Why is cervical cancer killing many more African-American women than we thought?

A new research analysis suggests the mortality rate of cervical cancer is higher than we thought, especially among African-American women. Miles O’Brien talks with Dr. Jennifer Caudle of the Rowan University School of Osteopathic Medicine about the findings, as well as the racial disparities in health care.

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    Now: the toll of cervical cancer and recent findings that suggest its death rate is higher than we thought.

    That's the focus of our weekly segment the Leading Edge.

    Estimates had shown more than 4,000 women in the U.S. die from cervical cancer each year, and that the death rate dropped dramatically over past decades. But an analysis published in the journal "Cancer" found the mortality rate is higher than previously thought, and it is significantly higher among African-American women.

    The findings were particularly concerning because cervical cancer can often be prevented through better screening, and the HPV vaccine can prevent some cases.

    Dr. Jennifer Caudle is a family physician and an assistant professor at Rowan University. She has been writing about these findings and the implications for her clinical practice, and she joins us now to tell us a little bit more.

    Dr. Caudle, good to have you with us.

  • DR. JENNIFER CAUDLE, Rowan University:

    Thanks so much.


    Tell us what's new about this study.


    Well, I think it's actually quite profound.

    As a family physician myself, as a woman myself, I thought that the results of the study were actually quite staggering. Basically, researchers found that we'd been underestimating the levels of cervical cancer mortality.

    And not only that, but we have also been underestimating the amount of racial disparities that exist in cervical cancer mortality. So, basically, the problem is bigger and worse than we thought. And I think that it's actually quite significant.


    Well, so, let's, first of all, talk about the underestimation in general.

    How could something like that happen? This was a study of studies, taking a second look at numbers, right?


    That's right.


    And what did they find that others overlooked?


    Right. Well, that's a great question, because the key here — and I always say the devil is in the details.

    The key with this particular study is, they took into account whether a woman had a hysterectomy or not. Now, when we talk about hysterectomy, a complete hysterectomy often is when a woman has her cervix removed.

    And, if you can imagine, if a woman doesn't have a cervix, her chance of getting cervical cancer is slim to none. That, along with the fact that black women tend to have a higher prevalence of hysterectomies, you can see how both of those factors, when they're actually taken into consideration, can cause the results that we saw.

    So, basically, when researchers looked at whether a woman had a hysterectomy or not, we found that our prior results actually had been underestimated, and more women had cervical cancer mortality rates, higher rates, and more racial disparities that than we thought.


    So, you really don't have to be a scientist to realize that, if you remove the group of people who don't have a cervix at all, you are going to have a different set of numbers.

    But let's — help us understand a little bit more about why African-American women might disproportionately be affected.



    And I'm really glad that we're talking about this. When I wrote my op-ed piece, you know, I was speaking as a family physician, but also as a black woman. And racial disparities in health care, it's not new. Unfortunately, we see racial disparities in health care in cervical cancer here, but also in many other cancers and other conditions.

    But one of the things that we're looking at is why exactly these racial disparities exist. And, yes, there are many organizations that have been working on this sort of topic globally. And there's not one answer.

    But we do think there might be some reasons why black women have higher rates of cervical cancer mortality, some of those being access to care, the ability to get screened early, to get screened period, the type of cancer that black women get vs. white women, and the types of treatments that are offered.

    So, those are some of the things that have been posed as possibilities as to why we see the discrepancy. But the bottom line is, it's unfortunate. And it's something we have to keep talking about.


    This is a particularly poignant one for those of us here at the "NewsHour." Of course, in November, we lost Gwen Ifill to gynecological cancer, a different kind of gynecological cancer.

    In the case of cervical cancer, I know it's very difficult for families who are affected, because, with screening, and in some cases a vaccine, it can be prevented.


    That's right.

    And that's, I think, one of the most important points here, is, as we're looking at the global issue of why are there racial disparities, why are there higher mortality rates than we thought, we also need to look at what we do have.

    And you're right. We have a screening tool to screen for cervical cancer. That's the Pap smear, along with the HPV Testing. We also have the HPV, or human papilloma virus, vaccine. That was made available in 2006, and it is indicated for young women.

    It doesn't protect against all strains of HPV that can cause cervical cancer, but it does protect against many of them. And the hope is that, in further years, we're going to see the benefit of that vaccine.


    As we speak here in Washington, the Trump administration, Congress appears poised to reverse Obamacare, the Affordable Care Act.

    What should we do about that?


    We know the Affordable Care Act provided care to maybe some millions, 20 million or so people. And the question is, what's going to happen if that changes and how it changes?

    And there are so many question marks that we don't have. One thing I know, as a family physician, though, is that we have to — whatever system we go to next, whatever — however Obamacare changes or doesn't change, we need to make sure that people still have access to quality and affordable care.

    And we need to make sure that we're really reinforcing preventative services, because things like colonoscopies, and Paps, and mammograms, not only do they save lives, but they save money down the line.

    And that's one of the things that we're talking about here with cervical cancer screening is, we have got to make sure that these preventative services are there.


    Dr. Jennifer Caudle, thank you very much for your time.


    Thank you.

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