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The center will use the funds to train parents and health care professionals while working to build a comprehesive, countywide cervical cancer prevention program.

By La Monica Everett-Haynes, University Communications
March 10, 2008

The increased use of the Pap test over the last several decades has helped reduce the number deaths associated with cervical cancer.

But the disease remains pervasive among low-income women and women of color, particularly those who are black, American Indian and Hispanic.

That gets to the central reason why The University of Arizona National Center of Excellence in Women’s Health, or WCOE, has led outreach efforts to inform Pima County women about cervical cancer.

And now, the center’s researchers and staff have more backing.

The center recently was awarded a $2.1 million five-year grant from the Centers for Disease Control and Prevention called Racial and Ethnic Approaches to Community Health Across the United States, or REACH U.S.

Located at University Physicians Hospital, the center will use the grant to support a countywide cervical cancer prevention partnership that will target underserved women.

The funds will be used to develop a "train-the-trainer" program, educating health outreach workers on prevention and the latest developments in HPV, which can lead to cervical cancer. The center will also provide information about the condition to parents in Pima County who have young daughters.

Those involved in the partnership include the UA’s College of Agriculture and Life Sciences, the Pima County Health Department, University Physicians Healthcare, Tucson Unified School District, Sunnyside Unified School District and the El Rio Community Health Center.

“Cervical cancer is very preventable, and I think that’s really why this is so important,” Martha Monroy, the UA's REACH team leader said.

Cervical cancer develops when abnormal cells are present in a woman’s cervix, which is the lower part of the uterus.

The cancer can be prevented if the abnormal cells are detected early enough through a Pap test and proper treatment is provided, according to the CDC.

Despite being highly preventable, the American Cancer Society estimates that more than 11,000 cases of invasive cervical cancer – the type that has spread to other tissues and organs – will be diagnosed this year and that nearly 4,000 women will die as a result of having the cancer.

“There are health disparities and structural issues, and it is because of structural barriers that they have some of the worse outcomes compared to white women,” Monroy said.

Barriers that Monroy said can partially lead to problems include the lack of access to services, to information and health insurance. The grant will focus on Hispanic populations, helping women who have difficulty finding information in Spanish.

“Part of what we’re going to be doing is dealing with all of those social determinants, from the policy issues all the way down to information attainment,” she said. “All of our partners will work to identify the barriers and work together to resolve those issues.”

When a healthy immune system is unable to get rid of the human papillomavirus, or HPV, infection, precancer and cancer cells can develop on the woman's cervix, resulting in cervical cancer.

The cancer can be prevented if the abnormal cells are detected early enough through Pap and HPV testing and followed by proper treatment. But about half the women who develop cervical cancer in the United States have never had a Pap test, the CDC reported.

Women are encouraged to get screened each year so that health care providers can detect any abnormalities early. Also, a new HPV vaccine for girls and young women can reduce the likelihood of developing cervical cance precursors, which generally show up in women over 30.

"Nonindustry-developed health education material available in this country – the things people have access to – is at least 12 years out of date,” said Francisco Garcia, the center's director and the leader of the multidisciplinary REACH team.

“We really have learned a lot more about cervical cancer and how to prevent it in the last 15 years. It’s been based on the Pap smear screening paradigm, but that paradigm is no longer up to date,” he said, adding that women need current information about precautions, treatments and new vaccinations.

“We’re trying to figure out how to take those services to the women and make sure that those who screen and have abnormalities get the diagnosis and follow-up,” he said.

Garcia said about 27 percent of the women in Pima County who have abornal Pap test results never return for follow-up.

“This is really a new opportunity for us,” said Garcia, who is also an associate professor of obstetrics and gynecology and public health. “Theoretically, cervical cancer is preventable, so we should not have any cases of advanced cervical cancer in this county,” Garcia added. “If we coordinate and integrate our efforts, that could be the case within a five-year time frame.”