Cervical cancer rates in Alabama are among the highest in the United States, but doctors say tools already exist to effectively eradicate the disease.
On average, about 7.5 in 100,000 women in the United States have cervical cancer each year, but for Alabama women that number rises to 9.1 per 100,000, a new report by the Alabama Department of Public Health shows.
Alabama’s incidence rate of cervical cancer — or the number of new cancers of a specific type — ranks the fifth-worst in the country, according to the Centers for Disease Control and Prevention. Black women are also more likely to get cancer than white women.
“At the cancer center, people come to us and the question we get more often is, ‘When are you going to find the cure for cancer?'” said Isabel Scarinci, vice chair for global and rural health in the UAB Division of Obstetrics and gynaecology. “My mother died of metastatic breast cancer, I can tell you this is very important. But my response is usually that we have a better deal for you – there is one case we can prevent.”
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Almost all cases of cervical cancer are caused by the HPV virus – a common sexually transmitted disease.
But between HPV vaccinations before sexual activity and regular checkups, cervical cancer is one of the few cancers that can be prevented, experts across the state said, and it’s important that residents try to use every tool available to save lives
Additionally, experts say almost all patients can survive five years or more if the cancer is caught early, according to the National Cancer Institute. These cases account for 43.8% of diagnoses.
address prevention and diagnosis
In addition to her work at UAB, Scarinci is collaborating with TogeTHER for Health’s Operation Wipe Out, an initiative designed to help Alabamaans take advantage of available tools — like HPV vaccination, Pap smears, and routine cancer screening — to fight the disease eliminate before it erupts.
“I’ve been researching cervical cancer my entire professional life and there’s not much more to discover, is there?” said Scarinci. “We have the tools, vaccinations and screenings and proper aftercare. And now it’s really in the hands of the service organizations, the population in general, to take the floor to talk about the availability of services.”
Women in Alabama also have higher death rates from cervical cancer across all populations. ADPH reported a statewide rate of 2.3 deaths per 100,000 women, while the death rate in Alabama was 3.3.
But cervical cancer forms slowly, Scarinci said. According to the American Cancer Society, the average age of a woman diagnosed with cervical cancer is 50.
The first step in prevention is vaccination, which is recommended for children between the ages of 11 and 12 but can start as early as 9 years old. ADPH reported that the vaccine protects against the two types of HPV virus that cause 90% of cervical cancers.
“The HPV virus causes most cases of cervical cancer, and if you get the HPV vaccine, it protects you from cervical cancer, which is exciting,” said Nancy Wright, director of ADPH’s Division of Cancer Prevention and Control. “I mean, there aren’t many types of cancer that we have a vaccine for. There are not many cancers that we can prevent.”
The number of children who are up to date on their HPV vaccine, which was recommended for girls in 2006 and for boys in 2011, varies among counties in Alabama.
Because immunizations can start so early and cervical cancer diagnoses typically occur between the ages of 35 and 44, Heather White, executive director of TogeTHER for Health, said people fighting cervical cancer in the state are “taking advantage of the long window of opportunity for cervical cancer want to grow to our advantage.”
After vaccination, regular screening and Pap smears can help healthcare providers identify changes in the cervix and treat precancerous cells. Screening for cervical cancer is important because early stages may not have clear symptoms.
The World Health Organization classifies cervical cancer elimination as follows:
- 90% of girls fully vaccinated by age 15
- 70% of women are screened by 35 and again by 45
- 90% of women diagnosed with cervical cancer, both precancerous and invasive, receive treatment.
White said that getting more women to be screened “could turn the tide in terms of disease rates,” but noted that some women in Alabama may have trouble accessing medical care.
“Women need to be able to find providers, that’s another problem we’re running into in rural counties in Alabama, you know, is just a shortage of healthcare providers,” White said, adding that TogeTHER is closely related to ADPH works together to identify the corresponding services already exist. “We want to be able to support the infrastructure that is already in place and just make it easier for women and children to access the services that are already in place.”
Scarini said she tends to see cases of cervical cancer in women who don’t have insurance or have low incomes.
“It’s this gradient ratio to poverty,” she said. “And so it’s a disease of poverty because it’s a disease of lack of screening.”
Alabama’s Breast and Cervical Cancer Screening Program offers free breast and cervical cancer screening to women who are underinsured or whose income is below 250% of the federal poverty line. In Alabama, that means individuals with solo earnings of $2,831 per month or less in 2022 will qualify. The program also offers additional diagnostic services.
Between June 2020 and 21, providers used the program to detect 312 pre-invasive and invasive cervical cancers. Since its inception in 1996, the program has enabled the detection of 3,227 cases of cervical cancer through screening.
Alabamaers who would like more information on screening assistance can call (877) 252-3324.
Wright, who attended the UAB Cervical Cancer Summit with researchers and family doctors across the state, said she believes some Alabamaans fear a cancer diagnosis because they “don’t have access to treatment or the money to get treatment.”
“I think a lot of Alabamaans don’t realize that cancer isn’t a death sentence. You know, the sooner we catch it, the more we can do to help you survive it,” she said.
White said ADPH hopes to release a “call to action” report summarizing the research in January. Now physicians, providers and researchers across the state are working together to identify and remove the barriers to treating patients at risk for cervical cancer.
Sarah Swetlik is a gender and political reporter at AL.com. It is supported by a partnership with Report for America. Help support the team here.