Confronting the Cervical Cancer Disparity among Latinas in Arizona

Nearly a third of Arizona’s population identifies as Hispanic or Latino. Compared to the general population, Latinos have a lower risk for most cancers. But some cancers, like cervical cancer, are more likely to strike Latinas — and are also more likely to kill them.

“If you look at the state of Arizona, the mortality rate for cervical cancer among Latinas is almost twice the rate of non-Hispanic whites,” says Antonio Estrada, MSPH, PhD, UA Mel & Enid Zuckerman College of Public Health professor and former co-director for the Cancer Health Disparities Program.

The good news is that cervical cancer can be prevented with a vaccine, as well as by screening and treatment techniques that can detect cellular abnormalities before they turn cancerous, preemptively treating cancers prior to their unwelcome arrival.

Prevention through Early Detection and Vaccination

Cervical cancer is caused by a common virus called HPV, or human papillomavirus. HPV infections are about as common in Mexican-American and non-Hispanic white women, with the virus affecting around 2 out of 5 women. In most people, an HPV infection eventually goes away, but in about 10 percent of cases the infection becomes chronic.

“Chronic infection is what causes the cancer,” says Jorge Gomez, MD, PhD, of the UA College of Public Health’s Center for Elimination of Border Health Disparities and the UA Cancer Center’s assistant director for cancer outreach. “It takes years to develop.”

The slow-growing nature of cervical cancer allows for it to be detected early by Pap testing, which can identify cellular abnormalities before they turn into cancer. When caught early, these abnormalities can be removed before they have the chance to develop into cancer.

Unfortunately, according to Dr. Estrada, when Latinas have cervical cancer, “they’re detected at a much later stage.”

In addition to making sure Latinas receive regular screening for cervical cancer, HPV vaccination can be encouraged — among both boys and girls. While Latino boys are more likely to be vaccinated against HPV than their white counterparts, only a little more than half of them have received the vaccination.

“The transmitter of HPV is males,” says Dr. Gomez. “We haven’t put any effort in educating the male population to be vaccinated. It is a travesty. We need to develop interventions.”

Health-care providers can play a major role in increasing their patients’ vaccination rates. Latino boys are eight times more likely to be vaccinated for HPV when a health-care provider recommended the vaccine to their parents.

“If we can immunize more women and especially more young men, then we can reduce the incidence,” says Dr. Estrada.

People without insurance might face financial barriers, but there is help for them. Children can obtain the HPV vaccine through programs like Vaccines for Children, and adults who need cervical cancer screening can obtain assistance through the National Breast and Cervical Cancer Early Detection Program. Making sure that everyone has access to HPV vaccination and cervical cancer screening is an important first step, as is making sure that people take advantage of these resources.

“We have to lower the fear and the anxiety related to cancer treatments,” says Dr. Estrada. “We can do that, but it requires an effort by the entire clinic, focusing on culturally sensitive outreach, recruitment and patient retention.”

The Mystery of Pap Testing among Latinas

While cervical cancer screening and HPV vaccination are important tools in reducing cervical cancer rates, Latinas are already making good use of these resources. In Arizona, Latina teens are more likely than their white counterparts to receive HPV vaccination. Additionally, 80.5 percent of Latinas have had a Pap test in the previous three years, giving them a slight edge over the 79.8 percent of women in the general population who have done the same.

Why do Latinas bear a higher cervical cancer burden if 4 out of 5 of them are getting regular Pap tests? The answer to that riddle may be found in the remaining 1 out of 5 women who has not had a recent Pap test.

“If 80 percent indicate that they’ve had them, then who is coming up with advanced cancer?” asks Dr. Estrada. “It must be somewhere in that 20 percent. To what extent is that 20 percent driving those higher mortality rates?”

It’s possible that the 1 Latina out of 5 not getting regular Pap tests is even less likely to have ever received one than the 1 white woman out of 5 not receiving regular Pap tests.

“That one-fifth of the population that is not getting into care is the focus to do outreach,” says Dr. Estrada. “We want to increase the screening; we want to do more culturally sensitive and appropriate outreach and education.”

Barriers to Cervical Cancer Prevention

In addition to socioeconomic status, geography can present a formidable barrier to health-care access, and in Arizona cervical cancer rates are highest in the rural Mohave, Graham and Greenlee counties. Previous research by Dr. Estrada found that women in rural areas are much less likely to receive cervical cancer screening than their urban counterparts.

“Rural counties tend to lack those kinds of services unless you know where to go,” says Dr. Estrada. “Once you get diagnosed, you have to go for care into the urban areas. If you’re living in Douglas it’s going to take you three hours to get here. If you’re living on the east, near New Mexico, it’s going to take you close to four hours to get into Phoenix. That’s hard.”

Some programs aim to address rural health-care access, including Federally Qualified Health Centers and Rural Health Clinics. “These are clinics that provide outpatient care in semi-rural areas and they do provide some level of screening,” says Dr. Gomez.

The vaccine can also help reduce cervical cancer nationwide, including in rural areas where vaccination might be more feasible than regular screening.

“I think it’s easier to implement that in a more systematic way than to have Pap smears being implemented throughout the state,” says Dr. Gomez.

In addition to geographical barriers, Dr. Estrada points to cultural barriers.

“It could be embarrassment, taking your clothes off in front of a male physician or even a female physician,” says Dr. Estrada. “Issues around husbands not wanting their women to get screened because a male physician might see their spouses’ or significant others’ private parts.”

With effective prevention and early-detection techniques, cervical cancer rates can be addressed by expanding health-care access and engaging in community outreach and education.

“Cervical cancer at this point should not even exist,” says Dr. Gomez. “It should not be in our communities.”