Prioritizing US Cervical Cancer Prevention With Results From a Geospatial Model

Abstract

Purpose To determine if differences in screening and vaccination patterns across the population may accentuate ethnic and geographic variation in future burden of disease. Methods Using Cancer in North America data provided by the North American Association of Central Cancer Registries, county cervical cancer incidence trends from 1995 to 2009 were modeled for the entire United States using ecologic covariates. Rates for health service areas were also modeled by ethnicity. State-level incidence was mapped together with Papanicolaou (Pap) screening, past 3 years (women ≥ 18 years old), and three-dose human papillomavirus (HPV) vaccine coverage (girls 13 to 17 years old) to identify potential priority areas for preventive services. Results US cervical cancer incidence decreased more during the periods 1995 to 1999 and 2000 to 2004 than during the period 2005 to 2009. During these 15 years, the most affected areas became increasingly confined to Appalachia, the lower Mississippi Valley, the Deep South, Texas, and Florida. Hispanic and black women experienced a higher incidence of cervical cancer than both white and Asian and Pacific Islander women during each period. Women in 10 of 17 states/districts with a high incidence (≥ 8.14/100,000) reported low Pap testing (< 78.5%), HPV vaccine coverage (< 33.9%), or both prevention technologies. Conclusion The decline in cervical cancer incidence has slowed in recent years. Access to HPV vaccination, targeted screening, and treatment in affected populations is needed to reduce cervical cancer disparities in the future.

Urban/Rural Differences in Breast and Cervical Cancer Incidence: The Mediating Roles of Socioeconomic Status and Provider Density

“…Researchers have increasingly documented the role of geography in health disparities research, both independent from and in conjunction with more traditional health disparities by race/ethnicity and socioeconomic status (Bell, Hoskins, Pickle, & Wartenberg, 2006; Chandra & Skinner, 2004; Diez Roux & Mair, 2010; Fogleman et al, 2015). Geographic health disparities, such as the differences in cancer incidence by urbanicity, point to potential modifiable influences on health that can affect entire regions and potentially also affect other health disparities (Andrews et al, 1994; Kish et al, 2016; Wells & Horm, 1998). The observed associations between urbanicity and breast and cervical cancer incidence were partly mediated by county-level SES and the density of primary care providers, both of which tended to be higher in urban areas.…”

“…Figure 1 illustrates the full paths and interrelationships of the potential mediation analysis. Examining how area-level variables work together to influence disparities in cancer screening and outcomes could support the development of locally-targeted interventions (Andrews et al, 1994; Kish et al, 2016; Wells & Horm, 1998). Evidence supporting each of these candidate mediation pathways would highlight different targets for interventions aiming to ameliorate urban/rural differences in counties’ cancer incidence rates.…”

Elimination of cervical cancer: challenges for developing countries

“…Immigrants, African-Americans, Hispanics and older women, particularly those of lower economic status and those living in economically deprived and rural areas of the country were shown to be at greatest risk. To overcome these ethnic and geographic disparities, the authors have recommended increasing access to screening through community involvement, door-to-door visits and the use of HPV self-collection [31]. These efforts should additionally include accurate data collection on ethnic and vulnerable group uptake of HPV vaccination, to ensure that all subgroups are equally exposed to cervical cancer prevention strategies.…”

Application of a geographic information system in the study of spatial aspects of cervical cancer incidence in Belgrade

“…Data on all identified cases that are already in the Cancer Registry, are routinely entered into GIS. On that way, it is possible to correlate an incidence with geographical and environmental parameters and discover of the disease emergence patterns within an area 15,30,31 .…”

“…The visualization of case distribution and evaluation of the accessibility of health care institutions can further be used for planning health care services (e.g. screening centers), both in regards to assessing the location of existing health care institutions, as well as to planning the opening of new ones in locations more favorable for the population 31,32 . The experience of Australian researchers indicates the importance of the distance between the place of residence of those invited for a mammography screening and the place it is being held.…”