Gynecologic cancers present a significant health and economic burden in the United States. While certain gynecologic cancers — namely cervical cancer — are largely preventable, there are steps we need to take to improve access and outcomes for women.
Kathryn G. Schubert, MPP, CAE
President and CEO, Society for Women’s Health Research
More than 100,000 new diagnoses of gynecologic cancers — any cancer that starts in a woman’s reproductive organs — and more than 32,000 gynecologic cancer deaths occurred in the United States in 2018. For cervical cancer — one of the five main types of gynecologic cancers — more than 11,000 women in the United States receive diagnoses and more than 4,000 women die each year.
In public health, we often reference the expression, “An ounce of prevention is worth a pound of cure.” This is an ideal lens through which we can view cervical cancer as a case study.
Prevention & early detection
The HPV vaccine is currently the most effective method to prevent infection, with the potential to prevent over 90% of HPV-associated cancers, as well as anal, vaginal, cervical, and vulvar precancers. The HPV vaccine has been available in the United States since 2006, and current guidelines from the Centers for Disease Control and Prevention (CDC) recommend that boys and girls ages 11 and 12 receive the HPV vaccine as part of routine vaccination. Beyond vaccinations, there are effective tools for early detection and treatment. Notably, cervical cancer is rarely found in women who get regular HPV or Pap tests to screen for cervical cancer.
Yet, despite vaccination and screening efforts significantly lowering overall incidence and mortality rates of HPV-associated cervical cancers, the United States lags behind other developed countries, such as England — where the immunization program has successfully almost eliminated cervical cancer in women born since September 1995 — when it comes to HPV vaccination and cervical cancer incidence rates.
There is a disconnect between prevention and early detection measures and the scientific evidence. A working group of researchers, clinicians, health policy leaders, and patient advocates convened by the Society for Women’s Health Research (SWHR) in June 2020 explored barriers to HPV-related disease prevention, diagnosis, and treatment. Their conversation surfaced takeaways that could benefit our nation’s collective public health.
Eliminating disease-associated stigma
The association between HPV and sexual activity hinders vaccination uptake and the impact of screening recommendations, resulting in a misperception that the vaccine is associated with early sexual activity and increased stigma surrounding HPV. Increasing uptake will require destigmatization among individuals of all genders and age groups.
Reframing the conversation
The HPV vaccine is a necessary public health measure for cancer prevention. While it’s known for preventing cervical cancer, the HPV vaccine can also prevent other anogenital (vaginal, vulvar, and anal) and head and neck (oropharyngeal) cancers in women and men.
Expanding gender diversity
Although HPV-associated cancers occur more often in women than men (21,100 vs 14,800 cases, respectively), more than 4 out of every 10 cases of HPV-associated cancer occur among men. As a society, it is important that educational materials and providers encourage all individuals to participate in this much-needed public health measure.
Gynecologic cancers — though described as “uncommon” or “rare” among women — still bear a heavy burden, and they can be preventable. They are significant to the women experiencing them and place economic strain on both the individual patients and on the U.S. healthcare system. In fact, a 2020 study showed the estimated annual medical expenditure attributed to gynecologic cancers from 2007 to 2014 was $3.8 billion, with an average cost of $6,293 per patient.
We have seen the impact that evidence-based practices like vaccination and screening efforts have had on incidence and mortality of cervical cancer rates, and we see an opportunity to further close those gaps through the steps outlined above. Capitalizing on these opportunities and ensuring sufficient research funding across gynecologic cancers will help ensure that we improve access and outcomes for all women.