Health & Medicine

These UK professors aim to cut cervical cancer rates in Eastern Kentucky. Here’s how.

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A pediatrician explains why she, as a doctor and a parent, recommends HPV vaccine for boys and girls ages 11-12.

With the help of a five year, $11 million grant, a team of professors at the University of Kentucky is setting out to help reduce cervical cancer in Eastern Kentucky women, in part by helping those who smoke to quit.

The project’s aim is to systematically curb the higher-than-average rates of smoking, lower-than-average rates of vaccinations given to young people to protect against the Human Papillomavirus Virus, and to screen women earlier and more often who are most at risk of getting cervical cancer. HPV is a sexually-transmitted disease contracted across genders that can greatly increase the risk of different cancers later in life, especially cervical , which is the most common type of cancer among women.

HPV is thought to be responsible for more than 90 percent of all cervical cancer cases, according to the Centers for Disease Control. Likewise, women who smoke are about twice as likely to get cervical cancer, according to the American Cancer Society.

The project, funded by the National Cancer Institute, is a collaboration between UK’s Markey Cancer Center, Ohio State University, the University of Virginia and West Virginia University, along with 10 health systems throughout each of these state’s Appalachian regions. In Kentucky, those health care providers are Big Sandy Health Care and Juniper Health. Big Sandy operates seven clinics across Eastern Kentucky, and Juniper Health has locations in Wolfe, Lee, Breathitt and Morgan counties.

The $11 million grant will be divided between the participating universities and their health care providers, but UK officials don’t yet know how much their cut will be.

Myriad grant-funded endeavors have been initiated across the state in recent years to prop up to Kentuckians struggling with health challenges and substance use. The largest grant to date, $87 million in federal money, was awarded to UK in April to help decrease opioid-related deaths by 40 percent in 16 counties.

Residents of rural America, including Appalachia, are generally at greater risk of health complications, often for lack of accessible medical treatment options, greater challenges in finding healthy foods, and spikes in smoking and other harmful habits. This is further detailed in a new study paid for by the Robert Wood Johnson Foundation, which shows life expectancy to be on the decline for white women in Appalachia and other regional rural areas. Women in larger metro areas are 15 times more likely to live longer than women in rural parts of the country, the study shows.

Though HPV vaccination rates nationwide hover around 60 percent, Kentucky ranks as one of the worst states for its immunization rates, despite it being the most common STD. In 2017, the commonwealth was balancing on the lowest rung of the ladder with eight other states who reported only between 29 and 40 percent of their populations had been immunized against HPV, according to the Kaiser Family Foundation. A few years earlier, between 2011 and 2015, CDC data showed Kentucky had the highest rate in the country for HPV-related cancers across genders.

The same is true with tobacco use. Though smoking rates nationwide and in Kentucky have generally been on the decline for decades, Kentucky smokers still consistently outrank the rest of the nation. Roughly 14 percent of all adults in the country — a little more than 34 million people — used tobacco products chronically in 2017, according to the CDC. During that same time in Kentucky, 25 percent of adults smoked and more than 22 percent of Kentucky women — some of the highest rates in the country.

Smoking increases a person’s risk for various types of cancers and shortens life expectancy. In a 2017 study, the Kentucky Coalition for a Smoke Free Tomorrow estimated the state spends around $1.9 billion each year on smoking-related health costs.

Smoking cessation programs are not new in Eastern Kentucky. But typically those programs, including from the state’s Cabinet for Health and Family Services, hinge primarily on information campaigns that publicize the habit’s risks.

Dr. Jessica Burris, who studies cancer prevention, control and its correlation with tobacco use, will lead the smoking cessation portion of the project. It’ll involve working with already established regional clinicians to document their patients’ smoking status and gauge whether they’re willing to quit smoking. Even if they’re not or they’re unsure, the patient will be partnered with a cessation counselor.

“Instead of ignoring the smokers who are not ready to quit today, we’re going to work with them anyway,” Burris said.

Counselors will tailor their approach with each patient, which could involve setting goals to smoke fewer cigarettes in one day, or setting a timeline for quitting in the future. The thinking, Burris said, is that “if you cut down, there’s a likelihood you’ll be able to quit in the future.”

The counseling support will also be assisted by prescription medication to help each patient quit, she said.

Dr. Mark Dignan, whose research includes studying the correlation between health education and cervical cancer rates in rural areas, will oversee the remainder of the project. That will include improving HPV immunization rates for children and young adults, ages 11-12 years old, and 13-26 years old. Age 26 is generally regarded as the maximum age where the HPV vaccine is most effective.

Dignan also will, in coordination with Big Sandy and Juniper Health, send HPV self-testing kits sent through the mail to women who need to get tested but might not have the financial or physical resources to visit a health care clinic. Dignan will chart the sustainability and impact of the mostly untested method, gauging whether or not it’s effective.

“We really shouldn’t have cervical cancer,” Dignan said. “We know what causes it, we can detect it, and we can treat it.” Its persistence in some regions for lack of resources and awareness is troubling, he said. “We really should fix this.”

Both expect around 70,000 Kentuckians could be impacted by the project, but full deployment won’t take place for several months. If the project ultimately yields positive results, both Dignan and Burris said the goal then will be figuring out how to implement these new systems permanently and how to transfer their model for use by other states.

Though the possibility for success is exciting to think about, earning success by testing new public health methods is always a gamble, Burris said.

“On the one hand, you want to use what’s been tried and tested because that’s what seems to work, but on the other hand, you’re always trying to advance science and public health as a whole, which means trying new things,” Burris said. “It’s a major and rare opportunity to dig deep and see what we can do.”

Alex Acquisto covers health and social services for the Lexington Herald-Leader and Kentucky.com. She joined the newspaper in June 2019 as a corps member with Report for America, a national service program made possible in Kentucky with support from the Blue Grass Community Foundation. She’s from Owensboro, Ky., and previously worked at the Bangor Daily News and other newspapers in Maine.
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