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Invasive Cervical Cancer Strikes Hispanics Hardest

Almost twice as likely as others to be diagnosed with disease

WEDNESDAY, Nov. 27, 2002 (HealthDayNews) -- Hispanic women are almost twice as likely as whites to be diagnosed with aggressive cervical cancer, a statistic that health experts say underscores the need for better screening programs and earlier detection efforts among minorities.

A new report looking at rates of cervical cancer in the United States between 1992 and 1999 found that the disease is becoming less common in all women. But Hispanics were twice as likely as other women to be diagnosed with the potentially deadly disease at any age. Overall, there were 16.9 cases per 100,000 Hispanic women, compared with 8.9 per 100,000 among other women, during the seven-year period.

"The problem is that they are not getting screened as [often as] the other women," said Dr. Sidibe Kassim, an epidemiologist at the Centers for Disease Control and Prevention and a co-author of the report appearing in this week's Morbidity and Mortality Weekly Report. Kassim said the CDC needs to develop "culturally appropriate" messages promoting screening -- including the Pap test -- for Hispanics.

The CDC estimates that 13,000 women will be diagnosed with cervical cancer this year, and 4,100 will die from the disease. When screening tests catch cervical tumors early, the five-year survival rate is better than 90 percent. But only 15 percent of women in whom the cancer has already spread when detected will live that long, Kassim said.

Cervical cancer can be caused by infection with human papillomavirus, which also leads to genital warts. Earlier this month, scientists announced that a vaccine against the HPV-16 strain of the virus, microbes implicated in about half of all cervical cancer cases, blocked 100 percent of infections in women who received it.

The U.S. Preventive Services Task Force recommends Pap screening every three years for women once they become sexually active.

Jane Delgado, a psychologist and president of the National Alliance for Hispanic Health, called the latest findings "old news," and said the public health community hasn't done enough to rectify the disparity.

Although the Pap test itself is cheap, if it is combined with a visit to the doctor, the price tag can top $40, Delgado said, and that's too steep for many women with low incomes and no health insurance. Hispanics make up 35 to 40 percent of the nation's uninsured, according to Delgado.

Theresa Byrd, a health behavior specialist at the University of Texas-Houston School of Public Health's El Paso campus, said that in addition to insurance coverage, there are cultural issues that help explain why Hispanic women are less likely than whites to be screened for cervical cancer.

Byrd has been working on ways to improve screening rates in Hispanics living along the U.S. border with Mexico, a country in which cervical tumors kill more women than any other cancer.

"What we found is that there's a lot of feelings of embarrassment about the exam itself and, in older women, some sense that their partners don't want them to have the exam," she said.

Many Mexican women also feel having a Pap test is a sign that they're sexually active, an image they don't want to broadcast, she added. "I'm not sure that's completely different from other cultures, but it's more pronounced in Mexican culture," she said.

Byrd and her colleagues have devised an array of materials, from printed brochures to Spanish-language videos, to overcome the resistance to Pap testing. They recently launched their campaign in the El Paso, Texas, area and are hoping to know soon if it works.

What To Do

For more on cervical cancer, try the CDC or the National Cancer Institute.

SOURCES: Sidibe Kassim, M.D., M.P.H., epidemic intelligence service officer, Centers for Disease Control and Prevention, Atlanta; Jane L. Delgado, Ph.D., M.S., president and chief executive officer, National Alliance for Hispanic Health, Washington, D.C.; Theresa Byrd, Dr. P.H., M.P.H., associate professor of behavioral sciences, University of Texas-Houston School of Public Health, El Paso branch; Nov. 29, 2002, Morbidity and Mortality Weekly Report
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