Journal explores cervical cancer, health disparities
 

Arnold School of Public Health researchers Saundra Glover (center) and Heather Brandt (left), with social worker Tiffany Stewart, discuss the reports in the Journal of the South Carolina Medical Association.

African-American women in South Carolina are 37 percent more likely to have cervical cancer than white women and have a death rate that is about 61 percent higher, according to a study by researchers at the University of South Carolina’s Arnold School of Public Health.
 

The findings from the study are reported in the December issue of the Journal of the South Carolina Medical Association, which has a series of articles and studies on cervical cancer in South Carolina.

The journal represents one of the first comprehensive statewide reports on cervical cancer incidence and mortality, said Dr. Saundra Glover, an Arnold School researcher and director of the Institute for Partnerships to Eliminate Health Disparities.

Eliminating health disparities is complex and involves many factors, including access to screening and follow-up treatment, she said.

“South Carolina has some of the greatest health disparities in the nation,” Glover said. “This report gives us a better understanding not only of cervical cancer incidence and mortality among African-American women, but also shows the critical role that community groups have in working with doctors and other healthcare professionals and leaders to ensure that women receive screenings and follow-up care.”

The report is timely, given the recent controversy surrounding a report by the American College of Obstetricians and Gynecologists that called for less frequent cervical cancer screening, Glover said.

Arnold School researcher Dr. Heather Brandt said that, although cervical cancer deaths nationwide have dropped 75 percent since the Pap test was introduced for screening, not all women have benefited equally from advancements in screening.

“Women of color, women living in rural areas and women living in poverty continue to develop cervical cancer and die at much higher rates,” she said. “The reports in this journal highlight the challenges that we continue to face in addressing cervical cancer in the United States and around the world.”

A critical need in meeting these challenges is having community partners work with women in cities and rural areas around the Palmetto State.

Social worker Tiffany Stewart, a community liaison, said, “When community residents, community-based organizations and institutions that will be affected are involved in initiating and promoting a call to action, then permanent, successful change is more likely to occur.”

One such effort is the Zeta Phi Beta Sorority Z-HOPE (Zetas Helping Other People Excel through Mind, Body and Spirit) Program, which is focused on increasing cervical cancer awareness among college students.

Among the findings reported in the journal:

• S.C. women who did not receive a Pap test were more likely to be over age 65, unmarried, have less than a high-school education and be from a non-Hispanic race group, including African Americans. ##BREAK##
• Nearly one-fourth of women not receiving a Pap test lacked healthcare coverage and nearly 20 percent were unable to see a healthcare provider because of costs.
• A telephone survey of African-American and white women found that about half of the study’s 1,002 respondents had “high” levels of knowledge about the human papillomavirus, a sexually transmitted infection that has been linked to cervical cancer. However, African-American women knew less about the virus than white women.
• A study of young women, ages 14 – 20, found that about 34 percent would not get the HPV vaccine because of cost.
• A study on the Upstate Witness Project, which addresses breast cancer and cervical cancer among African-American women, found that training “witnesses” and lay health advisers to be an effective method to reach women. The program was tested in African-American churches in Greenville, Spartanburg, Anderson and Pickens counties.
• A study of Latina women in South Carolina found that very few understood the purpose of the Pap test. Most Latina women sought healthcare for prenatal services.

Impact of Medicaid’s Elimination of Option 3
Cancer Treatment for Breast & Cervical Cancer
Best Chance Network

The South Carolina legislature must direct South Carolina Medicaid to restore funding to the Breast and Cervical Cancer Treatment Program to provide Medicaid-covered treatment for uninsured, low-income women in South Carolina aged 18-64 (Option 3.) This treatment coverage was eliminated on January 1, 2009 for those diagnosed outside of the Best Chance Network and for all women under 40.

Background: In South Carolina, the Best Chance Network (BCN) is funded by CDC funds for women aged 40-64 to be screened for breast and cervical cancer. Women screened and diagnosed through the BCN program are also eligible for Medicaid-covered treatment under Option 1 of BCN. At CDC’s current funding level of BCN, less than 10 percent of eligible women are screened. In 2008, with the first ever state funding of $2 million (NON RECURRING) for BCN, this program has been able to double the number of women screened and has allowed women aged 40-46 to be screened in addition to those aged 47-64.

Since July 1, 2005, the Breast and Cervical Cancer Treatment Program (Option 3) has provided Medicaid treatment services for more than 1,100 low-income, uninsured women. Forty percent of these women were under 40 years of age. These women have no way to pay for cancer treatment services.

Budget Cuts: Effective January 1, 2009, the SC Department of Health and Human Services has eliminated Medicaid-covered treatment for uninsured women diagnosed with breast and cervical cancer outside the BCN and for all women under age 40.

• This treatment program multiplies our state’s resources because it maximizes matching federal Medicaid dollars that South Carolina commits to the Option 3 (4 to 1 match.) This federal match provides approximately 79% of treatment costs for every dollar that South Carolina pays. With elimination of Option 3, South Carolina Medicaid estimates a savings of $1.6 million, which would lose $6 million in federal match
   
• This program also saves money by allowing low-income women to seek early diagnosis and timely treatment. Treatment of early stage cancer costs significantly less than late stage cancer and greatly increases a positive prognosis: national data and clinical studies show that it is 2.5 times more expensive to treat late stage breast cancer than it is to treat early stage breast cancer. If breast and cervical cancers are diagnosed early, the five-year survival rates are more than 98% and up to 99%, respectively, versus 27% for late stage diagnoses.

Medical authorities say many cases of cervical cancer can be prevented through screening and vaccination

A statewide campaign targeting cervical cancer kicks off this month with a bilingual billboard campaign to raise public awareness of the disease that strikes some 200 South Carolina women each year.

South Carolina ranks third in new cases of cervical cancer and eighth in deaths due to cervical cancer.  Cervical cancer is a disease for which many cases can be entirely prevented through screening and vaccination.

USC cancer researcher Dr. Heather Brandt is chair of a subcommittee of the S.C. Cancer AIliance that organized the billboard effort in partnership with the USC-Claflin EXPORT Center, South Carolina Cancer Disparities Community Network, and other individuals and groups from across the state.

Brandt said the subcommittee is part of an effort called “Moving to Action: Addressing Cervical Cancer in South Carolina.”

The billboards are on display in January as part of national Cervical Cancer Awareness Month. Funding for them comes from the American Cancer Society, Palmetto Health, and South Carolina Cancer Alliance.

Some 70 billboards, mainly in urban areas of the state, are up featuring a common “Stop Cervical Cancer” theme and individual messages urging women to “Stop Cervical Cancer in South Carolina” by having regular Pap tests, following up on abnormal Pap test results, and learning more about the HPV vaccine.

Brandt said Arnold School students and a recent graduate also are involved in Cervical Cancer Awareness Month activities on the USC campus.

A recent graduate of the exercise science program is canvassing the campus with HPV materials and posters and a doctoral candidate is helping the Thomson Student Health Center prepare a mass mail out on the HPV vaccine.

The subcommittee members also have prepared cervical cancer information suitable for inclusion in church bulletins and a one-page fact sheet.  Additional printed materials have been prepared in Spanish. 

Brandt said another highlight of the campaign is a special cervical cancer symposium of the Journal of the S.C. Medical Association to be published in October.

The special issue will be similar to the magazine’s August 2007 issue that focused on the soaring cancer rate of all kinds among South Carolina’s African-American population.

Brandt said a special feature on the issue will be a comprehensive listing of information resources on cervical cancer for health care providers and others.