In low-resource countries without well-developed screening programs, expanding access to human papilloma virus (HPV) vaccination is the best means of preventing cervical cancer and other diseases caused by HPV infection, according to an editorial in the October special issue of the Journal of Lower Genital Tract Disease, official journal of ASCCP. The journal is published in the Lippincott portfolio by Wolters Kluwer.
"For countries without screening and treatment, HPV vaccination offers the best and possibly only opportunity for protection against HPV-related neoplasia," write Herschel W. Lawson, MD, of Emory University School of Medicine, Atlanta, and Mona Saraiya, MD, MPH, of the US Centers for Disease Control and Prevention (CDC). Their editorial introduces a special collection of papers focusing on anogenital and HPV-related diseases in medically underserved populations.
Papers Highlight Burden of Lower Genital Tract Disease in Underserved Populations
Since the mid-twentieth century, there has been remarkable progress in reducing the burden of cervical and other lower genital tract cancers - first by cervical cytology screening (Papanicolaou test) and then by identifying HPV as the main cause of cervical cancer. Current HPV vaccines can reduce the risk of cervical cancer by preventing infection with "high-risk" types of HPV. The World Health Organization recommends universal HPV vaccination for girls aged 9 to 14 years. "Unfortunately, the application of this great health benefit has not been universal," Drs. Lawson and Saraiya write.
The special issue of JLGTD presents 15 research papers, with a focus on extending effective screening and prevention for cervical cancer to underserved populations, in the United States and around the world. Underserved women, both in the United States and in low-resource countries around the world, face barriers to healthcare due to a wide range of geographic and socio-economic factors.
T. Clark Powell, MD, MPH, and colleagues of University of Alabama at Birmingham looked at racial, geographic, and socioeconomic risk factors for advanced-stage cervical cancer among women in Alabama. More than half of women had advanced cancer at diagnosis - indicating "ample opportunities for improvement in both prevention and early detection," the researchers note.
Black women were more likely to have advanced cervical cancer at diagnosis, regardless of age, insurance, and geography. For white women, insurance status and age were significant risk factors. "Disparities in cervical cancer are multifactorial and necessitate further research into socioeconomic, biologic, and systems causes," the researchers write
A study by Meheret Endeshaw, MPH, Dr. Saraiya, and other CDC researchers found that foreign-born women living in the United States were twice as likely as US-born women to have never received cervical cytology screening (17% versus 7%). Women from Mexico, South America and the Caribbean, and Southeast Asia were least likely to have had this recommended screening test.
Endeshaw and colleagues also noted that foreign-born women living in the United States fewer years of their lives were less likely than others to have had cervical cytology screening. "These findings may inform cervical cancer screening efforts targeting foreign-born women," the researchers conclude.
While cervical cytology screening can reduce the incidence and mortality from cervical cancer, this intervention isn't accessible to most women living in low-resource countries. Given the barriers to effective screening in less-developed countries - including the need for coordinated follow-up testing and treatment for patients with abnormal screening tests - HPV vaccination is the most promising approach to lowering the rates of cervical cancer and other HPV-related diseases worldwide, Drs. Lawson and Saraiya believe. They conclude, "Clearly, applying sustainable funding sources, and vaccine delivery systems, newer screening, management and prevention technologies in a culturally sensitive fashion is important for those communities where access and resources are highly limited."