Interview with Phyllis Greenberger: January is Cervical Cancer Awareness Month
Phyllis E. Greenberger, M.S.W., is president and CEO of the Society for Women’s Health Research (SWHR), a Washington, D.C., based advocacy organization working to improve the health of all women through research, education and advocacy. Greenberger serves as chair of the Partnership to End Cervical Cancer, a unique collaboration of more than 30 leading consumer, professional and policy organizations, public health groups and health care professionals, including the National Healthy Mothers, Healthy Babies Coalition, who share a common objective of creating a new standard of preventive health care for women that includes screening and vaccination to prevent cervical cancer.
Q. Why does the cervical cancer vaccine represent such a breakthrough in women’s health?
A. This is the first vaccine to prevent any cancer. The availability of a cervical cancer vaccine marks an exciting technological advance in women’s health and is a critical next step in further reducing the burden of cervical cancer. In the United States, the introduction of widespread screening for cervical cancer through Pap testing helped reduce the incidence of the disease by 74 percent between 1955 and 1992. Today, vaccination with screening has the potential to help eliminate 70 percent of all cervical cancers worldwide. The available vaccine stimulates the body’s immune system to produce antibodies that help to prevent infection from cancer-causing human papillomavirus (HPV) types 16 and 18, which are responsible for 70 percent of all cervical cancers. Additional vaccines are in development.
Q. What are the mission and objectives of the Partnership?
A. The Partnership’s mission is to ensure the immediate inclusion of vaccines to prevent cervical cancer as part of routine preventive health care for all women in the United States. The Partnership is focused on addressing the following four major barriers impeding women’s access to cervical cancer vaccines and screening in the United States to achieve its mission:
- Minimizing health disparities that exist in the U.S. health care system;
- Ensuring that health insurance coverage for cervical cancer vaccination is adequate and reimbursement is in place;
- Ensuring that all physicians in the United States who care for women embrace vaccination as a way of eliminating most forms of cervical cancer; and?
- Developing educational tools to teach women about HPV and its link to cervical cancer.
Q. What causes cervical cancer?
A. Cervical cancer is caused by persistent infection with a common and contagious virus, HPV. It is estimated that at least 80 percent of women will acquire a genital HPV infection by the time they reach the age of 50. A woman can be infected with HPV at a young age but not develop cervical cancer for many years because the disease can progress slowly. Cervical cancer begins in the cervix and becomes gradually more invasive.
Q. What are some policy issues surrounding the cervical cancer vaccine?
A. Cervical cancer vaccines pose a unique set of medical, policy and fiscal challenges that must be addressed to ensure that women are able to benefit from both vaccination and screening. The first vaccine to prevent cervical cancer was recently added to the Centers for Disease Control and Prevention’s (CDC’s) Vaccines for Children (VFC) contract for girls between the ages of 9 and 18 years. The VFC program provides vaccines to children who are Medicaid-eligible, uninsured, underinsured or Native American.
However, there is little precedence for widely vaccinating adult women, and experience with vaccinating women is generally low among the physicians that women visit most, often, particularly obstetricians and gynecologists. The Partnership is currently working to ensure that the vaccines are embraced by medical professionals, public health officials, policymakers and women alike, because they represent a significant medical breakthrough that will save lives.
Q. How is HPV transmitted?
A. More than 30 types of HPV are spread through sexual contact and can be categorized into cancer-causing or non-cancer-causing types. The risk of HPV infection can increase based on the total lifetime relationships that the woman and her partner have had prior to their current relationship. However, monogamy does not necessarily remove the risk of HPV infection.
Q. Do condoms help protect against HPV infection?
A. Condoms are up to 70 percent effective in preventing HPV infection. They do not protect completely against the infection with the virus, because infection does not solely depend on penetrative intercourse; it can occur from skin-to-skin contact of the genital area. Reducing this skin-to-skin contact may reduce the risk of infection.
Q. Who is affected by cervical cancer?
A. All women are at risk for cervical cancer. Women of certain racial/ethnic groups, ages and geographic regions are more likely to be diagnosed with cervical cancer and die from it, particularly African-American women, older women of color, Hispanic women living on the Texas-Mexico border, Vietnamese-American women in central California and white women in Appalachia, rural New York State and northern New England.
Q. What is the prevalence and impact of cervical cancer?
A. Cervical cancer is the second most common cancer among women worldwide, resulting in an estimated 270,000 deaths each year. In the United States, approximately 10,000 women are diagnosed with cervical cancer each year, and nearly 4,000 die from it.
Q. What should individuals do to protect themselves from cervical cancer?
A. Girls and women aged 9-26 should speak with their doctors about getting vaccinated to protect themselves from most forms of cervical cancer. The vaccine protects against 70 percent of cancer-causing HPV types. In addition, women of all ages should schedule annual gynecologic exams and Pap smear screenings.
Q. What do pregnant and lactating women need to know about the cervical cancer vaccine?
A. The currently-approved cervical cancer vaccine has been classified by the U.S. Food and Drug Administration (FDA) as a pregnancy category B vaccine. American College of Obstetricians and Gynecologists guidelines advise that although the vaccine’s use in pregnancy is not recommended, no birth defects have been reported in animal studies. In clinical studies, the proportion of pregnancies with an adverse outcome was comparable in women who received the FDA-approved cervical cancer vaccine and in those women who received a placebo. If a pregnant woman has begun the vaccine series, completion of the series should be delayed until pregnancy is completed.
Lactating women can receive the cervical cancer vaccine that is currently on the market. This vaccine does not affect the safety of breastfeeding for mothers or infants. It is not known whether vaccine antigens or antibodies are excreted in human milk.
For more information about cervical cancer, visit www.nocervicalcancer.org.