The #gyncsm community was pleased to have Morgan Newman, MSW, Community Engagement Liaison for Cervivor (@IamCervivor) join us to chat about Cervical Cancer Updates and Global Impact. We had eighteen participants join us for the informative discussion.
Below are samples of the responses to our chat topic questions. You may view the complete transcript here. You may also find links to resources at the end of the post.
T1: What are the current HPV vaccination guidelines? What have been some of the main changes and how do these affect different age groups?
- T1: HPV vaccine works best when given before any exposure to HPV. Currently recommended are: - 2 doses for Age 9-14 (routinely 11-12) - 3 doses for Age 15-26 - Shared-Decision-Making w/ patient on whether to vaccinate Age 27-46. More via @CDCgov: cdc.gov/vaccines/vpd/h…
- A1: You'll see the ages have changed recently for the HPV vaccine to start early at 9 and 10. We love this resource from @HPVRoundtable that maps it out:
- Parents can check out this @CDCgov website cdc.gov/hpv/parents/va…
- #HPVvaccine; ideal and best for preteen 9-12 for all genders not just female! But definitely up to age 26; also approved for all up to age 45! Risk reduction not only for cervical ca but other #HPVcancers head/neck, #vulvarcancer , anal cancer etc…
T2: What are the current cervical cancer screening guidelines? What are some concerns around the updates?
- @AmericanCancer: #CervicalCancer testing should start at 25. Ages 25 to 65 should have a primary HPV test every 5 years. There are other considerations to read about here: https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html#:~:text=Cervical%20cancer%20testing%20(screening)%20should,test%20alone%20every%203%20years.. #GYNCSM
- A2: The concerns are real. A lot of us were diagnosed in our 20s with #cervicalcancer, the vaccine uptake is not quite there yet, and we're concerned women will become separated from their providers allowing them to fall through the cracks: https://cervivor.org/new-cervical-cancer-screening-guidelines-the-good-the-not-so-good-the-need-to-educate/. #GYNCSM
- T2: overview: Pap Smears look for cell changes and HPV Tests look for the virus that causes almost all cervical cancers. -Pap for Age 21-29 -Pap and/or HPV Test for Age 30-65 -Shared-Decision-Making w/ patient over 65, based on history. https://www.cdc.gov/cancer/cervical/basic_info/screening.htm
- T2: Pelvic exams still have value, especially if you have symptoms. Annual gynecologic exams are still an important part of care. Why Annual Pap Smears Are History – But Routine Ob-Gyn Visits Are Not https://www.acog.org/womens-health/experts-and-stories/the-latest/why-annual-pap-smears-are-history-but-routine-ob-gyn-visits-are-not
- re: over 65 screening: “The only way to know it is safe to stop being tested after age 65 is if you have had several tests in a row that didn’t find cancer within the previous 10 years, including at least one in the previous five years.”https://www.cdc.gov/cancer/dcpc/research/articles/older-women-cervical-cancer-screenings.htm
- T2: Follow-up is important after screening. Important Information via @theNCI : Next Steps after an Abnormal Cervical Cancer Screening Test: Understanding HPV and Pap Test Results https://www.cancer.gov/types/cervical/understanding-abnormal-hpv-and-pap-test-results
- A2 followup appropriate after abnormal pap or persistent HPV with high risk types is key! Requires knowing the results; navigation; insurance access to quality colposcopy; many community level data screening rates look “ok” but incidence/mortality still too high!
- A recent publication showed advanced stage at diagnosis and worse outcomes for women diagnosed with cervical cancer after age 65 (when screening cessation is recommended). Guidelines are just that - they must be individualized. https://www.sciencedirect.com/science/article/abs/pii/S0090825822000257?casa_token=U3jMRqfeetsAAAAA:gJ79TYp55Plj-h6RelqWWUtK5IJAJLvCQoo0xVeJOszSrWM1wj8Z2IIVWJsNftfzLMdemYPXeQ
T3: What are some of the recent treatment advances for cervical cancer? How can patients stay up-to-date and also learn about clinical trials?
- A3: There have been more options for #clinicaltrials for metastatic/recurrent #cervicalcancer being approved: immunotherapy treatments, including activated T-cells (that can recognize and kill cancer cells), therapeutic vaccines, and immune checkpoint inhibitors.
- The latest #CervicalCancer Treatment guidelines (Jan2022) from @NCCN are available: https://t.co/d7OdABRFLg NCCN Guidelines are a good place to start so you can ask questions about your doctor's plan for your care and discuss any variations from the guidelines.
- A3: We know finding information on #clinicaltrials can be daunting so we put this together: https://t.co/aAid1v4Luw. We are also fortunate to have great community partners like doctors at @NIH volunteering their time to navigate options and organizations like @Ancora_AI
- T3: Patient groups like @IamCervivor @StopHPVCancer and others can help with information on the latest #cervicalcancer treatments and provide guidance of finding clinical trials.
- A3: immunotherapy in cervical cancer nejm.org/doi/full/10.10…
- @ASCO guidelines for management of invasive Cervical cancer were updated in 2021 https://t.co/Yd1l5bRfGO #gyncsm "Clinicians may offer upfront pembrolizumab and chemotherapy with or without bevacizumab"
- A3: Ask your healthcare team about clinical trials. Get a second opinion even you like your healthcare team and want to stay with them. There is always something to learn.
T4: How has HPV vaccination and cervical cancer screening and treatment been impacted by the pandemic?
- @CDC_Cancer and @KPCommHealth: #CervicalCancer screening rates dipped 8% for women aged 21 to 29 years during the first 2 months of 2020 compared with the same period in 2019. https://jamanetwork.com/journals/jama/article-abstract/2777251
- Cervivor has been committed to our messaging, stressing the importance of #TakeCareofYou2022 our campaign that started in January during #CervicalCancerAwarenessMonth: cervivor.org/what-we-do/cca….
- A lesson learned from the pandemic could be allowing pharmacists to administer #HPVvaccines.
- T4: Screening for all types of cancer have been lower during the pandemic and are only recently starting to climb again. Cancers may have been missed or may be caught later. It is important for anyone at risk for #cervicalcancer to get their screening back on track.
- A4: I know in my home state of #Iowa, it is a top priority to get screenings back on track
- The NJ CEED Program is a grant-funded health screening program available to residents which includes cervical cancer screenings https://nj.gov/health/ces/public/resources/njceed.shtml
- T4: Unfortunately, childhood vaccination rates have plummeted during the COVID pandemic. According to @CDCgov the number of teens receiving an HPV shot in the US fell by 70 percent in 2020. One study in Boston looked at way to address: https://www.bu.edu/articles/2022/could-covid-pandemic-and-vaccine-hesitancy-cause-hpv-polio-measles-return/
T5: What is the research showing about disparities in prevention, screening, diagnosis and treatment for cervical cancer?
- Despite the fact that #cervicalcancer is preventable and treatable, the @theNCI estimated that 4,290 women would die of cervical cancer in the U.S. in 2021. We need to recognize the fact that #BlackWomen are dying from cervical cancer at a disproportionate rate.
- T5: one recent study: Latinos Suffer Higher Rates of Liver, Cervical, and Stomach Cancers https://salud-america.org/latinos-suffer-higher-rates-of-liver-cervical-and-stomach-cancers/
- @hrw released their report on #cervicalcancer in rural Georgia: bit.ly/3LTrwvr. You can also catch our Founder, @tamikafelder, being interviewed on @NPR about #BlackWomen and cervical cancer: https://www.npr.org/2022/01/31/1076895914/january-is-cervical-cancer-awareness-month-in-the-u-s?fbclid=IwAR38Y288SQ5Tooi_zS1r9Te6MTZpNZvqPGMObWBKJVS1UKValYlo7Zk6S-E and https://www.kcur.org/podcast/up-to-date/2022-02-26/black-women-are-chronically-failed-by-the-american-healthcare-system?fbclid=IwAR0D7g6rH9_uL9Efl2x9at17OaVhS8CKdl3cMASoHP0ehqkT2OmojhF1hNw.
- Latinas are the most affected by a #cervicalcancer diagnosis.
- A5: One study states: "Compared with Americans overall, #AsianAmerican screening rates are lower for #cervicalcancer (75.4% vs. 83.0%), breast cancer (64.1% vs. 72.4%), and colorectal cancer (46.9% vs. 58.6%)": bit.ly/3KxO2Iq.
- Why Are Many Women Overdue for Cervical Cancer Screening? #gyncsm https://www.cancer.gov/news-events/cancer-currents-blog/2022/overdue-cervical-cancer-screening-increasing?cid=eb_govdel "Asian women were most likely to be overdue for screening in 2019"
- More than 1/2 of new cervical cancer cases occur among women who have never or rarely been screened. When you don't have a consistent provider, it's hard to stay on a screening schedule. This disproportionally affects communities of color and rural areas.
- JAMA https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788175 "those identifying as LGBQ+ were less likely to be screened vs heterosexual (32.0% vs 22.2%;"
T6: Yesterday was #InternationalWomensDay. What new initiatives are WHO and others bringing to global efforts to reduce disparities and eradicate cervical cancer?
- @WHO is committed to eliminating #cervicalcancer by attaining: *90% of girls fully vaccinated by 15 *70% of women screened using a high-performance test by the age of 35 (again by 45) *90% of women with pre-cancer treated & 90% of women with invasive cancer managed
- T6: Cervical cancer presents an amazing opportunity because we actually have the science to, in many cases, prevent it plus catch and treat it in the pre-cancerous stage.
- T6: In 2018, the WHO Director-General announced a global call for action to eliminate cervical cancer and in 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination https://www.who.int/initiatives/cervical-cancer-elimination-initiative
- We were shining a light on cervical cancer with @WHO as they formally launched a global strategy to eliminate #cervicalcancer. We continue to advocate in solidarity by sharing our stories: https://www.youtube.com/watch?v=0HPcWZSSrCo . #GYNCSM #GlowTeal
- @ASCO has put out and recently updated Resource-Stratified Guidelines for the treatment of cervical cancer - with tiers to match guidelines with available resources in different areas.
We will not be chatting in April but we look forward to having you join us on Wednesday, May 11, 2022 for out 2nd Annual Digital Health Fair. If your organization would like to join us please DM us on Twitter (@gyncsm) or email us at gyncsm@gmail.com .
Thank you to all those who shared info about our chat.
Happy Spring,
Dee and Christina
ADDITIONAL RESOURCES
Think You’re Too Old to Get the HPV Vaccine to Prevent Cancer? Maybe Not
Nearly One-in-Five Women Diagnosed with Cervical Cancer Over Age 65
Cervical Cancer Treatment in Rwanda
Advancing NIH Research on the Health of Women 2021 Conference (Click on presentation tab to access videos)
Previous decline in cervical cancer incidence begins to reverse in low-income U.S. counties and stall in high-income counties
