In the United States, cancer continues to be the second most common cause of death behind only heart disease. In 2023, the American Cancer Society estimates that there will be close to 2 million new cases of cancer and just over 600,000 deaths.
One cancer that we must talk about, especially during February’s Black History Month because of the disproportionate way it affects women of color, is cervical cancer.
According to the World Health Organization, cervical cancer is the fourth most common form of cancer among women globally. In this country, the American Cancer Society estimates that there will be roughly 13,960 new diagnoses of invasive cervical cancer and 4,310 deaths from the disease this year alone. Those numbers should shock you. They translate into a death rate of nearly 31 percent for a disease that is not only almost entirely preventable through vaccination and screenings, but is also treatable and curable when it’s caught early.
In short, these thousands of deaths are completely unnecessary.
And who ends up dying is key. While Hispanic women have the highest rate of new cervical cancer cases, Black women have by far the highest death rate of any racial or ethnic group, according to the U.S. Cancer Statistics Working Group.
This problem underscores two important points: One, HPV vaccine education is absolutely essential and two, as a nation, we must resolve the disparities in our healthcare system that lead to poorer outcomes for Black women and other women of color. If we don’t, more women will die.
First, let’s address the issue of vaccine education. Lack of accurate information means some people don’t get the vaccines they need. With cervical cancer, this is the vaccine against HPV, the virus that almost always causes it.
Patients are eligible for the vaccine as young as 9 years old and up to 45 years old. Yet, in 2020 among adolescents ages 13-17, only about 58 percent were up to date with the entire vaccination series, according to the Centers for Disease Control and Prevention (CDC). This, despite the fact that when someone gets all the recommended shots before becoming sexually active (CDC recommended age of 11 or 12), it can reduce the risk of genital warts and cancer related to HPV by 99 percent, according to the American College of Obstetricians and Gynecologists. Most insurance companies cover the costs and, for those who are un- or underinsured, the Vaccines for Children program can help. The HPV vaccine has also been in use for more than 15 years, proving it is safe.
The American Cancer Society recently released a report on data from women ages 20 to 24 who were the first to receive the HPV vaccine that showed a 65 percent drop in U.S. cervical cancer rates between 2012 and 2019 — accomplished through enhanced screening with HPV testing and HPV vaccination. Despite the demonstrated success of the HPV vaccine, vaccination rates still fall below national targets, and only worsened during the pandemic. We must turn this trend around.
With these facts in hand, every eligible American — male and female (because, yes, there are HPV-related cancers in men, too) — should be getting the HPV vaccine.
Beyond that, screenings are a critical way to detect precancerous cells early, when they respond well to treatment. Cervical cancer used to be among the most common causes of death for American women. But since doctors began using the PAP test routinely, the death rate has dropped drastically. The HPV test has also become an important screening tool since it can detect infections by forms of HPV that pose a higher risk of leading to cancer. With those two tools, almost all cases of cervical cancer can be prevented.
So the fact that anyone gets cervical cancer in the first place, and dies from it in the second, is a sign of entrenched inequities in our healthcare system that prevent certain populations from getting the care they need.
Because, as one doctor from the Mayo clinic explained, there is no innate genetic difference that makes women of color more susceptible to this disease. Rather, she said, it’s because the long history of racism in this country has created disparities that have “infiltrated the health care system and have affected these women’s access to resources, and therefore some of the health care that they need. And this trickles down into poor outcomes, essentially.” Human Rights Watch echoed this sentiment when describing a 2022 report about the high rates of cervical cancer deaths among women in rural Georgia: “The stark racial disparities in outcomes show a clear pattern of discrimination and neglect.”
Barriers to care that can especially affect women of color include transportation and costs. It can be difficult to get to appointments, especially without a car or reliable, nearby public transportation, or if patients live in rural areas far from services. Access to screening services and follow-up of abnormal tests can affect stage at diagnosis and overall cervical cancer incidence; yet, many women in rural areas, in particular, experience barriers to optimal cervical cancer prevention, early detection and treatment. And cancer treatments can be expensive. In 2020, the annual medical costs of cervical cancer were $2.3 billion, according to the CDC. Per patient costs were in the tens of thousands of dollars, sometimes close to hundreds of thousands. For those without insurance or who are underinsured, such costs are insurmountable.
Barriers also include a lack of knowledge about cervical cancer, its symptoms and how to prevent it, as well as a lack of trust in healthcare providers. This stems from decades of mistreatment by the system, most infamously during the Syphilis Study at Tuskegee, when Black men afflicted with the disease were not offered available treatment. All of which translates into women of color being less likely to receive the preventive care that could save their lives. As a result, they are often diagnosed with later-stage cervical cancers that are more aggressive and harder to treat.
Of course, we can do better. And we must. The end of cervical cancer in this country is possible. It just requires relatively simple interventions like better, more uniform and equitable education for all patients, regardless of race or socioeconomic status, around the importance of the HPV vaccine alongside regular PAP and HPV screenings. Doing so would go a long way to ameliorating some of the ways racism has degraded healthcare in this country for women of color. It would also prevent thousands of unnecessary deaths. Which, of course, is everything.
Martha Nolan is a senior policy advisor at HealthyWomen. HealthyWomen works to educate women ages 35 to 64 to make informed health choices.