Abstract IA05: Research addressing cervical cancer disparities: Progress, challenges, and opportunities

Abstract

In 2007, disparities in cervical cancer incidence and mortality were evident among black vs white women, Hispanic vs non-Hispanic women, and rural vs non-rural women. Reasons for these disparities include lack of Pap testing, inappropriate follow-up after an abnormal test, and high rates of infection with high-risk human papillomavirus (HPV). In 2017, these disparities still exist. While early detection tests for cervical cancer have been available since the late 1950s, prevention of cervical cancer began with the identification of HPV as a necessary cause for cervical cancer and the subsequent development, testing, and approval of the HPV vaccine in 2006 for girls and 2011 for boys. Uptake of the vaccine in age-eligible girls and boys has been slow in the US, with better uptake--and a complementary reduction in HPV infection and preinvasive cervical abnormalities--in other countries such as Australia, the United Kingdom, and Rwanda. Screening guidelines have been updated to focus on more appropriate age and cotesting with HPV cytology. Challenges are apparent in assuring that rates of uptake of the vaccine series approach the 80% threshold set by the CDC for all populations. Moreover, rates of appropriate screening--including the new guidelines for cotesting--are challenging to maintain, as there is confusion regarding these guidelines among both patients and providers. Appropriate follow-up after an abnormal Pap test remains a problem, with lower follow-up among minority, low-income, and rural populations. There are many opportunities for increasing the uptake of the HPV vaccine series, appropriate screening, and prompt and proper follow-up of abnormalities in populations experiencing disparities. Several areas of investigation show promise and deserve further exploration. These include: one vs two/three doses of the HPV vaccine; HPV self-testing strategies to increase adherence to screening; and use of “see and treat” strategies to assure follow-up and treatment of cervical abnormalities in low-resource settings. In addition, creative and culturally appropriate multilevel intervention approaches should be tested to increase adherence in populations suffering from disparities. Strategies to increase adherence to HPV vaccine series, screening, and follow-up recommendations can make a significant reduction in cervical cancer incidence and mortality disparities. Citation Format: Electra D. Paskett. Research addressing cervical cancer disparities: Progress, challenges, and opportunities [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA05.