Objectives: To review populations of women in the United States at high risk for cervical cancer, assess known reasons for existing outcome disparities, and discuss potential strategies to reduce barriers to HPV vaccination and current strategies for cervical cancer prevention. Methods: An expert forum conducted September 12-13, 2008, by the Society of Gynecologic Oncologists including 56 experts in cervical cancer and titled "Future strategies of cervical cancer prevention: what do we need to do now to prepare?". Results: Although epidemiological data is useful and necessary to identify populations at high risk for cervical cancer, an understanding of the knowledge and attitudes regarding HPV and cervical cancer prevention of racial/ethnic groups and sub-groups within racial/ethnic categories is critical for the implementation of effective targeted and effective educational efforts. Inequities in cervical cancer screening, diagnosis and treatment and HPV vaccination may arise from a number of barriers including access to healthcare, cultural beliefs, and limited awareness of options. Conclusions: Initiatives to promote uptake of prophylactic HPV vaccination that target high-risk women need to be implemented before existing disparities widen. Although acceptability of HPV vaccination is promising, uptake is still low among low-income populations and specific racial/ethnic minorities. To address limited vaccine uptake it may be beneficial to establish national/state guidelines as well as culturally relevant interventions at the individual and community levels. The successful implementation of multiple integrated initiatives on HPV awareness, knowledge, and vaccination will diminish existing disparities in cervical cancer incidence and mortality.
Bibliographical noteFunding Information:
The authors have the following conflicts to disclose: Levi S Downs Jr., research support and honoraria from Merck Corporation and GSK. Isabel Scarinci, none. Mark H Einstein: Montefiore has received grant funding for research-related costs of clinical trials that Dr. Einstein has initiated or been the Montefiore PI from GSK, Merck, Hologic, Nventa Biotechnologies and Tigris Pharmaceuticals. Dr. Einstein has advised, consulted or participated as a speaker, but does not received an honorarium from the following companies: Merck, GSK, Roche, Tigris, Nventa, PDS Biotechnology, Qiagen (Digene) and Hologic. Yvonne Collins, honoraria from Merck Corporation and GSK. Lisa Flowers has served as an advisor to GSK and Merck.
- Cancer prevention
- Cervical cancer
- HPV vaccine
- Health disparities