Researchers to Lead Effort to End Cervical Cancer

Asserting that no one should die from cervical cancer, public health researchers at the University are leading a multistate initiative to prevent — or even eradicate — the disease.

The Cervical Cancer-Free Initiative is a multi-year project aimed at preventing the disease through vaccination against human papillomavirus (HPV) and effective screening for early signs of cervical cancer. Initial funding for the initiative is through a $1.5 million unrestricted educational grant to the UNC Gillings School of Global Public Health by GlaxoSmithKline.

The initiative is led by Noel T. Brewer, assistant professor of health behavior and health education, and Jennifer S. Smith, research associate professor of epidemiology, both at the public health school. They also are members of the UNC Lineberger Comprehensive Cancer Center.

“The goal of making states free of cervical cancer is ambitious but eminently achievable,” Smith said.

The initiative, which helps to coordinate efforts in California (via the California Medical Association Foundation), Alabama (through the University of Alabama) and North Carolina, eventually is expected to include other states. Each state will build a coalition of key stakeholders in cervical cancer prevention, including government, private, nonprofit and community groups. They will develop demonstration projects for ways to reduce cervical cancer, such as providing school-based access to adolescent vaccines including HPV vaccine. States also will develop projects to connect women to cervical cancer screening and treatment services and programs.

States are basing the interventions on the Carolina Framework for Action Against Cervical Cancer, which identifies four opportunities for preventing the disease:

  • Reduce HPV infection. Nearly all cervical cancer is attributable to persistent HPV infection. Vaccines can prevent infection by two types of carcinogenic HPV viruses for at least six years and maybe for a lifetime, Smith said. However, only one in three adolescent females in the U.S. have received HPV vaccine.
  • Improve screening. Almost all women who die from cervical cancer did not receive screenings or got them too infrequently, Brewer said. Although screening is highly effective for reducing cervical cancer deaths, about 17 percent of U.S. women have not been screened in the past three years.
  • Reduce screening errors. Like any screening test, Pap smears do not detect all cancers or cancer risks. About 30 percent of cervical cancer deaths are due to screening errors, Smith said. More sensitive HPV testing potentially is more effective in detecting problems early.
  • Provide follow-up care. One in 10 cervical cancer deaths happen because there was no follow-up after an abnormal Pap smear. Minority women and those living in rural communities are the most at risk for not having follow-up tests and/or treatment, Brewer said.

“We’re focusing on reducing cervical cancer disparities,” Smith said. “African-American women are twice as likely as white women to die from cervical cancer. Hispanic women also have higher rates of cervical cancer. People who live in rural areas and those who don’t speak English face substantial barriers to prevention, and we’ll be exploring ways to reduce their risks.”

Though each state will implement its own projects, UNC will measure the impact and examine the effectiveness of different approaches to preventing the disease. The goal is to identify the strongest interventions that can then be implemented nationwide.

“Lessons learned from prevention interventions from this initiative will also inform successful approaches for other states that aim to eliminate cervical cancer through combined benefits of vaccination, early detection and follow-up,” Smith said.

Cervical cancer is now fully preventable through vaccination, screening and early treatment, but use of those services needs to be higher to eliminate the disease, Brewer said. “In America, there’s no excuse for anyone dying of cervical cancer. This is a cancer we can conquer.”

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