As an oncologist, I am often confronted with patients with advanced gynecologic malignancies with limited successful options to cure them. The success of treating and curing patients with cancer depends not only on the skills and technologies, it is very much dependent on the patients and the stage of their diseases. Too often, we are not able to detect these malignancies early because we do not know what causes the disease and there are no early detection tests so that by the time a patient is in my office, the disease is at an advanced stage. Cervical cancer, however, is one of the few gynecologic malignancies that we know is caused by the Human Papillomavirus (HPV) that can be detected by a simple pap smear. Furthermore, cervical cancer can be prevented with an HPV vaccination.
So why are we having such a difficult time eradicating cervical cancer? Why are we still seeing patients with advanced and incurable cervical cancers? One explanation lies in the failure to have all women screened by pap smear for pre-invasive disease. We also are facing a low rate of girls and boys receiving the HPV vaccine. In fact, it is estimated only 30% of the girls receive the vaccination today.
Is socioeconomic condition a factor? A study published by Dr. Susan Vadaparampil from Moffitt Cancer Center looked at provider factors associated with disparities in HPV vaccination among low-income 9- to 17-year old girls. It noted a low rate of vaccination despite having Medicaid coverage. So what can we do to change this? I think we need to consider a school-based HPV vaccination program similar to requirements for other school based vaccinations such as mumps, measles and rubella. Is this unprecedented? No. Many Western countries and a few African countries have been successful in achieving a high vaccination rate when the school-based program is employed. Only with proper prevention and successful screening can we accomplish eradication of cervical cancer. Without prevention and screening, we will continue to see women with cervical cancer that is incurable even if we have the best surgeons, the best radiation units, and the best chemotherapy agents.