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Cervical Cancer Disparities

Compared with White women, Black women are:
  • more likely to be diagnosed with cervical cancer
  • more likely to be diagnosed at a later stage of cervical cancer
  • less likely to receive optimal treatment
  • nearly twice as likely to die of cervical cancer
Compared with White women, Hispanic women are:
  • more likely to be diagnosed with cervical cancer
  • more likely to die of cervical cancer

News

Data

NA=Native American 10.1, H=Hispanic 10.0,
B=Black 9.0, W=White 7.1, A=Asian/Pacific Islander 6.3
Source: National Cancer Institute Cancer
Stat Facts: Cervical Cancer

B=Black 3.4, NA=Native American 3.1,
H=Hispanic 2.5, W=White 2.0, A=Asian/Pacific Islander 1.7
Source: National Cancer Institute Cancer
Stat Facts: Cervical Cancer

Women Diagnosed with Cervical Cancer

Henrietta Lacks, an African American mother of five children, was diagnosed with cervical cancer at The Johns Hopkins Hospital in Baltimore in 1951.

Despite undergoing radium treatments, the standard medical care at the time, Lacks died of the cancer later that year at age 31.

Samples of her cancer cells, now called HeLa cells, have the extraordinary ability to continue reproducing and have been used in more than 75,000 scientific studies ever since.

Source: “The Legacy of Henrietta Lacks” (Johns Hopkins Medicine)

Jani

“This is very personal. This is very hard to talk about. This really, really sucked. I feel that my story can help somebody out there. You don’t want to be in my shoes.

I urge women to go get Pap smears. My story is going to remind you why you need to do that.”

Twenty-six year old Jani Marti’s heartbreaking story of being diagnosed with cervical cancer.

A 34-minute video.

Ashley

In 2015, at the age of 26, Ashley was told that she had cervical cancer.

“All of a sudden your life changes. No warning, no signs, no nothing.”

When she found out that she wouldn’t be able to become pregnant and have children, “that’s when it really started to hit me.”

A 9-minute video from AshleyHasLife.

Tamika

Tamika Felder hadn’t had a Pap test for a few years when an emergency room doctor urged her to get a physical exam. She went expecting to be told to lose weight, but in 2001, at age 25, I was diagnosed with advanced cervical cancer.”

Felder survived her cancer and founded the support group for cervical cancer survivors called Cervivor.

A 4-minute video from Roche Molecular Systems.

Patti Murillo-Casa

“I had just retired and my husband and I thought that we were going to travel the world,” says Patti Murillo-Casa. “We were so busy and then I got diagnosed with cervical cancer. it was shocking.  I did not expect this. It was not in our plans at all.”

“I had a fight for my life. Just one 5-minute visit for a Pap test would have avoided me going through so much heartache for me and my family.”

 “Latinas tend to shy away from this topic but they have to know  that having the human papilloma virus is nothing to be ashamed of. They have to visit the doctor annually and take care of themselves. They have to make sure that they put themselves first.”

“I want women to know that  they should not for any reason fail to go to their gynecologist and have the Pap test.”

A 6-minute video from Cervivor TV.

Kimberly Williams

When Kimberly Williams was a 42-year-old mother of two several years ago, she received a life-changing diagnosis of cervical cancer.

“’Oh my God, how long has this been living inside of my body? Am I going to die? Who’s going to raise my children?'” she thought.

At the time, Williams had never known anyone else who had experienced cervical cancer, and despite having had an abnormal pap smear in her 20’s, she spent the next two decades unaware that she was potentially carrying a strain of the human papillomavirus (HPV) responsible for more than 95% of cervical cancer cases.

“No one ever told me my HPV status. No one ever said, ‘Hey, this is something that you need to be checking….’ My story may have been different,” she says.

Williams survived her diagnosis, though it resulted in her undergoing chemotherapy, radiation treatment, as well as a radical hysterectomy removing her uterus, cervix, the connective tissue around the cervix, and part of the vagina.

“When I went through the chemo and radiation, I was actually divorced at the time,” Williams says. “So I was doing a lot of things, along with my two children, kind of by myself.

 

So it was me trying to make everything work. And I think that was one of the reasons why I wanted to advocate for women. Because it was so difficult.”

Williams now works with Cervivor, a group that describes itself as a “global community of patient advocates who inspire and empower those affected by cervical cancer.”

See “Cervical cancer kills Black women at a disproportionately higher rate than whites” by Alana Wise in the NPR website (January 31, 2022)

Cervical Cancer Disparities

Incidence

Black women. The incidence rate of cervical cancer is 22% higher in Black women than in White women. However, the disparity is much wider when rates exclude women who cannot develop cervical cancer because of a hysterectomy (removal of uterus and cervix), a procedure more common in Black women. One study found that after correcting for hysterectomy, incidence for cervical cancer was approximately 40% higher in Black than White women. From 2009-2018, cervical cancer incidence rates among Black and White women were stable.
Source:  American Cancer Society Cancer Facts & Figures for African American/Black People 2022-2024.

Hispanic women. The cervical cancer incidence rate among US Hispanic women is nearly 40% higher than among white women.
Source: American Cancer Society Cancer Facts & Figures for Hispanics/Latinos 2018-2020. Atlanta: American Cancer Society, 2018

Hispanics have a higher rate of cervical cancer compared with Whites. Hispanic women have an approximately 43 percent higher risk of cervical cancer incidence compared to White women.
Source: American Association for Cancer Research Cancer Disparities Progress Report 2022.

Hispanic women have a significantly higher incidence rate of cervical cancer and slightly higher mortality rate, with especially high rates occurring along the Texas-Mexico border.
Source: U.S. Preventive Services Task Force. Cervical Cancer: Screening (2018) 

American Indian/Alaska Native.  Compared to White people, AI/AN people had a higher incidence rate during 2014-2018 for cervical cancer.
Source: American Association for Cancer Research Cancer Disparities Progress Report 2022.

Screening

Black women. Several studies have found that African American women are screened for cervical cancer at rates similar to those for white women and that inadequate follow-up after screening and differences in treatment may be important contributing factors for their greater rate of mortality.
Source: American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021. Atlanta: American Cancer Society, 2019

Asian American women.  Asian women also have lower screening rates, especially those who have recently immigrated to the United States and may have language or cultural barriers to screening.
Source: U.S. Preventive Services Task Force. Cervical Cancer: Screening (2018)

Strains of HPV

Hispanic women. Cervical cancer is caused by persistent infection with certain strains of HPV. These carcinogenic strains of HPV have a higher prevalence among Hispanic women.
Source: American Association for Cancer Research Cancer Disparities Progress Report 2022.

Tumor type

Black women.The higher mortality rate in African American women may be attributable, in part, to the higher than average rate of adenocarcinoma, which carries a worse prognosis than the most common type of cervical cancer (squamous cell carcinoma).
Source: U.S. Preventive Services Task Force. Cervical Cancer: Screening (2018)

Stage at diagnosis

Black women.  Racial differences in stage at diagnosis may be due to differences in the quality of screening and/or follow-up after abnormal results. Black women have lower survival than White women for every stage of diagnosis, likely reflecting disparities in access to care and receipt of high-quality treatment. 
Source: American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

 

Black women are more likely than white women to be diagnosed with regional- or distant-stage disease. This may be due to differences in the quality of screening and follow-up after abnormal results. Lower socioeconomic status and lack of health insurance are also associated with lower screening rates and increased risk of late-stage diagnosis.
Source: American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021. Atlanta: American Cancer Society, 2019

Hispanic women. The proportion of Hispanic women with cervical cancer who are diagnosed with localized disease is slightly lower than that in non-Hispanic whites (42% versus 44%, respectively).  
Source: American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020.  Atlanta: American Cancer Society, 2018

Treatment

Black women. Black women have lower survival than White women for every stage of diagnosis, likely reflecting disparities in access to care and receipt of high-quality treatment. For example, one study found that among people diagnosed with early-stage disease, 17% of Black women did not receive surgery compared to just 9% of White women. Further, Black women are less likely to receive recommended radiation therapy for every stage of disease. 
Source: American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

Treatment differences accounted for 47% of black-white differences in cervical cancer mortality. Lack of health insurance may explain 19% of the excess risk for blacks. Among early-stage cervical cancer patients, a greater proportion of black women (17%) failed to receive surgery, which is the standard of care, compared to white (9%) and Hispanic (12%) women.
Source: American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021. Atlanta: American Cancer Society, 2019

5-year survival

Black women. The overall 5-year relative survival rate for cervical cancer among Black women is 56%, compared to 67% among White women, partly because Black women are more likely to be diagnosed with regional- or distant-stage disease.
Source: American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

Hispanic women.  Five-year survival for cervical cancer is 72% among Hispanic women and 70% among non-Hispanic whites.
Source: American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020.  Atlanta: American Cancer Society, 2018

Mortality

Black women. Cervical cancer death rates have declined steadily since the 1970s , mostly as a result of screening. Rates in Black women continued to decline by 2% per year from 2010 through 2019, but have stabilized in White women in recent years. Despite this progress, Black women remain 65% more likely to die from cervical cancer than White women, with an even larger disparity after rates are corrected for hysterectomy prevalence.
Source: American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

The overall mortality rate from cervical cancer among African American women is more than twice the rate among white women (when adjusted for hysterectomy rate since this procedure removes the cervix). Mortality is higher among older African American women. 
Source: U.S. Preventive Services Task Force. Cervical Cancer: Screening (2018)

Hispanic women.  Despite steady declines, death rates in Hispanic women during 2012-2016 remained 26% higher than those in whites. 
Source: American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020.  Atlanta: American Cancer Society, 2018.

Hispanic women have about a 20 percent higher risk of death from cervical cancer compared to White women.
Source: American Association for Cancer Research Cancer Disparities Progress Report 2022.

White women. Although white women overall have the lowest mortality rate from cervical cancer, white women living in geographically isolated and medically underserved areas (particularly Appalachia) have much higher mortality rates than the US average.
Source: U.S. Preventive Services Task Force. Cervical Cancer: Screening (2018)

American Indian/Alaska Native women.  American Indian/Alaska Native women have higher rates of cervical cancer mortality than the US average. Factors driving this higher rate may include (1) lower screening rates, with 16.5% of American Indian/Alaska Native women in 2012 reporting not receiving a Pap test in the past 5 years and (2) inadequate follow-up. 
Source: U.S. Preventive Services Task Force. Cervical Cancer: Screening (2018)

Why are Black women more likely to die from cervical cancer?

“There really isn’t a genetic difference that is causing Black women to die at higher rates of cervical cancer,” says Olivia Cardenas-Trowers, MD, a Mayo Clinic urogynecologic surgeon.

“It really has to do more with systemic racism. These disparities started way back when and have infiltrated the healthcare system and affected women’s access to resources and the health care that they need. This trickles down into poor outcomes.

Things that you might not even think of, like transportation, health literacy, even trust in their provider because of injustices that have happened in the past. These things affect their health care.

They may not undergo the typical screening that could catch a abnormality earlier and therefore these cancers may be diagnosed at later stages when the likelihood of mortality is higher. Also, they may have problems getting access to treatment. They may not have the finances to be able to undergo surgery, or chemo or radiation. So all of these can factor into the increased mortality in Black women.”

A 7-minute video from the Mayo Clinic

Some Reasons for Higher Death Rates in Black Women

“We do think there are reasons why Black women have higher rates of cervical cancer mortality,” says Jennifer Caudle, MD, of the Rowan University School of Osteopathic Medicine in New Jersey.

“Access to care, the ability to get screened early, to get screened period. The type of cancer Black women get vs White women and the types of treatment they’re offered.”

“Those are some of the things that have been proposed as possibilities as to why we see these discrepancies.”

A 2-minute video from the PBS News Hour.

Where Rates of Cervical Cancer Are High

Cervical cancer rates have been dropping in the United States over the past several decades. But some groups continue to have high rates.

These include Black women in the South, Hispanic women along the US-Mexican border, and White women in Appalacia.

Also specific groups of Native Americans, Asian Americans, Alaska Natives and Pacific Islanders have higher rates. This is due in part to lack of access to screening programs.

A 3-minute video from the National Cancer Institute.

 

Alabama Has Highest Rate of Cervical Cancer Deaths

In Alabama, the rate of cervical cancer deaths is higher than in any other state.

Black women are twice as likely as White women to die from cervical cancer in Alabama.

Some of the barriers to access to care for women, particularly in Alabama, are access to consistent coverage for insurance. Also, there just aren’t enough doctors in rural Alabama. And because there aren’t enough doctors, transportation to the health system becomes a significant barrier.

A 5-minute video from Human Rights Watch.

"Some women didn’t talk to doctors about their reproductive health"

“I conducted over 20 interviews with Black women from South Georgia about their experiences accessing reproductive healthcare, as well as their knowledge about the cervical cancer disease and prevention,” says Olivia Coley Pearson.

“As I anticipated, lack of medical insurance, as well as lack of reproductive and obstetrical and gynecological services located in rural counties were among the substantial barriers faced by most rural women with limited or no reliable transportation, as well as inadequate broadband (if at all) and other sources of public information.

However, I was continuously astonished by stories that revealed the extent to which women were traumatized by the worst kind of neglect and abuse at the hands of physicians who were less compassionate or lacked the resources and training needed to equitably treat all patients.

Internalized trauma has led to decades of generational mistrust and fear. Some women shared that they didn’t talk to doctors about their reproductive health because of mistrust of doctors and the system.”

Pearson, a community-based researcher for Southern Rural Black Women’s Initiative and Human Right Watch, is the first Black woman elected city commissioner of Douglas, Georgia.

Source: Black women die disproportionately from preventable cervical cancer.

Hispanics and Cervical Cancer

Why Hispanic Women Are Still Dying From A Curable Cervical Cancer

by Sarah Felbin

A lack of health insurance prevents some from regular physician visits. Language is often another obstacle. For women who aren’t proficient in English, medical jargon and pamphlets can be frustrating to receive.

Girls grow up without receiving proper sex education, resulting in a lack of self-care, a lack of information towards their body, and their overall health.

There’s also the cultural expectation that a woman’s role is to be in charge of the household. Especially in the Latino community, you do everything, you put yourself last, you have to take care of everyone else’s needs.

See: “Why Hispanic Women Are Still Dying From A Curable Cancer” by Sarah Felbin on the Women’s Health magazine website (October 15, 2021)

Voices about Cervical Cancer

Jacqueline Walters, MD

“African American women are two times more likely to die from cervical cancer.

We are affected more than any other racial or ethnic group,” says OBGYN physician Jacqueline Walters, MD.

“Early detection is your best protection. So you need to start with a well-woman exam. Go in for an annual visit with your doctor. This visit is two parts. It’s discussion and physical exam.

So make sure you’re asking for your cervical cancer screening that is appropriate for your age. For example, if you’re over the age of 30, you want co-testing. This is Pap test plus HPV.”

A 3-minute video from WMAR-2 News, a Baltimore television station.

 

Ciara

“The cool thing is you can prevent cervical cancer. How amazing is that?” asks singer and businesswoman Ciara. 

“Screen for things llike cervical cancer with Pap and HVP testing. Black women are twice as likely to die from cervical cancer than other women.”

“Go out there and make an appointment. Put yourself first, you have to. Putting yourself first is everything. Then you can take off and be your best self in every way possible.”

Ciara has teamed up with Project Health Equality and the Black Women’s Health Imperative for their “Cerving Confidence” campaign to raise awareness of cervical cancer in Black women.

A 2-minute video from MultiVu.

Jessica Shepherd, MD

“The best way to prevent cervical cancer is screening. So when you go to your doctor, you want to make sure that’s an annual relationship, you’re going to your doctor every year,” says OBGYN physician Jessica Stewart.

“At the age of 21 is when you want to start doing your Pap screening. And between the ages of 30 to 65 is making sure that you’re getting your Pap and HPV together. Because the HPV test is able to detect most cervical cancers. And don’t be afraid to ask questions.

The tests are covered by the Affordable Care Act. There should be no copay, no deductible.”

A 2-minute video from television station News4JAX in Jacksonville, Florida. The video also includes a conversation with sports reporter and cervical cancer survivor Erin Andrews. 

"We should not lose another soul to cervical cancer."

“African American women have the highest mortality rate for cervical cancer because we are not getting screened, we are not going to the doctors, we are not taking our health into our own hands,” say Latasha Bostick and Darlene Cook, cervical cancer survivors.

“They don’t have a vaccine for breast cancer, lung cancer, prostate cancer. They have a vaccine for us! We should not lose another soul to cervical cancer. Come on now y’all, It’s the new millennium! What are you waiting for? This cancer is preventable.”

A 1-minute video from CervivorTV.

"It's not just about you. It's about your loved ones, too."

Chilean-American actress and singer Cote de Pablo was too busy with her career and life to get a regular Pap test. When she finally got around to it, “things didn’t look too good. We thought I might have cervical cancer.” But after lots of worries, no cancer.

“I’ve always been very close to my mother. When we finally got the results, she broke down. And that’s when I realized it’s not just about me. It’s about your loved ones, too.

So, women get a Pap test to check for cervical cancer. Please pay attention to your health for you and the people who care about you.”

A 1-minute video from the Centers for Disease Control and Prevention (CDC).

An average of 11 women die of cervical cancer each day in the United States. Half of them are in their 50s or younger.

Source: Cancer statistics, 2022. American Cancer Society. 

"There are glaring racial disparities in cervical cancer deaths in the U.S."

“Although almost no one should die from cervical cancer, some groups—those that are historically marginalized and neglected in the US, including women of color, women living in poverty, and those without health insurance—die more often than others.

There are glaring racial disparities in cervical cancer deaths in the US and Black women die of the disease at a disproportionately high rate. Black women have a higher risk of late-stage diagnosis, and they are more likely to die from the disease than any other racial or ethnic group in the country.

In the state of Georgia, Black women are almost one and a half times as likely to die of cervical cancer as white women and these disparities increase at alarming rates as they age. Black Georgian women are more likely to have never been screened for cervical cancer, are diagnosed at a later stage, and have lower five-year survival rates.”

About Cervical Cancer

Learn about the risk factors for cervical cancer and what you might be able to do to help lower your risk. Know the signs and symptoms of cervical cancer. Find out how cervical cancer is tested for, diagnosed, and staged.

Learn how to lower your risk and about the symptoms, risk factors, screening tests, and diagnosis and treatment for cervical cancer.

Explore the links here to learn about cervical cancer prevention, screening, treatment, statistics, research, clinical trials, and more.

Understanding Cervical Cancer

“All women are at risk for cervical cancer,” says Tina Ayeni, MD, cancer surgeon at the Franciscan Physician Network in Indiana. “Ninety-nine percent of cervical cancers are due to HPV, which is a virus acquired sexually.”

“Sometimes cervical cancer can be asymptomatic. Sometimes it’s picked up just because there’s an abnormality on a Pap smear. More classic symptoms would include abnormal bleeding.”

A 1-minute video from Franciscan Health in Indiana. 

Signs & symptoms of cervical cancer

“If you have cervical cancer, you can get abnormal vaginal bleeding, even when you’re not on your menstrual cycle,” says Frita McRae Fisher, MD. You may also have some spotting or some bleeding after sexual intercourse. Other symptoms include pain, especially pelvic pain.

“The goal is to prevent cervical cancer so you never have to endure these signs and symptoms. So how do we prevent cervical cancer? We do so with screening and prevention and our two main tools are the Pap smear and HPV vaccination.”

An 11-minute video from Dr. Frita.

If you notice anything unusual for 2 weeks or more

Pelvic pain or pressure that doesn’t go away. You don’t know why you’re feeling too full too fast, even when you eat just a little. Unusual bleeding or spotting. Bloating pain or pressure.

These could be symptoms of a gynecologic cancer such as cervical cancer. If it goes on for two weeks or longer, see a doctor. It may be nothing, but find out for sure.

A 1-minute video from the Centers for Disease Control and Prevention

Cervical Cancer Screening Recommendations

“Cervical cancer is relatively easy to treat if it is caught at an early stage.”
The Society for Gynecologic Oncology

American Cancer Society (2020)

The American Cancer Society updated its guidelines in July 2020:

Women aged 25 to 65 should have a primary HPV test every 5 years. If primary HPV testing is not available, screening may be done with either a co-test that combines an HPV test with a Pap test every 5 years or a Pap test alone every 3 years. The most important thing to remember is to get screened regularly, no matter which test you get.

Those over age 65 who have had regular screening in the past 10 years with normal results and no history of CIN2 (moderately abnormal cells found on the surface of the cervix) or more serious diagnosis within the past 25 years should stop cervical cancer screening. Once stopped, it should not be started again.

Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests), unless the hysterectomy was done as a treatment for cervical cancer or serious pre-cancer.

Women who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) should continue cervical cancer screening according to the guidelines above.

Women who have been vaccinated against HPV should still follow these guidelines for their age groups. Some people believe that they can stop cervical cancer screening once they have stopped having children. This is not true. They should continue to follow American Cancer Society guidelines.

Source: The American Cancer Society Guidelines for the Prevention and Early Detection of Cervical Cancer

The American Cancer Society (ACS) recommendations on screening for cervical cancer are for individuals with a cervix who do not have symptoms of cervical cancer, who have never had a diagnosis of cervical cancer or precancer, and who do not have a health condition that weakens the immune system.
Screening for Cervical Cancer

Centers for Disease Control and Prevention (CDC) (2021)

If you are 21 to 29 years old, you should start getting Pap tests at age 21. If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test.

If you are 30 to 65 years old, talk to your doctor about which testing option is right for you:

  • Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test.
  • HPV test only. This is called primary HPV testing. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.
  • HPV test along with the Pap test. This is called co-testing. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test.

If you are older than 65, your doctor may tell you that you don’t need to be screened anymore if

  • you have had normal screening test results for several years, or
  • you have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.

Source: What Should I Know About Screening? (2021)

U.S. Preventive Services Task Force (2018)

Note: The USPSTF is currently updating its screening recommendations for cervical cancer (October 21, 2021)

For women aged 21 to 29 years, the USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).

The USPSTF recommends against screening for cervical cancer in (1) women younger than 21 years; (2) women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion; (3) in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

Source: U.S. Preventive Services Task Force. Cervical Cancer: Screening (2018)

The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine who make evidence-based recommendations about clinical preventive services. Most private insurance plans are required to cover without a copay recommended preventive services that receive a grade of A or B from the Task Force.

Screening guidelines made simple

Cervical cancer screening guidelines can be confusing, but they don’t have to be. This video breaks down a complicated subject into a few simple steps.

A 3-minute video from the American Sexual Health Association

When to get screened

Maria Lynes-Eme, MD, discusses the recommendations for when to get screened for cervical cancer and when youth should receive the HPV vaccine.

A 2-minute video from Med Center Health of Kentucky

What's the difference between an HPV test and a Pap test?

The HPV test and Pap test are done the same way. A health professional uses a special tool to gently scrape or brush the cervix to remove cells for testing.

HPV test. HPV is a virus that can cause cervix cell changes. The HPV test looks for cervical infection by high-risk types of HPV that are more likely to cause pre-cancers and cancers of the cervix. The test can be done by itself or at the same time as the Pap test (called a co-test) (with the same swab or a second swab), to determine your risk of developing cervical cancer. The American Cancer Society recommends a primary HPV test as the preferred way to screen for cervical cancers or pre-cancers in individuals 25 to 65 years with a cervix. (A primary HPV test is an HPV test that is done by itself for screening. The US Food and Drug Administration has approved certain tests to be primary HPV tests.)

A Pap test is used to find cell changes or abnormal cells in the cervix. (These abnormal cells may be pre-cancer or cancer, but they may also be other things, too.) Cells from the cervix are sent to a lab and looked at closely to see if the cells are normal or if changes can be seen.

Because a primary HPV test may not be an option everywhere, a co-test every 5 years or a Pap test every 3 years are still good options because they are all good at finding cancer and pre-cancer. But the primary HPV test is better at preventing cervical cancers than a Pap test done alone and does not add more unnecessary tests, which can happen with a co-test. The most important thing to remember is to get screened regularly, no matter which test you get.

Source: “HPV and HPV Testing” (American Cancer Society)

Which Human Papillomaviruses does HPV testing look for?

There are more than 100 human papillomaviruses. By convention, “HPV testing” refers to the clinical testing for either 13 or 14 of the high-risk HPV types that account for nearly all cervical cancers.

Some HPV tests provide “genotyping.” This refers to testing that specifically identifies HPVs 16 and 18, whereas the other high-risk HPVs are detected within a pooled group. HPVs 16 and 18 are considerably more cancer-causing than the others.

It is widely accepted that testing for low-risk HPV types (types 6 and 11) has no value in clinical practice and is strongly discouraged.

Source: “Current choices in cervical cancer screening” by Ilana Cass, MD, and Claudia L. Werner, MD on the Contemporary OB/GYN website (December 6, 2021)

What happens during a Pap test?

Pap tests, sometimes called Pap smears, are very important tests for finding abnormal cells on your cervix that could lead to cervical cancer.

Pap tests find cell changes caused by HPV, but they don’t detect HPV itself. They may be part of your regular check up, pelvic exam or well-woman exam.

During a Pap test, your doctor or nurse uses a small sampler — a tiny spatula or brush — to gently collect cells from your cervix. The cells are sent to a lab to be tested.

Source: “What’s a Pap test?” on the Planned Parenthood website

Lily videoed herself getting Pap Pap test to show it's not scary

Lily Taylor was diagnosed with cervical cancer at age 27. She admits she received an abnormal Pap test result six years earlier and foolishly didn’t follow it up.

“At the time, I thought I was invincible and because I was embarrassed, I convinced myself to not go and get another Pap and get checked out.”

Now at age 32, she’s made a video of herself getting a Pap test to show women “that it’s not as scary or embarrassing as you might sometimes think.”

A 3-minute video from Lily Taylor.

What happens during a HPV test?

An HPV test looks for some high-risk types of the human papilloma virus, including types 16 and 18, which cause most cases of cervical cancer.

During an HPV test, your doctor or nurse then uses a small sampler — a tiny spatula or brush — to gently take a small number of cells from your cervix. The cells are sent to a lab to be tested. An HPV test only takes a few minutes. It shouldn’t hurt, but you might feel some discomfort or pressure.

An HPV test may be part of your regular checkup. Sometimes you’ll get an HPV test at the same time as a Pap test — this is called co-testing. 

Source: “What’s an HPV test?” on the Planned Parenthood website.

Pap test led to sharp decline in cervical cancer deaths

The Pap test has been the most successful cancer screening program in history. The rate of cervical cancer, which was a leading cause of death among women, has fallen by more than 70 percent since the Pap test was introduced over 50 years ago. Previously, cervical cancer was the leading cause of cancer death in women, but now it is the fifteenth most frequent.

Source: hologicwomenshealth.com

Pap smear cervical cancer Helen Octavia Dickens

The Black Physician Who Popularized the Pap Smear

Helen Octavia Dickens, MD,  pioneered the popularity of the Pap smear, helping to save hundreds of lives. The daughter of a former enslaved person who encouraged her to become a nurse, Dickens had other ideas, remembering that “I got it into my head that if I were going to be a nurse, I might as well be a doctor.”

Dickens instigated a program, funded by the National Institute of Health, to carry out Pap tests to detect cervical cancer and was instrumental in spreading the use of the Pap test throughout Pennsylvania. 

For the story of Dickens’ remarkable career and the obstacles she overcame as a pioneering Black female physician, see “The female physician who popularised the Pap smear” by Rachel E Gross on the BBC website (October 12,  2020)

Insurance Coverage for Screening

Private health insurance. Coverage of cervical cancer screening tests is mandated by the Affordable Care Act (ACA or Obamacare), but that doesn’t apply to health plans that were in place before it was passed on September 23, 2010. If your plan started before that, it may still have coverage requirements mandated by your state, but each state is different.

Medicaid or public assistance: These programs in all 50 states and the District of Columbia cover screening for cervical cancer either routinely or on a doctor’s recommendation.

Medicare Part B. This covers tests used for cervical cancer screening, including a Pap test and pelvic exam every 2 years. For people at high risk for cervical or vaginal cancer, Medicare covers screening every year. This screening is provided without co-pay, co-insurance, or deductible as long as you go to a doctor that accepts Medicare.

Source: Cervical Cancer Prevention and Screening: Financial Issues

For low-income, uninsured, and underinsured women

CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screenings and diagnostic services to low-income, uninsured, and underinsured women across the United States.

You may be eligible for free or low-cost screenings if you meet these qualifications—

  • You have no insurance, or your insurance does not cover screening exams.
  • Your yearly income is at or below 250% of the federal poverty level.external icon
  • You are between 40 and 64 years of age for breast cancer screening.
  • You are between 21 and 64 years of age for cervical cancer screening.
  • Certain women who are younger or older may qualify for screening services.

For more information, visit CDC’s Find a Screening Program Near You.

HPV Vaccine Recommendations

“This vaccine can prevent most cases of cervical cancer if given before a girl or woman is exposed to the virus.”
Source: “HPV vaccine: Who needs it, how it works” (Mayo Clinic)

More than 9 of every 10 cases of cervical cancer are caused by human papillomavirus (HPV) infections. HPV vaccination can largely prevent cervical cancer, as well as other cancers caused by HPV, including cancers of the vagina, vulva, penis, anus, and back of the throat.
Source: Centers for Disease Control and Prevention (CDC) 

Centers for Disease Control and Prevention (2020)

HPV vaccination is recommended for all preteens (including girls and boys) at age 11–12 years. CDC recommends that 11- to 12-year-olds receive two doses of HPV vaccine 6 to 12 months apart.

Teens and young adults through age 26 years who didn’t start or finish the HPV vaccine series also need HPV vaccination. Teens and young adults who start the series later, at ages 15 through 26 years, need three doses of HPV vaccine.

Vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years may decide to get the HPV vaccine after speaking with their doctor about their risk for new HPV infections.

The only HPV vaccine currently distributed in the United States is Gardasil-9 (from Merck), which protects against 9 HPV types, including types 16 and 18 that cause most HPV cancers.

Source: Human Papillomavirus (HPV) Vaccination: What Everyone Should Know  (2020)

American Cancer Society (2020)

HPV vaccination can prevent more than 90% of HPV cancers when given at the recommended ages. The American Cancer Society recommends that boys and girls get the HPV vaccine between the ages of 9 and 12. Teens and young adults through age 26 who are not already vaccinated should get the HPV vaccine as soon as possible. Teens who start the series late may need 3 shots instead of 2. HPV vaccination is not recommended for persons older than 26 years.

Source:  American Cancer Society. Prevent 6 Cancers with the HPV Vaccine. (2020)

American Academy of Pediatrics

“The American Academy of Pediatrics recommends routine HPV vaccination for females and males. The Academy recommends starting the series between 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series.”

Source:  American Academy of Pediatrics.  Why AAP recommends initiating HPV vaccination as early as age 9 (2019)

Help your kids prevent cancer

“You love your kids and you do anything for them.  You’ve protected them since day one from all the  obvious things.

But what about cancer? HPV is a virus that infects 80% of men and women. If the body does not clear the virus, it can cause cancer.

The HPV vaccine is a safe and effective way to prevent  these cancers with no more side effects than any other vaccine. It’s an easy thing you can do to keep your children  healthy and protect them from cancer.”

A 1-minute video from MD Anderson Cancer Center.

About the HPV Vaccine in the U.S.

The only HPV vaccine approved and available in the United States is called Gardasil 9, produced by the U.S. pharmaceutical company Merck. It’s called “9” because it protects against 9 strains of HPV: numbers 6, 11, 16, 18, 31, 33, 45, 52, and 58.

These strains are associated with the majority of cervical cancer, anal cancer, and throat cancer cases,  as well as most genital warts cases and some other HPV-associated ano-genital diseases.

The vaccine was initially approved for only cervical cancer prevention, but in 2020 the FDA broadened approval to include the prevention of oropharyngeal cancer and other head and neck cancers.

Source: “The HPV Vaccine: Access and Use in the U.S.” on the KFF, also known as The Henry J. Kaiser Family Foundation, website.

How the HPV vaccine helps to prevent cervical cancer

When you are vaccinated with the HPV vaccine, your immune system is capable of combatting most of the types of HPV which can cause cervical cancer.

Many large studies have shown the vaccine is safe and effective in preventing dysplasia (precancerous changes in cells) and cervical cancer.

In one of the studies of the vaccine, young girls who received a placebo shot were more than 50 times more likely to develop cervical dysplasia after 4 years than girls who received the HPV vaccine.

A 3-minute video from the Danish Medicines Agency in partnership with the World Health Organization. Regional Office for Europe.

If the HPV vaccine had been available earlier, I wouldn't have suffered

If the HPV vaccine had been available when I was younger, I believe I wouldn’t have gone through cervical cancer, a radical hysterectomy, radiation and chemotherapy, and  two clinical trials, says Constance Hill.

“My advice for parents considering the HPV vaccine, if you can save your child from having to go through all the cancer treatments, do it.”

A 1-minute video from MD Anderson Cancer Center

Young Males Need the HPV vaccine to Protect Themselves, Too

“A lot of people typically associate HPV infections with cervical cancer, but high-risk HPV can cause a variety of cancers, including oropharyngeal cancer, which is cancer of the throat, tonsils and back of the tongue,” says  Michelle Chen, MD, of the University of Michgan.

Over 80 percent of the people in the United States who get oropharyngeal cancer are men. Over the past decade, oropharyngeal cancer has been increasing in incidence and it’s the fastest rising HPV-associated malignancy.

A 3-minute video from Michigan Medicine.

I don't want my daughters saying I didn't protect them from cervical cancer

“I gave the HPV vaccine to both of my daughters,” says Atlanta, Georgia, pediatrician Yabo Beysolow, MD. 

“I really do not want them to come to me 20 years from now, saying ‘Mom, I have cervical cancer and you did nothing to protect me’.”

“This is a vaccine that is safe, effective and it can prevent cancer.”

A 1-minute video from the Centers for Disease Control and Prevention.

Cervical Cancer Support Groups

“I created this Facebook Cervical Cancer Support Group as a support community for those effected by Cervical Cancer. You may be the patient, or the loved one of a cervical cancer patient. Here you can meet others battling this terrible disease, share stories, etc. This is a place where patients and survivors come together to support one and other.”

Cervivor is a community, a learning tool, an advocacy resource, and an online retreat for healing, connecting and thriving. While everyone experiences cervical cancer as an individual, we want to help survivors bring their collective wisdom together to create a community of advocates.”

 

The mission of the National Cervical Cancer Coalition is “to help women, family members and caregivers battle the personal issues related to cervical cancer and HPV and to advocate for cervical health in all women by promoting prevention through education about early vaccination, Pap testing and HPV testing when recommended.”

Active Cervical Cancer Facebook Pages

Free Downloads

“If You Have Cervical Cancer”
A short, simple guide to cervical cancer from the American Cancer Society.
Free download here 

A 2-page introduction to cervical cancer from the American Society of Clinical Oncology.
Free download here

Two-page fact sheet about cervical cancer from the Centers for Disease Control and Prevention (CDC)
Free download here

National Comprehensive Cancer Network Guidelines for Patients are developed by
the National Comprehensive Cancer Network, an alliance of leading cancer centers across the United States devoted to patient care, research, and education. The Guidelines present information in an easy-to-learn format for people with cancer and those who support them and explain the cancer care options likely to have the best results.
Free download here

Publications

American Cancer Society. American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

American  Association for Cancer Research: Cancer Disparities Research Report 2020

American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. Atlanta: American Cancer Society, 2018

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