Cervical Cancer Rates are Highest Among Poor and Minorities: Feds push program to educate, bridge cultural concerns, but doctors blame lagging health services. LAURAN NEERGAARD / AP 26jul2005

Mindfully.org note: As usual, the focus is on prevention of death rather than prevention of cancer. This is true in spite of the fact that prevention of cancer would be the most effective method of reducing mortality from it. This is true of all cancers. No person could argue with this.

However, most money is spent on research and treatment. To put this paradox into perspective one must perceive the healthcare industry simply as just another industry just like manufacturing cars or guns. Whether we focus on nonprofits such as hospitals and cancer organizations or for-profit businesses such as pharmaceuticals and genetic engineering corporations, it is vital to understand that this is just a business. We are perceived as nothing more than statistics to profit on.

If the industry were to prevent cancer, which by the way would require spending zero dollars, the profit incentive would be lost. By allowing cancers to continue, the industry insures future profits. We see their mission as this: "Keep the patient alive so that they can purchase continually more healthcare products." Obviously there are limits to the healthcare industry's profit from a dead person. But a healthy person also has extreme limits to profitability for the industry.

The healthy alternative would be to end the daily habits that give us cancer. End the war in Iraq and other places immediately; work less; exercise more; laugh more; stop using most healthcare products (shampoos, deodorants, etc); eat fresh, locally-grown organic produce; drive much less; stop using microwave devices (cell phones, wireless phones, food microwaves); end the use of household cleaning products except those which can be made by simple and safe ingredients (no bleach or ammonia products, etc). Maintain your own health by staying healthy in the first place. This takes initiative on your own part to educate yourself and stop relying on people and products that do not maintain your health.

We can end cancer, but only if we end the profit incentive for prolonging it.

WASHINGTON — Virtually all deaths from cervical cancer are preventable, yet the disease will kill almost 4,000 women in this country this year. Frustrated scientists know who most of them will be: black women in the South, Hispanics along the Texas-Mexico border, white women in Appalachia and the rural Northeast, Vietnamese immigrants.

Efforts are under way to reach those women, including a $25 million federal program poised to let communities recruit volunteers — average women who speak their patients' language and can engender trust — to push Pap testing and shepherd the newly diagnosed through an often-baffling medical system.

It's work made more urgent by the discovery that excess cervical cancer is a red flag for other health disparities: The same localities also have too-high rates of breast and colorectal cancer, strokes and infant mortality.

The new report, from the National Cancer Institute, will "hopefully ring a bell for policymakers" in those communities, said Dr. Harold P. Freeman, a cancer specialist who works in Harlem and directs the institute's Center to Reduce Cancer Health Disparities.

Pap smears are credited with slashing cervical cancer deaths by 75 percent in recent decades. This simple $50 test can detect precancerous cells in time to prevent cervical cancer from forming — or, if it's already there, in time to cure this usually slow-growing malignancy.

But most invasive cervical cancer is found in women who haven't had a Pap smear in five years, or never.

Poverty is one culprit. Also, women with no regular doctor slip through the cracks. Older women are less likely to get a Pap smear, as are recent immigrants, perhaps because of language or cultural issues.

"Cervical cancer shouldn't be a cause of death anymore, in fact it shouldn't be a problem anymore," said Dr. Stephen J. McPhee of the University of California-San Francisco. "Yet here we are in 2005 dealing with a problem that should have been fixed 25 years ago. It's a bad reflection on the U.S. health delivery system."

Some facts about cervical cancer disparities, according to a new report from the National Cancer Institute:

source: http://www.washingtonpost.com/wp-dyn/content/article/2005/07/25/AR2005072500870.html 26jul2005

High Cervical Cancer Rates Sign of Larger Problems

ALISON McCOOK / Reuters Health 22jul2005

NEW YORK — Despite overall declines in cervical death rates in the U.S., certain groups of women are significantly more likely to die from the disease, which is likely due to underlying disparities access to health care, according to a new report from the National Cancer Institute.

The investigators found that women living in areas with high death rates from cervical cancer were less likely to have a usual source of health care or to use preventive services, such as cancer screening.

These women also tended to have low income and education levels, and experienced relatively high rates of other diseases such as breast cancer, colorectal cancer and heart disease.

High rates of cervical cancer "are markers for a lot of other events," according to study author Dr. Harold P. Freeman, director of the National Cancer Institute's Center to Reduce Cancer Health Disparities in Rockville, Maryland.

Freeman added that all of the above diseases, like cervical cancer, can be screened for and treated.

In the case of cervical cancer, annual Pap smears help diagnose cervical cancer in its very early stages, when it can be very effectively treated, he said. It's a "cancer from which, presumably, no woman should die."

However, 4,000 women still die every year from cervical cancer, Freeman said, probably because, in part, they have limited access to services to detect the cancer in its early stages.

But to help reduce cervical cancer rates, experts also need to educate women about why it's important to be screened, and how to do it. "We need to couple education to access," Freeman told Reuters Health.

In their analysis, Freeman and his team reviewed the available study findings on cervical cancer rates in the U.S. and the circumstances of women living in areas where death rates remain high.

They found that cervical cancer death rates are generally declining in the U.S., but remain high among African-American women in the south, women living along the Mexican border, white women in Appalachia, American Indians in the Northern Plains, Vietnamese-American women, and Alaska Natives.

Freeman and his team summarize their findings in the NCI report Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities.

Previous research, also out of the National Cancer Institute, has shown that cervical cancer rates trended downward between 1975 and 2000, but women in high poverty counties had at least a one-third higher incidence than women in low poverty counties.

Cervical Cancer High Amongst Minorities and Poor

PRESS RELEASE / National Cancer Institute / NIH 18jul2005

Report Finds High Rates of Cervical Cancer Indicate Broader Problems in Access to Care

A new report released today by the National Cancer Institute, part of the National Institutes of Health, finds that high rates of cervical cancer are indicators of larger problems in access to health care. The report also finds that cervical cancer mortality, which is higher in certain geographic areas and populations, is a marker for other health disparities. The authors of the new report, compiled by NCI’s Center to Reduce Cancer Health Disparities (CRCHD) and titled Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities*, conclude that the nation’s public health system must improve its delivery of cervical cancer education, screening, and treatment and related health care to women at risk.

Despite a consistent decline in cervical cancer deaths in the United States overall, patterns of high cervical cancer mortality have existed for decades in specific geographic areas and populations. Those groups with the highest mortality rates include African American women in the South, Hispanic women along the Texas-Mexico border, white women in Appalachia, American Indians of the Northern Plains, Vietnamese American women, and Alaska Natives.

The authors of this report hypothesize that cervical cancer is an indicator of larger health system concerns, including medical care access, cultural issues, and health communication and education issues. To examine the underlying causes of this ongoing disparity, CRCHD embarked on a two-phase project, the Cervical Cancer Mortality Project. In the first phase, researchers reviewed the literature and analyzed both historical and current data on cervical cancer incidence, screening, treatment and mortality in the United States. An analysis of the literature showed that women suffering from high cervical cancer mortality share several life conditions: they tend not to have a usual source of health care; have lower rates of preventative health services, including cancer screening; have low incomes and educational levels; and live in regions with high rates of screenable and treatable diseases, such as breast cancer, colorectal cancer, cerebrovascular disease, and infant mortality.

CRCHD Director Harold P. Freeman, M.D., emphasized the importance of efforts to find a solution to this problem. “Effectively addressing cervical cancer mortality can provide a model for action and an opportunity to address not only the health problems facing women who are dying from cervical cancer, but also the full set of human circumstances that lead to health disparities.”

The authors of the report outline specific actions and targeted interventions to eliminate cervical cancer mortality disparities. These actions fall into four key strategy areas: access (services, outreach, and navigation); information and communication; collaborations, partnerships, and advocacy; and research.

The authors recommend that health care workers intensify outreach to women who have rarely or never been screened for cervical, breast, or colon cancer and other screenable diseases. To achieve this outreach, the report suggests that it is very important for women at risk for cervical cancer and other cancers to have a “medical home” — a usual source of medical care where they can receive screening and counseling, experience continuity of care, and build relationships with the medical caregivers. The authors also recommend pairing all women with patient navigators at local hospitals or primary health centers, who can help at-risk women through the health system once an abnormality has been detected. Increased patient navigator programs would help improve communication between primary care, screening services, and follow-up/treatment at hospitals.

The report also suggests strategies to remove cultural and economic barriers to care. When only male physicians are available to conduct examinations, distrust and cultural taboos may cause at-risk women to avoid screening. Increasing the number of female providers, particularly those of the patient’s race/ethnicity, is an important step in breaking down resistance to screening. The report also calls for improved coverage and reimbursement for cancer-related services. Specifically, the report recommends that any uninsured woman with cervical or other cancer should be considered eligible for Medicaid or Medicare for the duration of her treatment and follow-up care.

Native-born populations in high cervical cancer mortality areas tend to reach lower educational status and require materials written at a level that matches their reading levels. The authors of the report recommend working with community members to develop linguistically and culturally appropriate information about this disease. Effective translation is an integral part of reaching women in high-risk populations, and the report recommends improving provider-patient communication through provider tools and availability of language translation.

Additional research is needed to study the effects of numerous factors on cervical cancer mortality, including insurance status, transportation, lack of a medical home, human papillomavirus (HPV) prevalence, smoking, sexual practices, and condom use. The authors emphasize the need to optimize HPV testing and vaccine development to eliminate the cause of 90 percent to 95 percent of all cervical cancers. They also noted a need for additional research to develop better and more affordable screening tests for all women.

The authors recommend that all government, state, and local programs with an interest in women’s health pursue collaborations which promote a “whole woman” approach to health care. “The problem of cervical cancer mortality underscores the urgent need to analyze our entire health care system,” said Freeman. “Change can occur if the will exists to make it happen. We need to courageously craft the changes that will eliminate disparities and save lives.”

For more information about NCI’s Center to Reduce Cancer Health Disparities, visit http://crchd.nci.nih.gov/.

For more information about cancer, visit the NCI Web site at http://www.cancer.gov or call NCI’s Cancer Information Service at 1-800-4CANCER (1-800-422-6237).

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — is comprised of 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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* Freeman, HP, Wingrove BK, eds. Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities. Rockville, MD: National Cancer Institute, Center to Reduce Cancer Health Disparities, May 2005. NIH Pub. No. 05-5282.

FOR IMMEDIATE RELEASE Monday, July 18, 2005
CONTACT: NCI Press Office 301-496-6641