Telebriefing: New Vital Signs Report - How can we stop deaths from cervical cancer?

OPERATOR: Welcome and thank you for standing by. I'd like to inform our parties that your lines have been placed in a listen-only mode until the question and answer segment of today's conference. Today's conference is also being recorded, if you have any objections, you may disconnect at this time. I would now like to turn the meeting over to your host, Benjamin Haynes so you may begin.

BENJAMIN HAYNES: Thank you Calvin, thank you for joining us on this vital signs report on cervical cancer. We're joined by CDC's Principal Deputy Director, Dr. Ileana Arias, who will provide the opening remarks. Following those remarks, Dr. Arias along with Dr. Vicki Benard, the report's lead author, and Dr. Mona Saraiya will take your questions. Now I would like to turn it over to Dr. Arias.

ILEANA ARIAS: Thank you, and thank you all for joining us today to discuss the vital signs report, which is a special MMWR publication that highlights critical public health issues facing our nation. Each month in vital signs, we focus on the latest data about one of the critical issues facing our nation, but more importantly, what can be done about it. At CDC we work 24/7 to save lives and protect people and part of our role in doing so is to take a critical look at our health care system and to be honest with ourselves by talking about where we are falling short. Cervical cancer unfortunately is one of those areas where although there has been great improvement, we can do more and we can do better than we have done. Cervical cancer is a top cancer cause for women, currently ranking number 13 for new cancer cases and number 14 for cancer deaths. We have seen incredible reductions in cervical cancer incidents and deaths since the Pap test was introduced in 1950 for cancer screening. We know that cervical cancer screening works. Today, we have additional screening and prevention tools, including testing for the human papillomavirus or HPV, which could lead to cervical cancer and the HPV vaccine, which could prevent getting an HPV infection. Together cervical cancer screening and HPV vaccine could prevent as many as 93 percent of all cervical cancers. Despite these important advances, and opportunities however, the vital signs reports some sobering statistics and gaps in cervical cancer prevention. Every year, 12,000 women get cervical cancer and 4,000 women still die from it. While deaths from cervical cancer has fallen since the 1950s, we have stagnated in recent years between 2007 and 2011, the death rate remains stable, not yet reaching the healthy people 20/20 objective. This means thousands of women continue to die each year from cervical cancer. We can do better than this with both screening and vaccination. We can reach and go beyond the healthy people 20/20 objective and continue to reduce cervical cancer death. We know that cervical cancer screening saves lives, but unfortunately in 2012, over eight million women between the ages of 21 and 65 didn't get this life-saving screening in the past five years. With this vital signs, we ask ourselves why deaths have stagnated and why so many women have not gotten screened as recommending and not surprisingly the usual suspects emerge. One in four women without health insurance has not been screened in the past five years. However, access to health insurance isn't the only gap to close. The same number, about one in four of women with a regular doctor hasn't been screened for cervical cancer in the past five years. But of the women not screened, seven in ten women did actually have a regular doctor and health insurance. So although some of the failure to screen and prevent is related to lack of access to insurance and lack of access to a regular health care provider, other barriers come into play. Some of the failures related to individual barriers such as lack of awareness and knowledge, lack of transportation, culture beliefs, and others that play a role in a woman going in for cervical cancer screenings. The vital signs also points out where in our nation we need to do better. The south, unfortunately, has the highest cervical cancer burden, both incidents and death rate, and the largest percentage of women who are not screened. We know that cervical cancer occurs mainly in low resource, underserved regions, and it's linked to poverty, race ethnicity and other sources of health disparities. The southern states have a higher concentration of lower resource areas that have been shown to have higher rates of disease. Barriers include structural barriers such as transportation in rural areas and access, and subjective interpersonal barriers such as feared results, mistrust of health care system, and knowledge about the test. The Affordable Care Act will help with financial barriers and will help women get connected with a regular doctor, but we also need to address additional individual and systemic barriers to women. As I mentioned before, in addition to screening, we now have a vaccine to protect against cervical cancer. The HPV vaccine protects against HPV infections that cause most cervical cancers, yet we know that right now only about one out of every three girls and one out of every seven boys have received all three doses of the vaccine for protection. Preteens and teens are not getting HPV vaccination as often as other recommended vaccines, even though it is safe and it is effective. These numbers show us that we continue to miss opportunities to prevent cervical cancer. We need to close these gaps and make all women, make sure that all women get the recommended screening, especially among vulnerable populations. We also need to make sure that boys and girls get HPV vaccine when they receive other adolescent vaccines. So what can we do to increase the opportunities for all women to get preventive services they need? First of all, we need to do more to close the gap for women already linked into the medical system. When women see their doctors and nurses for other visits, they can help women understand the importance of getting screened for cervical cancer. Every visit to a provider can be an opportunity to screen or make sure that women are referred for recommended cervical cancer screenings and understand their screening options. When doctors and nurses give preteens and teens their other recommended adolescent vaccinations, it's another big opportunity, providers can recommend HPV vaccine as strongly as other vaccines. Again it is safe, it is effective. State and local public health departments can also promote recommended screening options and HPV vaccines to the public. Health departments can work with Medicaid programs, community health centers, and community groups to find women who need screening, help them get their medical appointments, and get the recommended follow-up care. The federal government is supporting these efforts in a number of different ways. CDC's national breast and cervical cancer early detection program provides low income, uninsured, and underinsured women access to timely, breast and serve cam cancer screening and diagnostic services in all 50 states, in D.C., the territories, and 11 American Indian Alaskan tribes or tribal organizations. Under the Affordable Care Act, most health insurance will cover preventive services like cervical cancer screening and HPV vaccines at no cost to the patient. The Vaccines for Children, or VFC program provides immunizations such as the HPV vaccine to eligible children free of charge. This increases access to children who might not otherwise be vaccinated because of inability to pay. The bottom line for us is that no woman should ever die from cervical cancer. Screening is proven to work, but not enough women are getting these recommended preventive services. We need to take action now to increase cervical cancer screening by educating women, eliminating barriers to care and seizes on existing opportunities to provide this preventive care. We already know that over half of cervical cancers occur in women who have never been screened or who have not been screened in the past five years. Increasing screening among these women will make the greatest impact on the cervical cancer burden in the U.S. Every visit to a provider is an opportunity to screen or make sure that women are getting screened, and that preteens and teens are getting vaccinated. I'd like to thank you for joining us today and we are now very happy to take any questions that you may have.

OPERATOR: Thank you. At this time, if you would like to ask a question, please press star 1 on your telephone keypad. It's Star 1 to ask a question. One moment please for our first question to come in. Our first question comes from Heather Pesoriero with CBS News. Your line is open.

HEATHER PESORIERO: Hi thank you for taking my call. Two questions, one is, um, the united services preventive task force recommended in March 2012 that... They recommend against screenings for cervical cancer with HPV testing alone or in combination with psychology in women younger than age 30 years. So I wanted to get your response to that and how that recommendation, I realize they made this 2012 and you were looking at the years from 2007 to 2011, but wondering what impact you imagine that  might have on screening rates going forward. And my second question is, you mentioned the relationship between socioeconomics and -- socioeconomic tiers and screening and mortality rates, and I'm wondering, and you mentioned the south, so, um, is it known which providers are providing these screenings, is it primarily happening in primary care settings or at specialist's offices, ob-gyn, and thank you.

VICKI BENARD: I'll address. I'll address the question first. Oh, I'm not -- sorry. This is Vicki Benard, and I will address your first question about the guidelines changing in 2012, where women less than 30 do not get the HPV test with the Pap test. And that's correct. And the reason that the guidelines are saying to wait until a woman's 30 is because prior to that, HPV is very common, the infection clears very easily, and so what we've seen is that once a woman gets 30, if she still continues to have HPV, it's usually HPV that's progressing and that may go on to pre-cancer or invasive cervical cancer. Before that, you know that HPV has been known to clear. But, a woman 21 to 30 still needs to get the Pap test every three years. She still needs to be screened. Did I address your first question?

HEATHER PESORIERO: Um, yes, because you were capturing the, wasn't your data capturing women ages 21 to 65?

VICKI BENARD: They were. And you're right; our data was only able to look at pap testing. Because the guidelines changed in 2012, and the survey that we looked at for the behavioral risk factor surveillance system only asks about Pap test, we do not collect HPV testing. That will come about in 2014.

HEATHER PESORIERO: So setting aside HPV testing, just so it's clear for, you know, readers and viewers, the recommendation setting aside HPV, women age 21 and up should still get cervical cancer pap's every three years.

VICKI BENARD: That's correct. If they're just getting a pap test, yes, they should get the pap test every three years.

HEATHER PESORIERO: And then after 30, then they can get the HPV.

VICKI BENARD: Yes. After 30 it's their choice, they can get the Pap test with the HPV test, called co-test or they can just get the Pap test every three years.

HEATHER PESORIERO: Okay. Thank you.

VICKI BENARD: And then your second question about the south. And do we know which providers are providing these pap tests? And I guess this would be for any region. The primary care providers do provide screening as well as specialists and we're really encouraging primary care providers to do the screening, now that we have all national organizations with a consensus of when to screen and how too often screen. It's a very easy opportunity for primary care providers, especially in community health centers to reach that never really screened population and to be able for them to access cervical scans screening easily.

HEATHER PESORIERO: In the primary care setting, I mean, you know, do people have the appropriate training to be able to give the screenings?

VICKI BENARD: Yes, they should, yes.

HEATHER PESORIERO: Okay, thank you.

BENJAMIN HAYNES: Okay Calvin, ready for the next question.

OPERATOR: Our next question comes from Leighann Winick with CBS News, your line is up.

LEIGHANN WINICK: Yes, hi, could you clarify the age recommendations for the HPV vaccine, and the ideal time, I know preteens get it, but is it effective after someone becomes sexually active and what do you know as far as insurance coverage past a certain age?

MONA SARAIYA: Hi, this is Mona Saraiya, yes, the recommendations for the HPV vaccine is to be routinely given at ages 11 to 12. It can be age nine up to age 26. The Affordable Care Act is consistent with those ACIP recommendations.

LEIGHANN WINICK: Why not after 26, in other words, is it; is there no effect after adulthood?

MONA SARAIYA: That's a great question, the FDA, the manufacturers that currently have the vaccine have recommended it and asked for FDA approval for those ages. There is, it'll probably be most likely less effective given after HPV infection occurs and usually most women are sexually active by a certain age. By age 16, 17, 50 percent of women, of the population are sexually active. It would be less effective. From public health recommendations, we're trying to encourage the HPV to be routinely administered during the adolescents, ages 11 to 12, routinely.

BENJAMIN HAYNES: Calvin, we have time for two more questions.

OPERATOR: Thank you. Our next question comes from Susan Schackman with CBS News, your line is open.

SUSAN SCHACKMAN: Hi, Leighann already asked my question, its okay, thank you.

OPERATOR: Sure, no further questions at this time.

ILEANA ARIAS: So in conclusion, thank you very much for joining us. Again, we are trying to make sure that everybody understands that cervical cancer is highly preventable by engaging in things, in measures that we know are effective, the science are supportive and are highly accessible. And that is routine as recommended cervical cancer screenings and especially the use of HPV vaccine among kids. We look forward to continuing to push our uptake of both of these strategies for the prevention of cervical cancer, and we're looking forward to seeing the sort of fruits of that labor; hopefully having a vital sign showing that we have gone beyond the stagnation that we've seen over time and started to go back to significant decreasing rates of cancer, cervical cancer, both illness and death among women. Thank you.

BENJAMIN HAYNES: Thank you Dr. Arias. And thank you all for joining us. Vital signs materials are going to be available at cdc.gov/vitalsigns and there will also be a transcript at cdc.gov/media. And if you have questions, contact the main media line at 404-639-3286. Thank you.

OPERATOR: That concludes today's conference, thank you for your participation, you may disconnect at this time. 

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES