By LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO

January is Cervical Health Awareness Month, a time when local health departments (LHDs) can increase awareness of cervical cancer, the role of human papillomavirus (HPV) as the leading cause of cervical cancer, and the importance of prevention and early detection in their communities.

Although the number of cervical cancer cases has decreased over time in the United States, thousands of women and their families, friends, and caregivers are affected by cervical cancer each year. The overall decline in cervical cancers is largely a result of increased screening through the Pap test, which detects cervical precancers.¹ The Pap test is recommended for women 21–29 years old every three years and for women 30–65 years old with HPV co-testing every five years;² therefore, it is important that LHDs encourage women in the community to get tested regularly to identify and treat precancers before they progress. To assist low-income and uninsured women to access cervical cancer screening, the Centers for Disease Control and Prevention (CDC) funds a National Breast and Cervical Cancer Early Detection Program, which supports LHDs to link clients to private medical providers to increase screening in their communities.³

In addition to getting regular Pap tests, another important prevention tool is the HPV vaccine. HPV has been linked to several forms of cancer and causes the majority of cervical cancers. The three-dose HPV vaccine series is routinely recommended for both girls and boys 11–12 years old and can be given to individuals up to 26 years old.⁴ The HPV vaccine is safe and effective for preventing HPV infection, but uptake of the vaccine has been slow since its introduction in 2007.

As a result of the slow uptake of the vaccine, the 2012–2013 President’s Cancer Panel Annual Report expressed the need for urgency in addressing HPV vaccination and recommended three major goals to increase vaccination rates, including reducing missed opportunities to administer the vaccine, increasing overall vaccine acceptance, and improving access to the vaccine.⁵ Despite this call for urgency, national HPV vaccination rates are 39.7% for girls and 21.6% for boys, well below the Healthy People 2020 goal of 80% completion for each.^6,7 However, if providers had taken advantage of every opportunity to vaccinate, it is estimated that 93% of girls 13–17 years old would have received at least one dose of HPV vaccine by 2012 and thousands of cervical cancer cases could have been prevented.⁸

NACCHO is dedicated to helping LHDs reduce the incidence of cervical cancer in their communities by sharing lessons learned from our HPV prevention project and connecting LHDs to our suite of HPV prevention resources.

NACCHO’s HPV Prevention Project
In fall 2014, in response to the low HPV vaccine coverage and the nation-wide focus on HPV, NACCHO, with funding from the CDC, awarded ten LHDs with support to participate in an action planning process and receive technical assistance to increase HPV vaccination rates in their communities. View the full list of participating LHDs here. LHDs worked with stakeholders, including state immunization programs, cancer and immunization coalitions, private medical providers, pharmacies, middle schools and professional schools, and faith-based organizations to develop and implement action plans. NACCHO is funding a second round of LHDs to develop action plans through June 2016.

LHDs in Action
One of the grantees, a current two-county partnership between the Dallas County (IA) Public Health Nursing Services and Polk County (IA) Health Department, is conducting a provider education campaign spearheaded by three highly motivated community immunization champion physicians. The champions will be visiting local provider offices for peer-to-peer education sessions to discuss strategies for improving HPV vaccination rates with office staff. The champions will also be distributing a provider toolkit with videos developed by the Iowa chapter of the American Academy of Pediatrics, posters created by the Iowa Department of Public Health, samples of reminder/recall postcards, examples of standing orders, and a booklet developed by the champions themselves.

How Can LHDs Get Involved?
LHDs can engage in the following steps to increase cervical cancer awareness in January and throughout the year:

• Ensure that the HPV vaccine is stocked in your immunization clinic; educate all staff who interact with patients about the benefits of the HPV vaccine; and confirm that systems are in place to support reimbursement for the HPV vaccine;
• Share information with the public by pitching to your local news to cover a personal story of women and caregivers dealing with cervical cancer and HPV; post cervical cancer messages on social media; and collaborate with radio and TV stations to air public service announcements to raise awareness and remind people where they can find a provider and get a Pap test;
• Recruit a local clinician to act as a spokesperson or “champion” for HPV vaccination;
• Work with your local government to get the office of the mayor (or county executive) and local legislators involved in the promotion of the awareness month; and,
• Hold a community event to increase awareness about cervical cancer and prevention through the HPV vaccine, such as hosting a screening of the documentary, Someone You Love: The HPV Epidemic.

HPV vaccination and early cancer screening can save lives, so take time in January to promote cervical cancer awareness and the HPV vaccine and celebrate the legacies of those who have battled cervical cancer. For more information, view resources from NACCHO’s Guide to HPV Resources for Local Health Departments, HPV vaccination policy statement, and the National Cervical Cancer Coalition.

References

1. National Institutes of Health. (1996). Cervical Cancer.NIH Consensus Statement, 14(1):1–38.
2. National Institutes of Health. (2014). Pap and HPV Testing webpage. Retrieved December 30, 2015, from http://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet
3. Centers for Disease Control and Prevention. (2015). National Breast and Cervical Cancer Early Detection Program webpage. Retrieved December 9, 2015, from http://www.cdc.gov/cancer/nbccedp/
4. Centers for Disease Control and Prevention. (2015). Human papillomavirus (HPV) and Cancer. CDC website. Retrieved December 1, 2015, from http://www.cdc.gov/cancer/hpv/
5. National Cancer Institute. (2014). Accelerating HPV vaccine uptake: Urgency for action to prevent cancer. A Report to the President of the United States from the President’s Cancer Panel. Bethesda, MD: National Cancer Institute.
6. Reagan-Steiner, A., Yankey, D., Jeyarajah, J., Elam-Evans, L. D., Singleton, J. A., Curtis, R., et al. (2014). National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States. MMWR. 2015; 64:784–92.
7. S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2015). Immunization and infectious diseases. Healthy People 2020 website. Retrieved October 28, 2015, from https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives
8. Centers for Disease Control and Prevention. (2013). Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013—United States. MMWR, 62(29):591–5.