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Jennifer S. Smith, Ph.d., M.p.h.
Published: 20 January 2011

Kristen Forbes of Noblesville, Indiana, had recently graduated from college when she was diagnosed with invasive cervical cancer at age 22. After a yearlong, painful battle, she succumbed to the disease, leaving behind a bright future and  grieving family members and friends.

Like most of the 4,000 women in the United States who die of cervical cancer each year, Kristen's death was preventable. We now have the medical know-how and the tools to stamp out this major cancer once and for all. What we need now, as our country honors National Cervical Cancer Awareness Month this January, is the will among members of the public health community – government officials and policymakers, medical professionals, insurers, women and others – to make it happen.

Cervical cancer used to be the leading cause of death for women in the U.S. With widespread use of Pap test screening in the last 50 years, cervical cancer rates have declined significantly, but have leveled to about 12,000 cases each year. This disease should be relatively easy to prevent. We know it's caused by the human papillomavirus, or HPV, a common sexually transmitted infection. Most HPV infections go away on their own, but persistent HPV infections can lead to cell changes that can progress to cervical cancer. Fortunately, with proper treatment, the disease can usually be stopped before cancer develops.

The HPV vaccine is now available and prevents infection from the two types of HPV that are responsible for 70 percent of all cervical cancers. We have an established screening tool – the Pap test – that identifies cell changes that can signal cervical disease or cancer. We also have newer technology – the HPV test – to help identify women who are at increased risk.

So how can we make sure no more women die of cervical cancer?

First, we need to increase HPV vaccination rates. The HPV vaccine is recommended for routine administration in girls ages 11 and 12, with a "catch up" provision for those up to age 26. Studies show, though, that less than one in two young adolescent girls has received it.

We also need to increase screening rates. At least half of all cervical cancer deaths are due to a lack of screening. Yet about 25 percent of women in the U.S. have not been screened in the past three years. Importantly, women who have been vaccinated still need to be screened to protect against HPV types not targeted by the vaccine.

Also, while the Pap test has led to a dramatic decrease in cervical cancer in the U.S., about one third of cervical cancer deaths are caused by screening errors with the Pap test, a problem that more sensitive HPV DNA testing could address. The HPV test is available, in conjunction with a Pap test, for women ages 30 and older.

Most importantly, we need to make cervical cancer prevention a top national health priority. Public health officials and policymakers should support--and fund--programs to educate women about this disease and enable them to access prevention and treatment services. Medical professionals should educate their patients and provide these services, and insurers should pay for them. Women must take charge of their health and get screened and ensure that their adolescent daughters get vaccinated. All of these groups' efforts must be coordinated for maximum efficiency and impact.

The elimination of cervical cancer is an eminently achievable goal. To achieve this vision, a new program – Cervical Cancer-Free America (www.cervicalcancerfreeamerica.org) – is driving state and local prevention programs, and ensuring that successful strategies are shared among the states. The initiative is led by the University of North Carolina at Chapel Hill's Gillings School of Global Public Health.

Since the initiative's launch last year, six states – Alabama, California, Indiana, Kentucky, North Carolina and Texas – have already joined the effort to become "cervical cancer-free." Major universities and other public health experts are leading the charge in each state, supported by government and other leaders.

The movement to eradicate cervical cancer is gaining momentum in our country. But there is more work to be done. Let's join hands and work together to ensure that no more women like Kristen Forbes lose their lives to this preventable disease.


Smith is director of Cervical Cancer-Free America

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