#gyncsm Community: January 2021

This month #gyncsm participated in the SaludAmerica #SaludTues "What Can We Do To Stop Cervical Cancer" chat with 54 participants including co-hosts @IamCervivor @NFIDvaccines and @StopHPVCancer. You may find a link to the complete transcript here and the analytics here (via Symplur).

Here are highlights of the #gyncsm and other participant responses to the topic questions:

Q1. Let’s start off by discussing HPV. What is it and what role does it play in cervical cancer?

A1: Over 99% of cervical cancers are caused by HPV, which is a very common virus transmitted by skin-to-skin intimate contact. Most people clear the virus, but when it persists it can cause cell changes leading to cancer.
A1. Cervical cancer is a type of cancer that occurs in the cells lining the cervix, the lower part of the uterus that connects to the vagina. Various strains of HPV, a sexually transmitted infection, play a role in causing most cervical cancers.
A1: HPV can cause warts as well as other cancers (anal, oropharyngeal, penile, vulvar, and vaginal) in addition to causing cervical cancer.

Q2. Who is most affected by HPV and cervical cancer? Who is at highest risk for getting cervical cancer?

A2: Any one with a cervix is at risk for cervical cancer.
A2: Access to healthcare is an important factor in who is most affected. More than half of new cervical cancer cases occur among women who have never been or rarely been screened. When you don't have a consistent provider, it's hard to stay on a screening schedule.
A2: Studies also show that HPV vaccination is very much influenced by provider recommendation. Those w/o a regular provider may not receive education and encouragement to receive the vaccine -which can be given up to age 45- or to give the vaccine to their children.
A2. Some groups are more at risk of developing cervical cancer, such as Latinas. Latinas’ cervical cancer rates are 44% higher than non-Latinas. https://salud-america.org/crisis-cervical-cancer-among-latinas/
A2: More Black and Hispanic women get HPV-associated cervical cancer than women of other races or ethnicities. About 9 Hispanic & 8 Black women compared to 7 White women were diagnosed with HPV-associated cervical cancer per 100,000 women. [tweet with graph]
A2: Communities of Color and those in rural areas have the highest rates of cervical cancer; heart-breaking because this disease is almost always preventable. We have the tools, now we need to find the will!

Q3. How can cervical cancer be prevented?

A3: The two most important things you can do to prevent cervical cancer are to get the HPV vaccine if you are eligible, and to be tested regularly, starting at age 21. https://www.cdc.gov/cancer/dcpc/resources/features/cervicalcancer/index.htm
A3. Screening tests can help prevent cervical cancer. A pap smear looks for precancerous cells on the cervix. Pap smears are recommended after age 21 and if normal, every few years. An HPV test can also be conducted to detect the virus that causes cell changes.
The HPV vaccine is over 99% effective at preventing pre-cancer caused by HPV types 16 or 18 in young women, which are linked to 70% of cervical cancers. The HPV vaccine is cancer prevention. Learn more: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet
Both the pap test (looks at cells for changes) and HPV test (looks for presence of HPV) are used to screen for cervical cancer. Guidelines are changing as we learn more about what's most effective. Check current recommendations and work w/ your provider to make a plan.
A3.3: However, it is important to talk to your healthcare provider to create a care plan if you are dealing with abnormal and precancerous results. Your doctor will help you figure out your best timeline for testing and care moving forward.

Q4. Let’s discuss the HPV vaccine. Who should receive the HPV vaccine? What can healthcare professionals do to increase HPV vaccination rates?

A4: @CDCgov recommends 11- to 12-year-olds get 2 doses of #HPV #vaccine. Males & females up to age 26 years who were not previously vaccinated should receive catch-up HPV vaccination. Adults age 26-45 years should talk to a healthcare professional [tweet with image]
A4. The HPV vaccine protects people from developing the virus that causes cervical cancer. The CDC recommends HPV vaccination for preteens 11 to 12 years old and everyone through age 26 years, if they are not vaccinated already.
A4. To increase HPV vaccination rates, the CDC recommends using consistent messaging, effectively answer questions, provide personal examples, and bundle the HPV vaccine with other recommended adolescent vaccines.
A4: Healthcare professionals must strongly recommend #HPV #vaccine for preteens, teens, and young adults. HPV vaccine=#cancer prevention. Learn more: https://www.nfid.org/infectious-diseases/hpv/
A4: The @NAPNAP has put together tips, talking points and additional resources for providers on discussing vaccines: https://www.napnap.org/cancer-prevention-and-hpv-vaccine-resources/
A4: We can increase HPV Vaccination rates by stoping stigma. People still don't think they are are risk because of the narrative of a certain type of person who is infected with HPV. We all have to work to #endSTIgma [tweet with image]

Q5. I don’t have a primary physician or health insurance. Can I still get tested and treated for cervical cancer?

A5. Yes. If you have no insurance or your insurance doesn’t cover screening exams, you are qualified for a free or low-cost screening. The CDC allows you to look for free screenings in your state: https://www.cdc.gov/cancer/nbccedp/screenings.htm
A5: A starting place is @CDC_Cancer National Breast and Cervical Cancer Early Detection Program (NBCCEDP) which provides breast and cervical cancer screenings and diagnostic services to low-income, uninsured, and underinsured women across the US
A5: Also learn more about clinical trials which can literally be life-saving for some patients. Get the scoop and links to databases @ https://www.nccc-online.org/hpvcervical-cancer/clinical-trials/
A5. Absolutely! Check with your local Public Health Department (most have programs to help you with financial assistance as well as finding a provider).

Q6. What can we do to address the stigma and misinformation around HPV?

A6. By increasing awareness and understanding of HPV and cervical cancer, we can fight the stigma. Research shows that if we can debunk myths and be clear about the facts, we can decrease the stigma that’s a burden for people with HPV. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838770/
A6: Address stigma with empathy & facts: 80% of sexually active men & women are infected with #HPV at some point in their lifetime. #DYK: #HPV #vaccination=cancer prevention? [tweet with image]
Q6. If we avoid talking about HPV, it won’t go away. If we talk about prevention and treatment options, we can fight the stigma.
A6: Most fears related to HPV vaccine are more related to myth than reality. A multi-level approach is required to achieve higher rates of HPV vaccination focusing on communicating effectively w/parents & patients about the vaccine benefits & non-vaccination risks. [tweet with infographic]
A6. Continue to learn the latest on HPV. Quit using the same language surround HPV - Keep addressing how common of a virus HPV actually is. Education, sharing our stories, etc. all matter!
Patient stories are important to addressing the stigma surrounding HPV and Cervical Cancer. Both @IamCervivor and @StopHPVCancer have done a wonderful job curating and sharing stories. Visit their sites and share.

Q7. What does a cervical cancer diagnosis mean? What resources are available for cervical cancer patients and survivors?

A7. Cervical cancer can be treated through surgery, chemotherapy, or radiation, depending on how much it has spread.
A7: Results from a pap and/or HPV test can be confusing as to what they mean for your next steps and screening and/or treatment plan going forward. Here is an overview from @theNCI https://www.cancer.gov/types/cervical/understanding-abnormal-hpv-and-pap-test-results
A7: Once Cervical Cancer has been diagnosed, there are resources from patient groups such as @IamCervivor and @StopHPVCancer. Information is also available from @GYNCancer such as this guide: https://www.foundationforwomenscancer.org/wp-content/uploads/FWC-Cervical-Cancer-Your-Guide.pdf
Peer support can be very important as you navigate a cancer diagnosis. Cervical cancer does have societal stigma and its impact can be downplayed. Being able to interact with a community who has been through it and "gets it" can have a tremendous impact.