pap smears at the age when cervical dysplasia presents itself. Only a third of people in the United States are vaccinated for HPV, according to Scribner.

Earlier-stage disease or precancerous cervical dysplasia can be detected early enough to treat routinely, Scribner says, and patients who are proactive in visiting a gynecologist or gynecologic oncologist have the best chance of favorable outcomes in cervical cancer.

Since people who do not get vaccinated for HPV are less likely to get screened regularly, this population is at a greater risk of being diagnosed with late-stage disease, which is more difficult to treat. Scribner suggests that encouraging HPV vaccination is still one of the most important factors that can reduce cervical cancer incidence.

TRANSCRIPTION:

0:08 | When we focus a lot on the science behind treating advanced locally, advanced, or widely metastatic cervical cancer, that's not really the focus of [where] we're going to gain the biggest bang for our buck. It is a huge public health concern that only a third of the patients in this country have gotten an HPV vaccine. When you look at the data of the screening history of the patients that don't get a HPV vaccine, they are most likely to not get Pap smears as they age. And that's the sad part about it, that you can comment and talk about and spend a lot of taxpayers’ dollars, and I'm glad we're doing these trials for these unfortunate people that have these advanced stage diseases.

But really, the focus should be on a public health perspective, making sure that women get their vaccines [as well as], understand [why] it's important to get their screening and treatment. Because I always tell women when they're in the office, and we're focused on management of their early cancer—because most of the times in gyn-oncology we don't see the dysplasia; that is really picked up and treated most of the time by the gynecology community, which I'm happy for—but if I do see the patients with cervical dysplasia in my clinic, I'm focusing on the fact that they're being proactive in their care.

The fact that they're coming to the doctor, they're getting their screening, [and] that they're involved in their health care is what really changes their long-term outcomes, because those are the people that don't get cervical cancer. Or, if [they're] getting cancer, it's going to be early stage, and we can cure those patients routinely. So that's the part that is the challenge, I think, from an oncologic perspective, is how do we get more people vaccinated?