Increasing Efforts to Reduce Cervical Cancer through State-Level Comprehensive Cancer Control Planning

Abstract

Reducing cervical cancer disparities in the United States requires intentional focus on structural barriers such as systems and policy that impact access to human papillomavirus (HPV) vaccination, cervical cancer screening, and treatment. Such changes are difficult and often politicized. State comprehensive cancer control (CCC) plans are vehicles that, if designed well, can help build collective focus on structural changes. Study objectives were to identify the prioritization of cervical cancer in state CCC plans, the conceptualization of HPV within these plans, and the focus of plans on structural changes to reduce cervical cancer disparities. Data were gathered by systematic content analysis of CCC plans from 50 states and the District of Columbia from February-June 2014 for evidence of cervical cancer prioritization, conceptualization of HPV, and focus on structural barriers to cervical cancer vaccination, screening or treatment. Findings indicate that prioritization of cervical cancer within state CCC plans may not be a strong indicator of state efforts to reduce screening and treatment disparities. While a majority of plans reflected scientific evidence that HPV causes cervical and other cancers, they did not focus on structural elements impacting access to evidence-based interventions. Opportunities exist to improve state CCC plans by increasing their focus on structural interventions that impact cervical cancer prevention, detection, and treatment, particularly for the 41% of plans ending in 2015 and the 31% ending between 2016 and 2020. Future studies should focus on the use of policy tools in state CCC plans and their application to cervical cancer prevention and treatment. Cancer Prev Res; 8(7); 636-41. Ó2015 AACR.

State statutes and regulations related to human papillomavirus vaccination

“…[35][36][37][38] Another emerging issue which has been explored elsewhere is the tendency to focus on females for HPV related policy and interventions. [38][39][40][41] Virginia's language of limiting its…”

“…school-entry requirements to only female students does not reflect CDC guidelines 41 and shifts the burden of cervical cancer prevention entirely to female students. As we note elsewhere, 40 this is likely reflective of the changing science around HPV and the delay in reflecting such science in policy, as Virginia enacted this law in 2007, 9 the same year that CDC's Advisory Community on Immunization Practices (ACIP) issued its first recommendations related to HPV vaccination. 42 These recommendations exclusively applied to females.…”

Combating Cancer Through Public Health Practice in the United States: An In-Depth Look at the National Comprehensive Cancer Control Program

“…Population-based early detection or screening is currently recommended by USPSTF for only a few types of cancer: mammography for breast cancer, pap smear for cervical cancer, colonoscopy (and other tests) for colorectal cancer, and the use of low-dose computed tomography for lung cancer screening [22]. Cancer plan reviews have shown that the vast majority contain cervical cancer content with 80.4% containing educational activities with a focus on individual behavior change [48]. Clinician behavior change was included in 41.2% of plans, and 11.7% identifying specific systems or environmental changes to bring about this change in clinicians [48].…”

“…Cancer plan reviews have shown that the vast majority contain cervical cancer content with 80.4% containing educational activities with a focus on individual behavior change [48]. Clinician behavior change was included in 41.2% of plans, and 11.7% identifying specific systems or environmental changes to bring about this change in clinicians [48]. This work does extend to NCCCP-funded areas of relatively low resources, such as the USAPIJs.…”

Mapping Evidence on Management of Cervical Cancer in Sub-Saharan Africa: Scoping Review Protocol

“…The interventions include prevention, early detection (screening and diagnosis) and treatment (20). Improvements in CC screening, involve addressing systems challenges and changing policies of public health structural interventions which alter structural context for health and are often politicised (21). Women are more likely to seek help when the disease is already at advanced stages (22).…”