Ohio State Researcher Hopes ‘Generational’ Approach Can Help Reduce Cervical Cancer In Appalachia

Women in Appalachia face some of the highest rates of cervical cancer in the country. They are also among the groups of women least likely to receive cancer screenings. 

The Ohio State University Professor Electra Paskett has dedicated much of her career to understanding the reasons behind why women in Appalachia are more likely to contract and die of cervical cancer. 

“So when we started this study, there were three factors that were related to cervical cancer — tobacco use, lack of pap screening and HPV infection,” she said. “So, what we started to do in the first five years was really qualify all of those.”

This year Paskett and her colleagues received a multi-million-dollar grant aimed at cervical cancer prevention. The team will be working with medical providers in 10 health systems in West Virginia, Kentucky, Ohio and Virginia to implement a multi-pronged cervical cancer prevention program. It will include helping women quit smoking and aims to increase the number of women who get screened for cervical cancer and receive the HPV vaccination. 

“What we will be teaching the providers and the clinics is how to offer that to their patients,” she said. “It will not only focus on the individual woman, but … on their family members, both their children and other family members, who might smoke for example. We call it a generational family-based intervention delivered by the clinic.”

Paskett recently presented her work at West Virginia University’s School of Public Health.

11/14/19 9:30 a.m. — This story was updated to reflect Dr. Paskett’s correct affiliation. It’s The Ohio State University.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.

A Conversation About Cancer Rates in Appalachia

Rural Appalachia has some of the highest cancer mortality rates in the country — up to 36 percent higher than what is seen elsewhere. The culprit? That’s a multi-fold answer. Kara Lofton talked about cancer rates in Appalachia with freelance reporter Lyndsey Gilpin, who wrote a story addressing the discrepancy. Data journalism website FiveThirtyEight published the story earlier this month.

In one of the opening paragraphs of the article you write: “In rural Appalachian Kentucky, the cancer mortality rate is 36 percent higher than it is for urban, non-Appalachian people in the rest of the country; in rural Appalachian Virginia it is 15 percent higher; in those areas of West Virginia, 19 percent. Those are pretty stunning statistics. What is going on in rural Appalachia to make cancer rates so much higher here?

 

It’s really because of this perfect storm of unfortunate circumstances. You have a rural population with very high obesity rates, high rates of smoking, really high poverty rate, a  high unemployment rate and then you have a lack of education. And then on top of that you have the health care side of things with lack of access to preventive care and lack of access to really good treatment. 

You also write that “[p]eople in much of rural Appalachia are more likely to die within three to five years of their diagnoses than those in both urban Appalachian areas and urban areas across the U.S. Why is that?

 

That’s primarily because of this lack of access we’re talking about. And even when people can get care they have to drive farther and wait longer and perhaps not have access to advanced clinical trials or really great health care systems hospitals – things like that – that can provide them with the best kind of available resources for the best outcomes and survival rates. 

 

Preventive screenings are one of the best tools we have to catch cancer early. What role does access to preventive services – or access to care at all – have on cancer rates in Appalachia?

Preventive care is perhaps the biggest piece of this puzzle. From everyone I talked to it seemed like that was the part they are trying to fix and it could be the most immediate fix. And so a lot of the cancers they focused on were preventable cancers. So breast cancer, colon cancer, lung cancer and cervical cancer. There are a lot of barriers to get to the point when they can access something as easy as a screening.

You mention in the article that economic, social and environmental factors also play a role in cancer incidence. What is going on in rural Appalachia that is different from the rest of the country?

 

Lifestyle is a big part of it, but lifestyle factors have a lot to do with the economics and the social and environmental factors. So obviously this isn’t new to anyone I talked to in Appalachia. Poverty and the decline of the coal mining industry have a very real effect on specific health care outcomes.

 

Appalachia is well known as a hub for commercial coal production. Is coal mining causing higher cancer rates?

It’s not as clear as that. We can’t draw the direct connection between coal pollution in cancer. Almost everyone I spoke to that was living in eastern Kentucky talked about the fact that they were leery about water contamination  and its relationship with cancer or other chronic illnesses, but if you look at the research there’s not enough to prove that link. There is research that shows mortality and chronic illnesses are higher in coal producing counties. 

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.

W.Va. Has High Rate of Cervical Cancer Despite Preventive Vaccines

Human Papillomavirus – more commonly known as HPV — is the most common sexually transmitted infection in the United States. It is so common that almost all sexually active individuals will get it at some point, which puts them at risk for developing various cancers. The good news: HPV is preventable. The bad news: vaccination rates are low nationwide, with particularly troubling statistics coming out of West Virginia.

Shelly Dusic found out she had cervical cancer two weeks after she got married. She was 22.

“And I was probably the most grateful person to find out I had cancer you’ve ever seen,” says Dusic. “Because for the six years prior to that, I’d been told by four doctors that I’d never live to see 30, that they didn’t know what was wrong with me. [I had] been through seven diagnostic surgeries and we didn’t know what was wrong.”

Her first symptoms of having HPV – irregular, heavy periods, debilitating pain in her right side – started when she was about 16. She had a hysterectomy to address the cancer when she was 23.

Dusic was quick to point out that her case was not “normal.” The average age of cervical cancer diagnosis in the United States is 48.  

“But being exposed to the virus that causes cervical cancer in your teens or early 20s is very common,” she says.

HPV viruses (there are more than 100 related strains) cause almost all cases of cervical and anal cancers, according to the National Cancer Institute. HPV can also cause other cancers, including cancer of the mid-throat. Once someone is infected with HPV, they will carry it until the virus leaves their system – or doesn’t; there is no cure.

“We need to get the word out that we have a vaccine that can prevent cancer,” says Kathryn Moffett, head of the pediatric infectious diseases at West Virginia University School of Medicine.

“Giving the HPV vaccine is not about giving your child permission to be sexually active,” says Moffett. “Those are very important conversations to talk to your kid about making good choices, and waiting on things and being monogamous – those are all really important things. It’s about prevention – give it before anyone is even remotely considering doing anything. Give it at 11 and 12 when they get a really brisk response and they get a response to all the serotypes in the vaccine – then you are protected.”

Moffett says millions of doses of the vaccine have been given in the ten years since the vaccine was approved, but that West Virginia continues to experience low vaccination rates. There are no known serious side effects to the vaccine.

“Unfortunately, we are number one in HPV-related cervical cancer deaths and number four in HPV-related infections in the United States,” says Moffett. “That’s bad.”

Part of West Virginia’s high cervical cancer rates may be due to other risk factors. Smoking, for instance, increases the risk of cervical cancer, as does poverty and being overweight, according to the American Cancer Society.

Shelly Dusic was diagnosed with cervical cancer in 2002 – four years before the first vaccine came out.

“The day the FDA approved the vaccine for HPV, I bawled like a baby,” says Dusic. “Because for the first time there was hope that no other woman had to go through what I went through, and no one should.”

According to the CDC, about 79 million Americans are infected with HPV. About 14 million people become newly infected each year, with no cure yet in sight.

Dusic is now 36 and hasn’t been sick since her surgery. She loves being well. But she says she still has trouble walking through the aisles of Walmart and passing the baby section.

“And I think about the things that that vaccine could have saved,” she says. “It would be worth it.”

Dusic is now a Health Information Specialist for the WV Breast and Cervical Cancer Screening Program, which has been partnering with the WV Immunization Network to try and increase HPV vaccination rates in Appalachia.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

State Immunization Network Hosts First West Virginia HPV Summit

Human papillomavirus, more commonly called HPV, is the most common sexually transmitted infection in the United States, affecting about 1 in 4 Americans. The HPV virus can cause cervical cancer, of which West Virginia has the highest incidence rate in the country.

“We are holding the HPV summit today because we have a vaccine that can prevent cancer – this is a wonderful development that we have that we can use to really keep our communities healthy,” said Elaine Darling, Program Manager for the West Virginia Immunization Network.

“And yet only about 40 percent of females in West Virginia ages 13-17 have received the vaccine, and when you look at males it’s even lower at 24 percent. And yet we can prevent cancer among them, but we are just not reaching as many people as we should.”

The summit included representatives from more than 45 organizations, such as state agencies, insurers, schools and faith communities.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

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