Kelly Dunn
HED 414
C. Rath
Cervical cancer is considered to be a slow-growing reproductive disease that affects thousands of women in the United States annually. This particular type of cancer forms within and/or on the tissue of the cervix. The cervix is part of the female reproductive tract, which connects the uterus to the vagina. Cervical cancer begins when surface level cells on the cervix divide uncontrollably causing cervical lesions, which if left untreated can progress into cancer. If not found in the early stages, cervical cancer can spread from the surface of the cervix, deep into the tissue of the cervix as well as the surrounding tissues within the vagina and uterus (Slaz,
2010). It is estimated that there is an incidence rate, or rate of new cases, of approximately twelve thousand women per year, with roughly four thousand of those women dying in the year
2010 alone (Fisher, 2009; Lindau, 2001). Research shows that while although all women are at risk for developing cervical cancer, the majority of women that actually die from the disease are low-income women and/or women of minority groups, such as African Americans and
Hispanics. Due to various social, political, and cultural factors, as well as disparities in the healthcare system, such as access to resources and socioeconomic status, thousands of lowincome and primarily minority women die unnecessarily from cervical cancer.
Several risk factors are involved when looking at various causes for cervical cancer.
Some of these include, the HPV virus, smoking, a weak immune system, sexual history and number of sexual partners, and the lack of regular PAP smears (Slaz, 2010; Hughes, 2009;
Charney, 2006). The HPV infection, also know as the Human Papillomavirus, is one of the most common sexually transmitted infections in the United States today (Cox, 2006). It is contracted through sexual contact from person to person, and is known to be associated with almost all cases of cervical cancer due to the fact that the virus has the capability to alter the cells on the cervix (Cox, 2006).
HPV is a significant health problem especially in regards to women developing cervical cancer because it affects millions of people, both men and women alike (Cox, 2006). With more than one hundred known strains of HPV, the rate of contraction has continued to increase regardless of the availability of vaccines, thus increasing the overall amount of women that could potentially be more prone to developing cervical cancer at some point in their life (Cox, 2006).

All of the currently known HPV strains can pose potential future health problems, but two in particular are known to be extremely aggressive in regards to cervical cancer in women. These strains include, HPV 16 and HPV 18. Both strains are known to be associated with approximately 70% of cervical cancer cases in women ages 16-26 years old (Cox, 2006). These statistics further support the necessity of PAP smear testing in women, especially those that are sexually active.
Sexual history and the number of sexual partners is an important risk factor. Research shows that women that have or have had numerous sexual partners have a much high rate of developing cervical cancer because they have a much high rate of contracting other sexually transmitted infections (Slaz, 2010; Hughes, 2009; Charney, 2006). Previously having and/or currently having an S.T.I. can make a woman more susceptible to developing cervical cancer, due to various infections creating physical changes within the reproductive tract (Fisher, 2009;
Lindau, 2001). Engaging in smoking and a weak immune system can also increases one’s risk of developing cervical cancer because the body’s ability to fight infection and disease is lessened
(Lindau, 2001). Furthermore, tobacco products contain numerous known carcinogens, which physically affect an individual’s overall health as well. Lastly, the lack of regular PAP smear testing can be crucial in determining whether or not a woman will develop cervical cancer.
Annual PAP smears are extremely important because this is not only an opportunity for a woman to have the capability to monitor her own sexual health, but it is also a chance for physicians to ensure that no abnormalities are present.
In the early stages of cervical cancer there may not always be noticeable symptoms, which reinforces why women should receive annual PAP smears. The PAP smear itself is a procedure where a gynecologist scrapes cells from the top layers of the cervix, which are then analyzed to check for any abnormalities. The PAP smear test is extremely important for women because the tests can find abnormal cells in early stages, thus allowing physicians to treat women earlier (Slaz, 2010; Hughes, 2009; Charney, 2006). Early detection and treatment is more likely to be effective in combating cervical cancer, as opposed to finding abnormalities in later stages which could have already progressed into cancerous lesions. Today, there are three main options that physicians offer patients in order to treat cervical cancer. These include, surgery, radiation therapy, and chemotherapy. Each treatment method can be costly, but generally the more extensive the damage, the more costly the procedure is to treat an individual.

Secondary prevention, the annual utilization of the PAP smear test in women, is an efficient way in which to decrease the rates of cervical cancer (Cox, 2006). While although PAP smear testing is readily available for many women, the financial cost of the procedure is simply not affordable for some women, especially low-income and uninsured women. This inability to access important cancer screenings that can help to better prevent a woman from developing cervical cancer can be a life altering occurrence, one in which every woman should have an equal right to. Women that an uninsured and/or who do not have the ability to pay out of-ofpocket for PAP smear testing are essentially left unprotected, thus affecting their overall quality of life and leaving them vulnerable to disease (Slaz, 2010; Hughes, 2009; Charney, 2006).
Through secondary prevention, PAP smears could drastically cut down rates of developing cervical cancer, as well as decrease the amount of deaths caused by cervical cancer
(Fisher, 2009; Lindau, 2001). If found in the early stages, cervical lesions can be treated with small procedures that are relatively cost effective. Unfortunately, for women of low socioeconomic status and income level, this is not always the case. Research shows that minority and low-income women are less likely to receive cervical cancer screenings and that when the cancer is finally detected, it is commonly found in later stages which require more drastic measures to cure and can frequently lead to death if action is taken to late (Slaz, 2010; Hughes,
2009).
Currently in the United States, deaths from cervical cancer in women can be almost completely eliminated due to regular PAP smear screenings as well as follow up exams if abnormal results are reported, and yet roughly four thousand women die from the disease annually (Slaz, 2010; Hughes, 2009; Charney, 2006). Research also shows that it is more common for minority and low-income women to be diagnosed with cervical cancer at later stages than opposed to early detection, and survival rates for patients diagnosed are lowest in high-poverty regions (Fisher, 2009; Lindau, 2001). While as a society we strive to eliminate various disparities among different races, these factors do indeed still exist, causing barriers for women in regards to cancer testing (Slaz, 2010). Some of these barriers include level of income, whether or not a woman is insured, and her race and ethnicity. While although all women are equally as important when considering cervical cancer screening, studies have found that it is the low-income and minority women that are least likely to be tested and more likely to die form the disease (Fisher, 2009; Lindau, 2001).

In the year 2002, statistics showed that the lack of insurance among women, especially younger women, was the largest barrier in regards to receiving annual PAP smears (Slaz, 2010;
Hughes, 2009; Charney, 2006). Also in 2002, in the United States it was reported that approximately sixteen million women, mostly with low-income and/or minority backgrounds, did not have healthcare insurance. Thus being said, a large proportion of women are not receiving adequate healthcare and are excluded from various medical services that many may in fact need, including having an annual PAP smear to check for cervical cancer (Fisher, 2009;
Lindau, 2001). Moreover, African American and Hispanic women are reported as having an overall lower net worth when compared to white women, thus hindering them further in regards to accessing healthcare services (Hughes, 2009).
Besides a lack of insurance, other numerous barriers exist today as well that prevent equal access for women to receive cervical cancer screening. These include various financial barriers, which can be correlated with a woman’s education, career, and income levels; those that work in low-paying jobs, with little education typically face harsher health outcomes than affluent women. Limited access to services in poor and low-income areas affects many women as well due to the severe lack of health resources, including cancer screenings. Politically and socially speaking, we simply do not spend an adequate amount of money providing valuable and much needed resources, such as hospitals and clinics, in areas of low standing and/or low income and high poverty levels. Due to this, low-income and minority women are often more prone to developing various diseases, including cervical cancer (Fisher, 2009).
Cervical cancer is now the second most common cancer in women today, with breast cancer being the first (Fisher, 2009; Lindau, 2001). While although it is considered to be a slowgrowing disease, by no means does that decrease the importance of preventative methods being utilized in order to decrease mortality rates in women. In particular, low-income and minority women are much more likely to die of the cervical cancer as opposed to affluent women.
Barriers in the healthcare system ultimately divide women based on their race, ethnicity, income level, and socioeconomic status, thus creating disparities, which have been found to affect a woman’s quality of life. Moreover, women that are not able to access the necessary health services and resources are much more likely to face harsher health outcomes, including death, from cervical cancer diagnoses, due to the fact that they are not able to access the same resources as more affluent women.

FACT SHEET
WHAT:
• Cervical cancer is considered to be the second most common cancer in women.
•

It is estimated that there is an incidence rate of approximately twelve thousand women per year, with roughly four thousand deaths in the year 2010 alone.

•

The HPV virus is known to cause nearly all cases of cervical cancer.

•

Cervical cancer can be drastically prevented through PAP smears.

WHO:
• All women can be affected by cervical cancer regardless of race or age.
•

Women of low-income and women in minority groups die more often than white women.

•

Women of low-income and women in minority groups have less resources and access to cancer screenings.

•

Women of low-income and women in minority groups are less likely to be screened.

WHY:
• In 2002, in the United States it was reported that approximately sixteen million women, mostly those of low-income and minority groups, did not have healthcare insurance.
•

Income, insurance, and race/ethnicity are barriers for women in healthcare.

•

Financial barriers are present, with more than 16 million uninsured women

•

Limited access of services in poor and low-income areas,

•

Social mistrust is present within the healthcare system, depending on one’s cultural background •

Miscommunication and language barriers between medical staff and patients are also present PREVENTION:
•

The PAP smear test is an effective way to detect abnormal cells in the cervix.

•

If done annually, PAP smears can help physicians to treat cervix lesions early before the progress into cervical cancer.

•

Early detection can be key to saving a woman’s life.

•

The later the abnormalities are discovered, the more expensive the treatments are.

References

Cox, J. (2006). Epidemiology and Natural History of HPV. Journal of Family Practice,
553-9.
Charney, P. (2006). Access to Cervical Cancer Screening: Training Internists So Skill
Limitations Are Not a Barrier to Care. Journal of Women's Health (15409996),
15(8), 977-980. doi:10.1089/jwh.2006.15.977
Fisher, J. W., & Brundage, S. I. (2009). The challenge of eliminating cervical cancer in the United States: A story of politics, prudishness, and prevention. Women &
Health, 49(2-3), 246-261. doi:10.1080/03630240902915101
Hughes, C. (2009). Cervical cancer: prevention, diagnosis, treatment and nursing care.
(Cover story). Nursing Standard, 23(27), 48-56.
Lindau, S., Tomori, C. C., McCarville, M. M., & Bennett, C. C. (2001). Improving Rates of Cervical Cancer Screening and Pap Smear Follow-Up for Low-Income Women with Limited Health Literacy. Cancer Investigation, 19(3), 316.
Salz, T., Gottlieb, S. L., Smith, J. S., & Brewer, N. T. (2010). The Association Between
Cervical Abnormalities and Attitudes Toward Cervical Cancer Prevention.
Journal of Women's Health (15409996), 19(11), 2011-2016. doi:10.1089/jwh.2009.1790