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Recommendations for a national agenda to substantially reduce cervical cancer

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Abstract

Purpose

Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening, provide an unprecedented opportunity to greatly reduce cervical cancer in the USA. Despite these advances, thousands of women continue to be diagnosed with and die of this highly preventable disease each year. This paper describes the initiatives and recommendations of national cervical cancer experts toward preventing and possibly eliminating this disease.

Methods

In May 2011, Cervical Cancer-Free America, a national initiative, convened a cervical cancer summit in Washington, DC. Over 120 experts from the public and private sector met to develop a national agenda for reducing cervical cancer morbidity and mortality in the USA.

Results

Summit participants evaluated four broad challenges to reducing cervical cancer: (1) low use of HPV vaccines, (2) low use of cervical cancer screening, (3) screening errors, and (4) lack of continuity of care for women diagnosed with cervical cancer. The summit offered 12 concrete recommendations to guide future national and local efforts toward this goal.

Conclusions

Cervical cancer incidence and mortality can be greatly reduced by better deploying existing methods and systems. The challenge lies in ensuring that the array of available prevention options are accessible and utilized by all age-appropriate women—particularly minority and underserved women who are disproportionately affected by this disease. The consensus was that cervical cancer can be greatly reduced and that prevention efforts can lead the way towards a dramatic reduction in this preventable disease in our country.

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Notes

  1. In March 2012, the ASCCP/ACS/ASCP and the USPSTF included HPV testing in their updated recommendations.

  2. The ACS/ASCCP/ASCP and the USPSTF 2012 recommend screening begin at 21 years of age.

  3. Consistency among guidelines has been accomplished over the past year, with the American Cancer Society, the American Society for Colposcopy and Cervical Pathology and the American Society for Clinical Pathology issuing joint guidelines that are essentially the same as the newly released USPSTF guidelines. In addition, the American College of Obstetrics and Gynecologists endorsed these guidelines and is expected to update their own guidelines to match them.

Abbreviations

ACA:

Affordable Care Act of 2010

ACIP:

Advisory Committee on Immunization Practices

ACS:

American Cancer Society

ASCCP:

American Society for Colposcopy and Cervical Pathology

ASCP:

American Society for Clinical Pathology

CCFA:

Cervical Cancer-Free America

CDC:

Centers for Disease Control and Prevention

CHIP:

Children’s Health Insurance Program

FDA:

Food and Drug Administration

FERPA:

Family Education Rights and Privacy Act

FQHC:

Federally Qualified Health Centers

HPV:

Human papillomavirus

NBCCEDP:

National Breast and Cervical Cancer Early Detection Program

Pap:

Papanicolaou

UNC:

University of North Carolina

USPSTF:

United States Preventive Services Task Force

VFC:

Vaccines for Children

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Acknowledgments

Authors would like to thank organizations and corporations who support Cervical Cancer-Free America in its efforts to greatly reduce cervical cancer rates in the USA. Authors also would like to thank Tracy Morris and Helaine Bader for their contributions to the writing of this paper.

Conflict of interest

The Cervical Cancer-Free America launch meeting was funded by unrestricted gifts from GlaxoSmithKline, Hologic, Qiagen, and Merck Corporation. Dr. Noel T. Brewer has received research grants, served on paid advisory boards, and/or been a paid speaker for Merck and GSK. Dr. Kenneth Alexander serves on the speakers Bureau for Merck vaccines, has spoken on behalf of MSD (Merck’s European branch), for Sanofi, and also serves as a paid advisor for Merck vaccines. Dr. Richard Crosby has received research grants and been a paid advisor for Merck. Dr. Warner Huh has served as a consultant for Roche Diagnostics, Merck Corporation, and GlaxoSmithKline. Dr. Gregory D. Zimet is an investigator on research grants funded by Merck’s Investigator Initiated Science Program (MISP). Dr. Jennifer Smith has received research grants, unrestricted educational gifts, served on advisory boards, and/or has been a paid speaker for GSK, Hologic Gen-Probe, Merck and QIAGEN.

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Authors and Affiliations

  1. Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, 27599-7400, USA

    Jennifer S. Smith

  2. American Cancer Society, Atlanta, GA, 30303, USA

    Debbie Saslow

  3. Pediatric Infectious Diseases, University of Chicago, Chicago, IL, 60637, USA

    Kenneth Alexander

  4. Sibley Center for Gynecologic Oncology and Advanced Pelvic Surgery, Washington, DC, 20016, USA

    Mildred R. Chernofsky

  5. University of Kentucky College of Public Health, Lexington, KY, 40536, USA

    Richard Crosby & Baretta R. Casey

  6. Women in Government, Washington, DC, 20004, USA

    Libby Derting

  7. Division of Gynecologic Oncology, Lankenau Hospital, Wynnewood, PA, 19096, USA

    Charles J. Dunton

  8. North Carolina Department of Health and Human Services, Raleigh, NC, 27699, USA

    Jeffrey Engle

  9. The University of Texas School of Public Health, Houston, TX, 77225, USA

    Maria Fernandez & Sally W. Vernon

  10. School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    Mona Fouad, Warner Huh & Theresa Wynn

  11. The Permanente Medical Group, Sacramento, CA, 95815, USA

    Walter Kinney

  12. Medical University of South Carolina, Charleston, SC, 29403, USA

    Jennifer Pierce

  13. National Hispanic Medical Association, Washington, DC, 20036, USA

    Elena Rios

  14. American Pharmacists Association, Washington, DC, 20037, USA

    Mitchel C. Rothholz

  15. Denver Public Health, Denver Health and Hospital Authority, Denver, CO, 80204, USA

    Judith C. Shlay

  16. School of Medicine, Indianapolis, IN, 46202, USA

    Rivienne Shedd-Steele & Gregory D. Zimet

  17. University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA

    Joan Walker

  18. Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, 27599-7400, USA

    Noel T. Brewer

  19. Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, 27599-7400, USA

    Leah Devlin

Authors
  1. Jennifer S. Smith
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  2. Noel T. Brewer
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  3. Debbie Saslow
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  4. Kenneth Alexander
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  8. Leah Devlin
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  9. Charles J. Dunton
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  10. Jeffrey Engle
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  11. Maria Fernandez
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  13. Warner Huh
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  14. Walter Kinney
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  15. Jennifer Pierce
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  16. Elena Rios
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  17. Mitchel C. Rothholz
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  18. Judith C. Shlay
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  19. Rivienne Shedd-Steele
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  20. Sally W. Vernon
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  21. Joan Walker
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  22. Theresa Wynn
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  23. Gregory D. Zimet
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  24. Baretta R. Casey
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Corresponding author

Correspondence to Jennifer S. Smith.

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Smith, J.S., Brewer, N.T., Saslow, D. et al. Recommendations for a national agenda to substantially reduce cervical cancer. Cancer Causes Control 24, 1583–1593 (2013). https://doi.org/10.1007/s10552-013-0235-8

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