Latinas are nearly twice as likely to die from cervical cancer as non-Hispanic white women. They also have the highest rate of cervical cancer among all women, according to data from the Centers for Disease Control and Prevention (CDC).
The high incidence of cervical cancer among minority women “all boils down to access,” said Dr. G. Sealy Massingill, president of the Texas Association of Obstetricians and Gynecologists.
"The lack of access prevents people from getting the health care that they need, and that leads to bad outcomes," Massingill said. "When you ignore a problem, it becomes a problem."
Cervical cancer is one of the most preventable and treatable diseases, yet it claims thousands of U.S. women's lives every year. In 2018, 45 women in the San Antonio area are projected to lose their lives due to cervical cancer, according to the Texas Department of State Health Services.
As many as 93 percent of all cervical cancers are preventable by doing two things: getting the human papillomavirus (HPV) vaccine and getting regular Pap tests. Still, each year more than 12,000 new cases of cervical cancer are diagnosed in the U.S., and more than 500,000 worldwide, according to the CDC.
Alegra Woodard, 54, a self-described "Afro-Latina," was diagnosed with Stage 1 cervical cancer at age 36. Within four days of receiving the diagnosis, she underwent a full hysterectomy before the tumor metastasized and spread to other organs. She told the Rivard Report that she had never missed an annual Pap test or did not have irregular or concerning results from a Pap smear. leading up to her diagnosis. Doctors told her they "simply weren't able to detect anything before it developed into cancer."
At the time, Woodard had never heard of the HPV virus and was unaware that there was a vaccine.
She said her experience with having no prior symptoms or abnormal test results highlights the need for people to "be their own advocate for their health" by receiving annual Pap smears, and for parents to vaccinate their children against HPV.
"Even after my diagnosis I had not heard much about HPV or how it [may have contributed] to my cancer," Woodard said. "And when I talk to people now, a lot of them are still really surprised to learn" that HPV affects both men and women, and that cervical cancer is preventable.
Cervical cancer occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina. The greatest risk factor for cervical cancer is infection by the HPV virus, a group of more than 150 viruses, that is most commonly spread during vaginal or anal sex.
HPV is so common that nearly all men and women get it at some point in their lives. The virus can be passed even when an infected person has no signs or symptoms. In most cases, HPV goes away on its own and does not cause any health problems, but when it remains it can cause health problems such as genital warts and cancer.
“The biggest reason why people get cervical cancer is missed opportunities by way of missed vaccinations and screenings,” said Dr. Georgie McCann, a gynecological oncologist with UT Health San Antonio.
According to the CDC, 69 percent of U.S. women 18 and older have had a Pap smear in the last 3 years.
“If you’re not getting a regular screening with a [Pap test] you are more likely to miss a treatable and curable early cervical cancer or cervical dysplasia,” the growth of precancerous, abnormal cells found on the surface of the cervix, McCann said.
The HPV vaccine can prevent infection by the two types of HPV virus – Types 16 and 18 – that cause 70 percent of all precancerous cervical lesions and cervical cancers. The CDC’s Advisory Committee on Immunization Practices has recommended HPV vaccination at age 11 or 12 for females since 2006 and for males since 2011.
Cherise Rohr-Allegrini is the San Antonio program director with the Immunization Partnership, an advocacy organization working to eradicate vaccine-preventable diseases through public policy initiatives.
She said that in Bexar County, 45.2 percent of girls age 13 to 17 completed the HPV vaccines series in 2016. The national average stands at 49.5 percent.
“Kids below poverty level are more likely to be vaccinated than those at or above poverty-level,” Rohr-Allegrini said. CDC data show that 58.6 percent Bexar County girls living below the poverty level completed the HPV vaccination series in 2016, compared to their peers living at or above the poverty level at 38.9 percent.
Low income families often take advantage of preventative health measures as a means of controlling future healthcare costs they may not be able to afford. More affluent families may utilize vaccines at lower rates “knowing they have the privilege of accessing health care” if they become ill, she said.
Hispanic girls age 13-17 in Bexar County have a 48.9 percent vaccination rate, compared to white, non-Hispanic girls at a 34.5 percent rate.
More Hispanic women will be vaccinated for HPV and are, therefore, less likely to get cancer; but for those who forego the vaccine, the cancer they may develop is more likely to progress and become untreatable due to limited access to health care.
“That’s why Hispanic women are more likely to die – because they don’t have access to health care,” Rohr Allegrini said. Because of this, the rise in HPV vaccination rates may not make a difference in how disproportionately cervical cancer affects this population.
According to 2016 U.S. Census estimates, nearly 60 percent of Hispanic people under the age of 65 in Bexar County are uninsured.
Most people with HPV will never show any signs of the infection until it has already caused serious health problems, which is why regular check-ups are so important, McCann said.
She said signs of potential cervical cancer include bleeding in between periods, bleeding after intercourse, worsening pelvic pain, and swelling in one or both legs, but that “patients should not need warning signs.”
"They should be coming in for regular screenings [because] cervical cancer is treatable and preventable,” McCann said.