COVID-19 exacerbates cervical cancer disparities in Appalachia
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Amid the COVID-19 pandemic, people are putting off care, letting self-care strategies slip and falling back into unhealthy habits as they spend more time isolated and at home.
At The Ohio State University, we are seeing the potential long-term effects of COVID-19 every day. And at The Ohio State University Comprehensive Cancer Center — James Cancer Hospital and Solove Research Institute (OSUCCC), we are particularly concerned about how the pandemic could worsen cervical cancer disparities in Appalachia, a region where rates are among the highest in the United States.
Today, on HPV Awareness Day, I hope we can not only bring attention to the global effect of the disease, but focus on those populations who are not receiving adequate support in the fight against HPV due to the inequalities that plague health care around the world.
I serve as co-leader of the cancer control program and director of the Center for Cancer Health Equity at OSUCCC — James, where our work serves as a model for studying how to eliminate cancer health disparities. We use a team science approach to understand and intervene in problems that range from cancer prevention and early-detection exams to making sure people with cancer receive the care they need.
Our research is meant to prevent or reduce the burden of cancer through intervention strategies that we hope change behaviors and allow patients to take control of their own health. This is a particularly important goal for populations who typically are underserved and lack sufficient health care access.
To help make meaningful changes in this area, investigators from OSUCCC — James and University of Michigan launched the CARE program in 2003, the acronym for which stands for Community Awareness Resources and Education.
The initiative focuses on reducing cervical cancer incidence and mortality by targeting three main issues: HPV infection, timely cervical cancer screening and smoking cessation.
Cervical cancer rates are higher in Appalachian Ohio, Kentucky, West Virginia and Virginia than the rest of the United States. Among this population, we also see lower HPV vaccination and screening rates, as well as higher smoking rates.
The Appalachian region suffers from geographic isolation, above-average poverty rates, low household income and below-average educational attainment, making it a prime area for misinformation, limited health care access and unhealthy behaviors like tobacco use.
The CARE program’s research is built upon four core principles:
- the social determinants of health framework;
- community-based, participatory research;
- multilevel framework (as we like to say, “from cells to society”); and
- a transdisciplinary team of researchers and community members.
Studies are being conducted in community-based settings that represent the underserved population of women in the area. The studies utilize the OSU Center for Cancer Health Equity’s advisory committees, community partners and participating clinics.
The third phase of the program, CARE 3 — which started in 2018 — is initiating clinical-specific implementation plans across four states to address three areas of cervical cancer prevention: tobacco use, HPV vaccination and cervical cancer screening.
The populations with which we work come with their own barriers and solutions, so we use a multilevel approach in our work.
We target local health systems by establishing automatic reminder and follow-up systems. We teach providers what to do; how to assess for smoking, offer screening and vaccination; and how to address hesitancy. We provide patients with culturally appropriate materials that answer many of their questions and address their concerns about smoking cessation, the vaccine and screenings.
Many of the reasons for nonadherence stem from a lack of funding in communities like those in Appalachia. Over the last year, the COVID-19 pandemic has exacerbated these challenges.
COVID also has led to people paying less attention to recommended screening and vaccination, as well as an increase in smoking. Both of these factors are heightened in Appalachia, where vaccination rates are lower, screening numbers are low and smoking rates are high. Any of these factors can cause higher rates of cervical cancer in the years to come.
And, unrelated to COVID, many people in these regions are still unaware that the HPV vaccination can be given to both men and women from ages 9 to 45 years.
With the development of an effective vaccination and our continued understanding of risk factors and prevention methods for cervical cancer, we’re making strides in our fight against the disease in places like Appalachia. However, as is the case in many medical areas right now, the tangential effects of the pandemic could lead to a setback of the progress we have made.
As we acknowledge HPV Awareness Day, I hope we consider populations like those we see in our CARE program and remember that the progress we have made in cancer death rates should lead to better outcomes for everyone, not just those who live in our own communities.
At OSUCCC — James, we call on other health systems to rise to this challenge, as well, using their resources to work toward improving the outcomes of patients and community members who live in underserved and at-risk areas. Together, we can bring progress in reaching a cancer-free world to all people.
For more information:
Electra Diane Paskett, PhD, can be reached at paskett.1@osu.edu.
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