Is Cervical Cancer Preventable? Screening and HPV Vaccination Insights

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Dr. Abigail Zamorano of McGovern Medical School at UT Health Houston discusses key prevention strategies for cervical cancer, focusing on the importance of cervical cancer screening and the HPV vaccine. She explains how screening can detect pre-cancers, preventing progression to cancer, and highlights the role of the HPV vaccine in reducing the risk of cervical cancer and other HPV-related cancers.

[ACT]IVATION TIP

“…to not only think about cervical cancer treatment but also cervical cancer prevention.”

See More From [ACT]IVATED Cervical Cancer

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Understanding Antibody Drug Conjugates (ADCs) in Cervical Cancer

Transcript:

Lisa Hatfield:

Dr. Zamorano, are there ways to prevent cervical cancer?

Dr. Abigail Zamorano:

There are ways to prevent cervical cancer. This is one of the really exciting things about cervical cancer in general is that we have not only great treatments, but we also have ways of preventing the cancer from ever occurring. So one of those is through cervical cancer screening. Cervical cancer screening is important because it gives us the opportunity to diagnose and treat pre-cancers to keep them from ever becoming a cervical cancer.

The other great way of preventing cervical cancer is with the HPV vaccine or the vaccine for the human papillomavirus virus. This is a vaccine that can be given to individuals, both boys and girls as early as age nine and has really done remarkable things around the world to decrease the prevalence of HPV and also to decrease the incidence of cervical cancers. HPV is linked and causes most cervical cancers as well as many other cancers of the genital tract and also the oropharyngeal or mouth and throat tract. The HPV vaccine has been really remarkable because it not only will decrease that individual’s risk of obtaining a high-risk strain of HPV, but also decreases their ability to have a high-risk strain and then spread it to others.

HPV is a sexually transmitted disease. But the way I discuss it with my patients is that it’s not an STD like they might traditionally think of. It’s one that is not tested and then treated like many others. But it is many times actually managed by our body’s own immune system and treated by our body’s own immune system. But sometimes patients acquire a high-risk strain of HPV that lingers that our bodies are not able to get rid of.

And it’s these high-risk strains that linger that can cause cell changes that can lead to pre-cancer and cancer such as cancer of the cervix. So my [ACT]IVATION tip for this question is to not only think about cervical cancer treatment but also cervical cancer prevention. That one of the things that I speak to my patients about because they always ask me what they can do for themselves and then also their family and friends is to talk about cervical cancer screening with them, to talk about the HPV vaccine with them, to encourage them to have their family and friends, their children vaccinated, go through screening so that we can try to prevent as many cervical cancers as possible.

Lisa Hatfield:

There are some guidelines for when the HPV vaccine should be given. Is there a maximum age for the HPV vaccine?

Dr. Abigail Zamorano:

So the maximum age is listed as 45. This is in conversation with a physician. So the set maximum age is 26. However, it can be given between the ages of 26 and 45 after a conversation between the patient and the provider. This is typically a good idea, but it’s always important to have this shared decision-making.

Understanding Antibody Drug Conjugates (ADCs) in Cervical Cancer

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Dr. Abigail Zamorano of McGovern Medical School at UT Health Houston explains essential details about antibody drug conjugates (ADCs) for cervical cancer, including benefits, side effects, and their impact on quality of life. She discusses the importance of maintaining a strong patient-provider relationship, especially when navigating side effects like ocular issues and neuropathy, and emphasizes the role of regular eye exams.

[ACT]IVATION TIP

“…maintain close communication between provider and patient in order to share the experience of receiving an antibody drug conjugate.”

See More From [ACT]IVATED Cervical Cancer

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 Cervical Cancer Disparities | Key Factors for Black and Latinx Patients

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 Is Cervical Cancer Preventable_ Screening and HPV Vaccination Insights

Is Cervical Cancer Preventable? Screening and HPV Vaccination Insights

Transcript:

Lisa Hatfield:

Dr. Zamorano, for patients and care partners learning about antibody drug conjugates for the first time, what key information should they know about the benefits, the potential side effects, and overall impact of these treatments on quality of life?

Dr. Abigail Zamorano:

So I think that you touched on something really important here, and that is quality of life. Antibody drug conjugates are really amazing. They’re a really great way of delivering really high doses of chemotherapy targeted to cancer cells. They do have side effects. One of the most significant side effects that we see with our ADCs in cervical cancer are ocular or eye side effects. So we work very closely with an ophthalmologist or an optometrist, some eye doctor, for very frequent exams during this treatment phase.

It’s really important for both the provider and the patient to understand how, what symptoms might result, when to bring up symptoms to the provider, the oncologist, or the eye doctor, and then what they can do to help prevent any symptoms from occurring. There’s a lot of eye drops involved. It can feel very tedious. But it’s important, because we want to both treat the cancer, but also maximize their quality of life.

There are other side effects that can come up, such as neuropathy, which is numbness and tingling of the hands or the feet. This can be very common with these ADCs. Again, it’s just important for a patient to know that this could be a possibility and then to bring it up with their provider so that they can talk about management strategies. Because ADCs are given in the recurrent disease setting, I do counsel patients that I have a lot of hope in ADCs and their ability to treat cancer, but this is still recurrent cancer, and I can’t take away that fact.

And so I am very hopeful that this treatment will work, and we will see that the cancer stabilizes or shrinks, goes away in the best scenario. But that might not happen. And I really want to maximize quality of life during this treatment process in the off chance that it’s not working and that these are the last, you know, months to years that this patient has.

I always keep that type of conversation open with my patients, because I want them to tell me really how they’re feeling in order to maximize quality of life. So my [ACT]IVATION tip for this question is to maintain close communication between provider and patient in order to share the experience of receiving an antibody drug conjugate. Both the experience of going through the various eye exams and using the eye drops to any symptoms that the patient is receiving and how the treatment is impacting their quality of life.

Lisa Hatfield:

So let’s say you have a patient that comes in, has recurrent cancer and is considering antibody drug conjugate. We might have a patient watching this who is going through this, trying to consider if they want to start this therapy. Can you explain from say day one, what that might look like?

They’re trying to organize their schedule with work and kids. What will that patient experience starting on the first day of that treatment and maybe the subsequent months of treatment? How often do they have to come in? How is that dose delivered? How much time will that take away from their work or their family? Can you explain that a little bit, what the course might look like?

Dr. Abigail Zamorano:

So this is delivered not unlike other more traditional chemotherapies. So it is delivered in an infusion suite with an infusion nurse with an oncologist available if there are any issues or questions. Similarly to when the patient has had chemotherapy for, they get labs beforehand to make sure that the chemotherapy is delivered at an appropriate dose and that they’re safe enough to receive the dose of chemotherapy. What is unique about receiving antibody drug conjugates is that the patient also does need a close relationship with an eye doctor. Either an optometrist or an ophthalmologist.

And so we and many other centers have developed very close relationships with local eye doctors to help facilitate this. It doesn’t need to be an ophthalmologist in the medical center. A lot of optometrists that could be local to the patient could see the patient, which are sometimes a little bit easier to get into. Also the company that provides the antibody drug conjugate has really great resources for providers that are, and also for patients that are just starting on this journey to help make it as easy, as seamless as possible. They provide a lot of literature, they are there to answer questions.

They have lists of eye doctors that other providers have worked with. So there, there are ways of making this a little bit easier for the patient. There are also start kits that the patient can receive that again help them navigate this a little bit better. In terms of the patient experience, it is an infusion every few weeks just like other chemotherapies. The typical feelings afterwards, there can be again some nausea, predominantly there’s fatigue afterwards. I do counsel patients that the first cycle is their learning experience.

They’re learning how, what symptoms to think about. They’re learning how the regimen of the eye drops, and then they’re learning how they’re going to feel on each day. The second cycle in my experience, working with patients is typically a little bit easier. And this is not unique to ADCs, this is any chemotherapy. Because they’ve already been through one cycle, they kind of know which days are going to be their low days and then which days are going to be their high days. Typically, they’re feeling kind of fatigued for about 10 days, and then they start to feel better.

So the second half of the treatment cycle, they’re more able to get back to their routine activities and can kind of reinsert themselves into their usual life. But every patient is different. Sometimes, they need a little bit of extra help, or sometimes patients are feeling really great. These ADCs are designed to be continued until toxicity or progression. And so patients are potentially on these for quite a long time depending on their response both cancer-wise and then other body side effect-wise. And so this could be something that someone is on for some time.

Exploring Antibody Drug Conjugates in Cervical Cancer Treatment

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Dr. Abigail Zamorano of McGovern Medical School at UT Health Houston explains how antibody drug conjugates (ADCs) are revolutionizing cervical cancer treatment. She discusses how these therapies deliver targeted chemotherapy to cancer cells, minimizing exposure to healthy tissue while maximizing effectiveness.

[ACT]IVATION TIP

…for patients to talk to their providers about what next steps might need to occur if their cancer were to recur.”

See More From [ACT]IVATED Cervical Cancer

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Advancing Cervical Cancer Care: Breakthrough Treatments and the Power of Clinical Trials

Transcript:

Lisa Hatfield:

Dr. Zamorano, what is an antibody drug conjugate as it relates to cervical cancer? And how do you see antibody drug conjugates shaping the future of cervical cancer treatment?

Dr. Abigail Zamorano:

An antibody drug conjugate is this really fascinating new way of delivering essentially chemotherapy to cancer cells. It is essentially a chemotherapy backpack where it is a therapy delivered to the patient, usually through an IV, similar to the way that chemotherapy is delivered. But instead of giving a large dose across the entire body, as is is typical with traditional chemotherapy, it’s packaged in these little backpacks that go directly to cells that express certain proteins, specifically in certain types of cancers. Now, there are other cells in our body that also have these proteins. And so there are side effects to these therapies. But the really exciting thing is that it allows us to give a really high dose of chemotherapy directly to the cancer cell.

Though the way that these have been made possible is really through clinical trials. And so we always, we appreciate all of the patients and providers that have enrolled in clinical trials to make this happen. I think that this is the direction that a lot of cancer therapy will take in the future. Of course, as I said, there are side effects to these therapies, but we’ve learned how to manage these really well, and I think that these are really exciting options for our patients.

My [ACT]IVATION tip for this question is for patients to talk to their providers about what next steps might need to occur if their cancer were to recur. I think it’s helpful in some ways to have these conversations even before cervical cancer has come back, because it allows the patient to be thinking of what might be down the pipeline. It also helps the provider think what options they might have for this patient, whether they’re these new antibody drug conjugates or if there’s a new clinical trial that this patient could enroll in.

It kind of keeps the, it gets the ball rolling. I also encourage patients to think about their body holistically, think about their nutrition, think about their physical activity, because we could have a really good treatment option for recurrent cancer. But sometimes patients are not able to receive that therapy, because they have a poor performance status or their nutritional status isn’t good enough. And we worry about the toxicity of these therapies. So sometimes this is unavoidable, but I really encourage patients, when you’re feeling good, do lots, you know, eat well, stay active, try to keep your body as healthy as possible.

Lisa Hatfield:

Okay, thank you. Now, are there currently FDA-approved antibody drug conjugates, and is it just for recurrent cervical cancer, or can it be used for early stage cervical cancer or frontline therapy even in more advanced stage?

Dr. Abigail Zamorano:

There’s one antibody drug conjugate that is approved for cervical cancer, and it is just in the recurrent setting at this time. But this is a new frontier in the field of cancer therapy, and so I expect that there will be more within years.

Lisa Hatfield:

Okay, thank you. And then if a patient does have recurrent cancer and is interested in the antibody drug conjugate, but doesn’t live near, maybe doesn’t live near an academic center or in a big metropolitan area. Can these be delivered at a community hospital? Or where can they find these treatments?

Dr. Abigail Zamorano:

These should be available no matter where you live. We always encourage patients with gynecologic cancers to see a gynecologic oncologist. But we also recognize that not every patient lives next to a gynecologic oncologist. And so there are really wonderful medical oncologists that are very well-equipped to treat gynecologic malignancies, including cervical cancer, and they would be able to deliver these antibody drug conjugates.

Advancing Cervical Cancer Care: Breakthrough Treatments and the Power of Clinical Trials

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Dr. Abigail Zamorano of McGovern Medical School at UT Health Houston discusses groundbreaking advancements in cervical cancer treatment, including immunotherapy and antibody-drug conjugates for recurrent disease. 

[ACT]IVATION TIP

“…remember how far we’ve come in just even a short amount of time and all of these new advancements and thinking about that these advancements have only been made possible with clinical trials. So more clinical trials are in the pipeline. I really encourage providers and patients to think and consider clinical trials when they’re at a juncture point of their cancer-directed therapy..”

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Is Cervical Cancer Preventable? Screening and HPV Vaccination Insights

Transcript:

Lisa Hatfield:

Dr. Zamorano, what are exciting advancements in cervical cancer treatment that are on the horizon?

Dr. Abigail Zamorano:

This is a great question. There are so many exciting things on the horizon for cervical cancer. You know, for so long, we were stuck with the same treatments for cervical cancer. A while ago we had a new treatment that really revolutionized how we treat advanced stage or recurrent cancer. But then it had been about a decade until we had almost anything more.

And now we have the inclusion of immunotherapy both in the initial treatment of locally advanced cancer and metastatic or advanced cancer and also in recurrent disease. And now we have these antibody drug conjugates that have just come out, which help us manage recurrent disease as well. So all of these are really exciting things on the horizon, and they have been only made possible with really active clinical trials. 

My [ACT]IVATION tip for this question is to remember how far we’ve come in just even a short amount of time and all of these new advancements and thinking about that these advancements have only been made possible with clinical trials. So more clinical trials are in the pipeline. I really encourage providers and patients to think and consider clinical trials when they’re at a juncture point of their cancer-directed therapy so that we can learn even more about the best ways of treating cervical cancer.

Cervical Cancer Disparities | Key Factors for Black and Latinx Patients

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Dr. Abigail Zamorano of McGovern Medical School at UT Health Houston discusses disparities in cervical cancer treatment among Black and Latinx communities. She highlights key barriers—access to care, transportation, and caregiving—and shares strategies for patients and providers to improve treatment access and continuity of care.

[ACT]IVATION TIP

“Speak up about barriers—patients should seek support and resources, while providers must anticipate challenges and involve caregivers in care planning.”

See More From [ACT]IVATED Cervical Cancer

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 Understanding Antibody Drug Conjugates (ADCs) in Cervical Cancer

Understanding Antibody Drug Conjugates (ADCs) in Cervical Cancer

Transcript:

Lisa Hatfield:

Dr. Zamorano, what disparities have you observed in the treatment of cervical cancer among different demographic groups? And can you provide an overview of key barriers for Black and Latinx communities? And how can patients avoid or address these barriers?

Dr. Abigail Zamorano:

I say that the most significant barriers are also what are causing the disparities. The most significant barriers are typically in a patient’s ability to identify a problem and then to access a provider for a diagnosis and then ultimately access a provider team for treatment.

This is a multi-step process that really relies on patients’ ability to access care whether through a hospital setting, an emergency room or a provider if they have insurance or a clinic that can provide screening or diagnosis without insurance, which can be really challenging to find, and it’s a difficult system to navigate.

When patients are ultimately diagnosed with cervical cancer, the most common treatment is a combination of both chemotherapy and radiation. Unfortunately, this treatment is really time-intensive. It’s every day and must be completed within a certain number of weeks. And so it can be really hard on patients to access this treatment, whether it’s for transportation difficulties, because they live far from their clinic, or sometimes transportation difficulties even if they only live five minutes from the clinic.

It’s also really hard on patients who have, who provide child or elder care, who work, who speak languages other than English, who have other responsibilities. And so I do encourage both provider teams and patients to speak up about any barriers that they might foresee and in order to best address them in order to make the diagnosis and then the treatment as seamless as possible.

My [ACT]IVATION tip for this question is to speak up about barriers and this applies to both providers and to patients. I really encourage patients to think about what their provider is recommending and to think about the different things that they’re going to need in order to meet all of those goals. I encourage patients to lean on their support groups in their family and their caregivers, because they’re probably going to need a little bit of help through this process.

I also encourage providers to think about what their patients might need, think about where their patients live, what resources they have, think about what support groups they have at home and for providers to also pay attention to their caregivers. The caregivers of patients are so important for patients to complete their therapy. And a lot of times we don’t ask the caregivers how they’re doing and what they’re going to need to help their patients. And so including the patient and the caregiver in the discussion is really important.

Lisa Hafield:

Okay, thank you, that’s great. And I do have one follow-up question in talking about barriers, particularly with access. So you have a clinic in Houston that does screenings in the Hispanic community. So if a patient comes in and is screened and the results come back abnormal on the screening, what is the next step for that patient? Will these clinics that could be around the country or throughout, in different states, will they provide continued care, or will they provide referrals for these patients who are already maybe having difficulty with access? What is the next step for those patients who may receive those abnormal results?

Dr. Abigail Zamorano:

An abnormal cervical cancer screen doesn’t always mean a cervical cancer. Most of the time it means a cervical pre-cancer. And that can be very low grade or very mild, which sometimes those go away on their own. Our bodies are really good at managing our own illnesses. And even with early pre-cancers, sometimes our immune systems help manage those. The higher grade pre-cancers that are closer to cancer typically do require a treatment. Our clinic does provide both the diagnosis of pre-cancer and the management. These are procedures that we perform in the clinic. 

They don’t need someone to be in the hospital or in the operating room, necessarily. So we’re able to provide all of these services in our clinic. Most clinics that provide cervical cancer screening, typically just provide the screening and then have other specialty clinics that they would refer out to for the management of abnormal results. Ours is a little unique because we do it all together, and we really aim to be a referral center for all of those clinics that do a great job at screening the population and reaching as many patients as possible. But we want to be the specialty center that then manages the cervical pre-cancer to prevent it from ever becoming cancer. For the patients that are ultimately diagnosed with cancer, we have referral patterns, and we have ways of navigating them to cancer-based therapy.

Screening Saves Lives: Overcoming Barriers to Cervical Cancer Prevention

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What can be done to address the decline in cervical cancer screening rates among Hispanic individuals since the COVID-19 pandemic? Dr. Abigail Zamorano of McGovern Medical School at UT Health Houston discusses the impact of reduced screenings, shares resources available for those struggling to access care, and offers practical guidance on where patients can turn for preventive services, including free and low-cost screening programs.

[ACT]IVATION TIP

“If you don’t have a provider that you see regularly, ask your family and friends for recommendations. Look at options online, reach out to community centers, and check with your county health department. Organizations like the American Cancer Society and the Foundation for Women’s Cancer can also help connect you with screening programs.”

See More From [ACT]IVATED Cervical Cancer

Download Resource Guide Download Spanish Resource Guide

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Cervical Cancer Disparities | Key Factors for Black and Latinx Patients

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Advancing Cervical Cancer Care: Breakthrough Treatments and the Power of Clinical Trials

 Exploring Antibody Drug Conjugates in Cervical Cancer Treatment

Exploring Antibody Drug Conjugates in Cervical Cancer Treatment

Transcript:

Lisa Hatfield:

Dr. Zamorano, your research highlights the significant decline in cervical cancer screening rates among Hispanic individuals during the COVID-19 pandemic and then the limited rebound in subsequent years. For Hispanic patients who may have missed their cervical cancer screening during the pandemic or are having trouble getting screened now, what advice and resources would you recommend to help them get the preventive care they need and where can they find support in their communities?

Dr. Abigail Zamorano:

Right. We did see a decrease in cervical cancer screening rates among Hispanic individuals during the height of the COVID-19 pandemic. And, unfortunately, screening rates have not increased sufficiently in that population since the height of the pandemic to cover the decreases that we saw.

So this means that Hispanic individuals are now being screened at even lower rates than they were before the pandemic. I encourage all individuals with a cervix to get back to routine health evaluations, including cervical cancer screening. For screening, you can go to a g`eneral OB-GYN or gynecologist, sometimes even some PCPs, internal medicine or family medicine providers can do cervical cancer screening. So you can always ask.

I tell patients though, if you’re having trouble finding a place or location, a provider to see you, you can start by asking friends and family if they have any recommendations and then also look for screening programs in your community. A lot of communities hold cancer screening events or clinics that are accessible to all despite insurance status. And so that’s a great way of finding a place.

For example, I am the director of the Houston PAP Project, which is a no cost cervical cancer screening program in Houston. We see primarily uninsured Hispanic individuals in the greater Houston area, and we hold our clinics on Saturday mornings. I do say that the important thing about screening is also managing abnormal results. A screen is only as good as management of an abnormal screen, because it’s those abnormal screens that we can then provide treatment for to help prevent the development of any cancer.

So one of the things that we do in the Houston PAP Project is we not only do the cervical cancer screening, but we also do the follow-up evaluations and treatment to try to prevent as many cervical cancers as we possibly can. To do this, we provide a lot of education and counseling to patients because we understand that this process can be very scary. It is scary because it’s, you know, seeing a provider having a pelvic exam.

It’s also scary because people are worried about what they, what might be found. They’re worried about the fact that they might have a pre-cancer or a cancer. And so we provide a lot of counseling to help guide patients so that they can help overcome that barrier. We also ask patients about their social determinants of health to determine if there’s additional barriers that are keeping them from accessing either their cervical cancer screening, their pre-cancer management, diagnosis, and treatment, or if there are things that are preventing them from otherwise accessing routine health care.

So all of these are incorporated into the clinic that we run. But we are not necessarily unique. There’s programs like ours across the state, across the country. And so I encourage patients to look into what resources might be available.

My [ACT]IVATION tip for this is for patients to get back into screening. If you don’t have a provider that you see regularly, ask your family and friends for recommendations. Look at options online, Reach out to community centers. Sometimes your county health department can have options. Also look for different resources online through the American Cancer Society or Foundation for Women’s Cancer. Sometimes you can find even some cancer prevention and screening programs through those.

[ACT]IVATED Cervical Cancer Checklist

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[ACT]IVATED Cervical Cancer Spanish Resource Guide

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ACTIVATED Cervical Cancer Spanish Resource Guide

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What Steps Can Patients Take to Combat Cervical Cancer Disparities?

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Cervical cancer disparities persist, but how can patients help improve disparities? Expert Dr. Shannon MacLaughlan from University of Illinois discusses the value of patient advocacy, elevating patient voices, and proactive patient advice for self-care. 

[ACT]IVATION TIP

“…focus on yourself. I take care of women almost exclusively, and they’re the mamas and the sisters and the daughters, and they’re the caregivers, and they are focusing on everyone else. And now it’s time to focus on yourself and get yourself through this and then circle back, and we’ll start taking care of everybody else together.”

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Disparities in Cervical Cancer Treatment: The Role of Poverty and Systemic Barriers

 How Does Insurance Status Impact Cervical Cancer Diagnosis?

How Does Insurance Status Impact Cervical Cancer Diagnosis?

Transcript:

Lisa Hatfield:

Dr. MacLaughlan, what are the next steps in addressing the disparities you’ve identified in cervical cancer diagnosis and management, and how can patients be involved in this process?

Shannon MacLaughlan:

The most important thing that a patient can do is take care of themselves and get through your treatment successfully. You are a survivor of that cancer the moment you hear the word cancer. The moment you get that diagnosis, you are a survivor, and you focus on that. Try not to isolate yourself, because this is a team, it’s a team sport. Your medical team should have a team, and you should have a team.

Then, when you are feeling healthy, and when you are energized, I need you to spread the word. The most impactful way a patient can contribute to breaking down barriers is to start from the inside, to share your story, to talk about it. Advocacy can be as simple as going home and talking to your family about the kind of cancer that you have, how it started, what they can do to prevent it, what they can do to prevent it in their kids. Just start there, and then when we get you healthy again, then it’s time to elevate your voice.

I feel strongly that when we see disparities in outcomes related to cancer, it is the fault of the system, and it’s a little too easy and maybe not realistic to tell a patient to advocate for yourself with your doctor, because you might not have a choice in your doctors, and that’s just easier said than done. The system has to take ownership. We have to take ownership, and we have to learn from you.

And so those of us trying to break down these inequities and introduce some justice, particularly in the world of cervical cancer, we aim to elevate the voices of the people with the lived experiences and the communities who are experiencing it, because most often patients come to my office and they say, even though this was a thing, I didn’t even know we had our own ribbon. I hand out ribbons to patients with cervical cancer because they’re survivors. I need them to talk about it.

I need them to talk about it in their communities so that they know it’s a thing, and they hold us accountable. So my action item is, one, focus on yourself. I take care of women almost exclusively, and they’re the mamas and the sisters and the daughters, and they’re the caregivers, and they are focusing on everyone else. And now it’s time to focus on yourself and get yourself through this and then circle back, and we’ll start taking care of everybody else together.

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Why Does Access to Care Matter in Cervical Cancer Treatment?

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What is the role of socioeconomic status in advanced cervical cancer treatment? Expert Dr. Shannon MacLaughlan from University of Illinois discusses impacts of socioeconomic status and psychosocial determinants of health on cervical cancer care, the importance of clinical trials, and proactive patient advice to optimize care.

[ACT]IVATION TIP

“…no matter what your experience may be, when you go to a doctor or other provider with cervical cancer, whatever that experience is, I want you to know that one, you are not alone. You are not the only person experiencing this. It is not your fault. You are not to blame for this. And so whatever you may feel or experience in the clinical encounter or the encounter with the academic centers or the cancer center or the front desk or in radiology, whatever you experience, know that you are a survivor, know that you are strong and resilient, and please do not feel shame.”

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 How Does Insurance Status Impact Cervical Cancer Diagnosis?

How Does Insurance Status Impact Cervical Cancer Diagnosis?

Transcript:

Lisa Hatfield:

Dr. MacLaughlan, how does socioeconomic status impact treatment and outcomes in advanced stage cervical cancer?

Shannon MacLaughlan:

So, first of all, I’ll say that cervical cancer is as largely a preventable cancer, and socioeconomic status and other psychosocial determinants of health are usually contributing to an individual’s ability or access to get preventative care. And so our patients who are presenting with advanced disease, or even most patients who were diagnosed with cervical cancer have not had adequate screening. And so socioeconomic status and other social determinants of health really play a role in whether or not the cancer can be prevented to begin with.

The best cure is to never let it happen. Now, when it comes to outcomes in advanced stage, there are two things that I would point out. Number one, we do have some qualitative research, not my work, but some really important work that demonstrates that when reviewing a medical record, you’re much more likely to identify negative language coming from a provider as a descriptor for a patient. If the patient is from a vulnerable community or from a lower socioeconomic status or is not white.

And that doesn’t necessarily mean your provider is saying bad things about you. What it’s saying is, this is my least favorite, but I still see it, this unfortunate patient. Another example would be, this patient is noncompliant. And the word noncompliant, what a provider should mean by that is that that person is not able to do everything we ask of them. Well, that could be because we are asking too much and not listening to them for what their goals are and what they needed. So an alternative of describing that would be, these are the things that the patient can do as opposed to emphasizing what we’re telling them to do that they’re not doing.

All of that is evidence of implicit bias, and implicit bias and systemic racism are things that are really hard to undo unless you go back to the beginning. And in this case, that means research. So when it comes to outcomes in treatment for advanced cervical cancer, I have to point out that though we have had some exciting advances in treatment of recurrent and metastatic cervical cancer, I have to point out that there are very few patients of color on those clinical trials. Most of them are done in Europe or in predominantly white-privileged communities in the United States.

And that has to do with ease of participation in clinical trials, because it’s hard enough to get yourself through cancer treatment. We are extremely demanding of our patients and survivors. And then you add to that a clinical trial protocol, it’s even harder. There are more visits, there’s more. And so those coming from marginalized, underrepresented communities aren’t represented in the research being done to find cures.

So that means we may find something that we think works. We don’t know if it’s going to work in a patient who has no one similar to them who participated in the treatment before. And so until we can really be inclusive in the clinical trial research, and even not just clinical trial research, but all kinds of research, meaning learning more about tumors that grow in particular communities and what’s going on in community levels or at the community level with extrinsic sources of stress or exposures or pollution or health outcomes or food insecurity, all of those things are going to play a role in someone’s health. And the healthiest people are most successful at surviving cancer treatment, let alone the cancer itself.

My [ACT]IVATION tip for this is no matter what your experience may be, when you go to a doctor or other provider with cervical cancer, whatever that experience is, I want you to know that one, you are not alone. You are not the only person experiencing this. It is not your fault. You are not to blame for this. And so whatever you may feel or experience in the clinical encounter or the encounter with the academic centers or the cancer center or the front desk or in radiology, whatever you experience, know that you are a survivor, know that you are strong and resilient, and please do not feel shame.

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How Does Insurance Status Impact Cervical Cancer Diagnosis?

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 Health insurance status has some clear impacts on cervical cancer stage at diagnosis. Expert Dr. Shannon MacLaughlan from University of Illinois discusses key points from her cervical cancer research findings.

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Transcript:

Lisa Hatfield:

Dr. MacLaughlan, how does your research highlight the role of health insurance status in influencing the stage at which cervical cancer is diagnosed among different racial and ethnic groups?

Shannon MacLaughlan:

Well, we found that patients who have private insurance or Medicare are much more likely for their cervical cancer to be diagnosed in an early stage than an advanced stage. We already knew going into this particular work on the SEER database, we already knew that there were some inequities that broke out by race and ethnicity, such that Black patients, Hispanic patients, and Native American and Alaska Native patients were more likely to present with an advanced stage cervical cancer than their non-Hispanic white counterparts. And it turns out that having insurance can mitigate that discrepancy.

Now, that research is really designed to teach a system that we have to do better. That research is hard to package into something for a particular person to do differently in their life. It’s easy to say, “Go get insurance.” But we all know that in real life, it is not that easy. So what’s really going on here is that screening programs are effective in populations who are getting screened, and insurance is a marker of someone who has access to primary care and preventive care and the ability to focus on health at all. 

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Does Cervical Cancer Care Differ Between Academic and Non-Academic Centers?

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What are key points about advanced cervical cancer treatment in academic versus non-academic settings? Expert Dr. Shannon MacLaughlan from University of Illinois discusses patient care at academic versus non-academic cancer centers, multidisciplinary care, support services, clinical trials, and the importance of second opinions. 

[ACT]IVATION TIP

“…there’s always a role for a second opinion, and insurance providers are mandated to provide coverage for a second opinion. And that can be an important door for you to open to make sure that your case is reviewed at one of those academic centers.”

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Transcript:

Lisa Hatfield:

Dr. MacLaughlan, what role do academic centers play in the treatment of cervical cancer? And how might patients at these centers receive different care compared to those at non-academic centers?

Shannon MacLaughlan:

An academic cancer center, or a cancer center that has been designated as a comprehensive cancer center, or a National Cancer Institute cancer center, is going to have a certain, they’re required to provide multidisciplinary care that meets the highest standard of care. So an academic center or an NCI-designated center will, by definition, have the internal quality metrics, ensuring that they are doing the right thing, which you shouldn’t have to guess whether or not your team is doing the right thing.

But one of the biggest contributors to cervical cancer existing is and/or recurring and women dying from it is that we don’t always do the right thing. So, an academic center, number one is going to provide for you a multidisciplinary team. You need to make sure that that team includes a gynecologic oncologist.

You may need a radiation oncologist. The best multidisciplinary care of the patient with cervical cancer also includes a palliative care team that can manage pain control and other symptom management effectively. And these centers are required to screen patients for other needs than just treating the cancer. So if you go to an oncologist, wherever we are, we are going to be experts in the cancer and how to treat it.

And hopefully, we are keeping up with the latest and greatest and most effective treatment options. And if you go to a cancer center that has NCI designation or is an academic center, then that should come with it…the understanding that taking care of a patient with cancer is more than just killing the tumor.

It’s about taking care of the patient and taking care of that patient’s family and taking care of that patient and their family in the context of their community. We see often in patients with cervical cancer, the need for transportation services, for social work support, not only to cope with the diagnosis, but to cope and navigate with the treatment that we lay out for you and how to plug it into your life and deal with the financial toxicities that come along with it. And those academic centers are going to be equipped with the teams who can connect you with smoking cessation and assist with food security and other things that contribute to your wellness.

The other important thing about academic centers is access to clinical trials. And in the world of cancer care, access to clinical trials is a marker of quality and better outcomes for patients. We are also starting to see, now that we’re looking for it, we’re starting to see that we can, oftentimes we see survival outcomes diverge based on things that it shouldn’t. Diverges for Black women, not as effective as white women.

We can close those gaps when patients participate in clinical trials. It doesn’t necessarily mean that a clinical trial is available to a particular individual and that they may not be eligible for anything in that moment, but access to those clinical trials is a critical big picture for successful treatment of cervical cancer or any kind of cancer.

And then finally, I would say that academic centers have the mandate of educating the next generation of providers, and we need to do better. So, for several years, I ran a clinic specifically for patients with cervical cancer. And just doing that, spending a day seeing patients, only patients, dealing with cervical cancer, was such an important learning opportunity for the residents and the medical students because I hate to tell you, but we are often taught in medical school that cervical cancer isn’t a problem anymore and that we cured it with successful screening.

But we didn’t. We haven’t actually made any headway meaningful in incidence of cervical cancer in a couple decades. So, it is important that we educate our next generation of providers that cervical cancer is, in fact, a problem. The treatment that we provide for cervical cancer is in and of itself very tasking and somewhat traumatic thing for a patient to experience. And providers need to learn how to provide culturally-accessible, empathic care for patients coming to the table with this particular kind of cancer.

So, that’s more of an ask than a recommendation. I ask you to go to an academic center so that you can teach the next generation. That’s really important to me. Now, my [ACT]IVATION tip for this topic is that you always have an opportunity for a second opinion.

Why does that matter? It matters because not everyone has access to an academic center for cervical cancer or any kind of cancer. You might not live near an academic center. You may not, even if you do live near one, you might not be able to get into one. But there’s always a role for a second opinion, and insurance providers are mandated to provide coverage for a second opinion. And that can be an important door for you to open to make sure that your case is reviewed at one of those academic centers.

Lisa Hatfield:

Okay, thank you. And I’m also a big advocate for getting an expert opinion, somebody who just sees those types of cancers. So, do you recommend if a patient is diagnosed with cervical cancer, they are not near an academic center, would you recommend that they do that at the time of diagnosis to try to seek out a second opinion or a consult at least once right at diagnosis? Is that the best time for that, do you think?

Shannon MacLaughlan:

Absolutely. The most effective time for a second opinion is before you start treatment. Once you initiate a treatment, there are very few certain…because you’ve started it, it’s almost always the best thing to continue doing it. Even if it’s not what I would have recommended to you to begin with. If you’ve already initiated it, you’re committed. So it’s tricky when you have a new diagnosis. It can be anxiety-provoking to have to wait for a second opinion or wait to get in for one or wait to start your treatment. But if at all possible, that’s the most effective time.

I would also add that many centers offer community doctors access to their tumor boards. I hate the term tumor board, but because it’s universal, I can’t change it. A tumor board is a multidisciplinary conference in which providers of each subtype gather and review cases. And so many academic and comprehensive cancer centers will offer that service to community physicians so that you may, if you can’t physically get to an academic center for a second opinion, then you may be able to have your case reviewed. There could be a telehealth option. Sometimes that’s an option when crossing state lines is necessary. And then finally, if all else fails, getting a second opinion on the pathology can be helpful.

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Advancements in Cervical Cancer Treatment: Targeted Therapies and Immunotherapy

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Advancements in cervical cancer treatments have created a new landscape for patient care. Expert Dr. Shannon MacLaughlan from University of Illinois discusses immunotherapy, targeted therapies, antibody drug conjugates, and proactive advice for patient care. 

[ACT]IVATION TIP

“…ask your team about clinical trial opportunities, because clinical trials are how we discover the next best treatment. And if you are eligible for a clinical trial, then that means you could gain access to that treatment early. So ask your provider about clinical trial opportunities.”

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Transcript:

Lisa Hatfield:

Dr. MacLaughlan, what exciting advancements in cervical cancer treatment are on the horizon? For example, how do targeted therapies like antibody drug conjugates fit into the broader future landscape of cervical cancer therapies?

Shannon MacLaughlan:

There are a lot of exciting developments in cervical cancer. And it’s exciting as a gynecologic oncologist because earlier in my career when I talked with someone diagnosed with stage IV cervical cancer or who had a recurrence, there were basically no treatment options that would work, and now we have so many options for patients, and I am starting to see complete responses in situations I’ve never seen before.

So some specific advances, I would say, one, would be in the surgical approach of cervical cancer. We are getting much better at taking care of patients who have surgeries and minimizing the impact of the surgery on their body. With regard to systemic treatment options, I would say the most, the biggest impact I’ve seen so far is the addition of immunotherapy for the treatment of cervical cancer such that I have seen patients with stage IV disease have complete responses to their treatment, and I’ve seen patients who have had recurrences in their spine get complete responses and get to another remission, and that’s exciting. That’s the lease on life that we could not talk about just a few years ago.

Targeted therapies are an important phenomenon and movement in all cancer care, because it represents thinking about cancers differently. If we think about cancers based on where they start, where in the body they are started so if we think of cervical cancers just as a cancer that starts in the cervix, then we can only lean on experience from other patients who have cervical cancer, and it puts our thinking into a very narrow box. Targeted therapy means that we’re looking at the cancer, not where it started, but what that tumor is doing under the microscope. What proteins is it producing, what mutations does it have? And those mutations are usually a clue to how the cancer is surviving. And if we can have that kind of a clue, then we can choose a treatment that can target that particular mutation, no matter where the cancer started in the body.

It’s a very new kind of drug called an ADC or an antibody drug conjugate. What that means is the antibody targets the mutation. All it does is bind to the cancer cell, but it’s got attached to it, a little molecule of chemo, and so it sneaks itself into the cancer cell and the chemo can kill the cancer cell from the inside, instead of the outside. And that can improve efficacy. It definitely changes the side effect profile and toxicity profile. And so that has opened up additional doors for patients with cervical cancer that weren’t previously available. 

My [ACT]IVATION tip for this topic is to ask your team about clinical trial opportunities, because clinical trials are how we discover the next best treatment. And if you are eligible for a clinical trial, then that means you could gain access to that treatment early. So ask your provider about clinical trial opportunities.

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Disparities in Cervical Cancer Treatment: The Role of Poverty and Systemic Barriers

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Cervical cancer treatment disparities exist, but what role do poverty and systemic barriers play? Expert Dr. Shannon MacLaughlan from University of Illinois discusses the impact of poverty and systemic barriers and proactive patient advice for improving your care and reducing cervical cancer disparities. 

[ACT]IVATION TIP

“…for someone who is diagnosed for the first time, bring someone with you, bring someone with you, every time you see any kind of provider, when at all possible, because the health care system has not been designed for you, obviously, because we failed you. Bringing someone with you helps you close that gap.”

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Transcript:

Lisa Hatfield:

Dr. MacLaughlan, what are the noted disparities you’ve observed in the treatment of cervical cancer among different demographic groups?

Shannon MacLaughlan:

This is a tough question to answer, not because I don’t know the answer, but because the answer requires taking ownership of the problem as a provider. Cervical cancer is preventable, because we have a very effective vaccine against the HPV virus, and because we have tools to screen for cervical cancer, including Pap smears, including HPV testing, and when patients are diagnosed with cervical cancer, it means the system failed them. It means that everything we think we’re doing to prevent something bad from happening to a person, we are not doing effectively.

And so when I think about a preventable cancer and who gets it, it’s the people who fall through the cracks. And the people who fall through the cracks are the people who are coming from vulnerable communities, where perhaps their biggest existential threat is not whether or not they get a Pap smear, but whether or not they can put food on the table, or whether or not they have a roof over their heads, or whether or not they can keep their children safe. So disparities and inequities tend to align with poverty and systemic racism and implicit biases and just flat-out marginalization.

So that the demographics that are experiencing the highest mortality, and experiencing the highest incidence of cervical cancer are women of color, Native American and Alaska Native patients, patients of Hispanic backgrounds, and immigrants. So my action tip for this, for someone who is diagnosed for the first time, bring someone with you, bring someone with you, every time you see any kind of provider, when at all possible, because the health care system has not been designed for you, obviously, because we failed you. Bringing someone with you helps you close that gap.

For our Hispanic patients, a huge barrier is a language barrier, and we’re required, if we don’t speak the language, we’re required to provide interpreters in the context of the clinic visit, but the clinic visit is actually only a very small part of a treatment journey. The moment you have to navigate getting to the campus of a medical center, you have to navigate the medical center itself. You may have to ask for directions. You’re going to have appointments with a gynecologic oncologist or radiation oncologist, nuclear medicine, radiology, an infusion unit. Come with another set of eyes and ears. It’s a great idea to bring your own interpreter, if you can.

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