Persistent disparities of cervical cancer among American Indians/Alaska natives: Are we maximizing prevention tools?

ElsevierVolume 168, January 2023, Pages 56-61Gynecologic OncologyHighlights•

Cervical cancer screening participation among AI/AN women is below the U.S. national average with a range of 57.1–65.0%

AI/AN women in the age group of 50–64 had the lowest rates of up-to-date cervical cancer screening at 51.2%

HPV vaccination rates have increased over time with a current completion rate of 58.6%, but remain below national goals

AbstractBackground

Cervical cancer incidence and mortality disparities experienced by American Indian/Alaska Native (AI/AN) women have persisted for decades. Pap smear screening and HPV vaccination are powerful tools to prevent cervical cancer. We evaluated the utilization of these tools among AI/ANs living in the Pacific Northwest (PNW).

Methods

The Indian Health Service (IHS) National Data Warehouse's Epi Data Mart was analyzed using all healthcare visits from 2010 to 2020 from IHS, Tribal, and Urban Indian clinics in the PNW. Women ages 21–64 were included and considered up-to-date on pap smears if they had either cytology within 3 years or cytology with HPV testing within 5 years of the most recent clinical encounter. HPV vaccination rates for both sexes were calculated for individuals ages 9–26. HPV vaccination was considered complete if: two vaccines were received prior to age 15 or after three vaccinations if initiated after age 15.

Findings

Cervical cancer screening rates are below the national average of 73.5% ranging between 57.1% - 65.0%. Sub-analysis of age groups shows substantially lower rates of up-to-date pap smear screening in the 50–64 age group. HPV vaccination rates have increased over time for both sexes across all age groups. However, the current vaccination rate of 58.6% is well below the Healthy People 2030 goal of 84.3%.

Interpretation

Cervical cancer screening and HPV vaccination are the cornerstones of cervical cancer prevention and early detection. These tools are underutilized and public health efforts can be strengthened to improve cervical cancer disparities in AI/AN women.

Funding

Author ASB: Funding for this project has been provided through the Robert Wood Johnson Foundation Harold Amos Minority Faculty Development Grant and the National Cancer Institute K08 Mentored Clinical Scientist Development Award.

Keywords

American Indians or Alaska Natives

Pappilomavirus vaccines

Papanicolaou test

Cervical cancer screening

HPV

Health disparities

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