Executive Summary Cervical Cancer Plan of Texas

Cervical Cancer in Texas

Texas is a large and diverse state with a population of over 20 million people. Every year, more than 85,000 Texans are diagnosed with cancer, and another 37,000 die from the disease. In 2006, it is projected that more than 1,100 women will be diagnosed, and 391 women are expected to die from cervical cancer in Texas. More than half of new cases are diagnosed in women under 50, and two-thirds of cervical cancer deaths occur in women over 50.

Although Texas cervical cancer incidence rates are declining, following a national trend, Texas women continue bearing an unequal cancer burden, with minority women more likely to develop and die of the disease.

Cervical cancer incidence rates are highest in Hispanic women in Texas, with mortality rates highest in African-American women. Women in these two groups are more likely to be diagnosed with cervical cancer at later stages, when the disease has already spread and is more difficult to treat.

In addition to ethnic and racial disparities in cervical cancer, marked geographic disparities also exist. Cervical cancer incidence rates are higher along the Texas-Mexico border, regardless of ethnicity. Hispanic women living on the Texas-Mexico border have higher cervical cancer rates than Hispanics living anywhere else in the U.S. Mortality and incidence rates also are higher in rural - rather than urban - Texas counties.

Cervical cancers detected at the earliest stage have 10-year survival rates of 99 percent. Overall, the rate of women in Texas having had a Pap test in the last three years is high at 82 percent. Yet, significantly lower screening rates exist for identified groups of women, including those: 1) with low educational levels, 2) who identify as Hispanic as well as African-Americans, Asian/Pacific Islanders and Native Americans, 3) over 65 and 4) women living in rural and Texas-Mexico border counties.

New discoveries into the causes of cervical cancer are leading to screening and prevention technologies that can change the future effects of the disease. The most recent cervical cancer advances involve the human papillomavirus (HPV). HPV is a virus recognized as the leading cause of cervical cancers. Almost all men and women become infected with HPV at some point in their lives, and for many, their bod's immune system will fight the virus. For some women however, the HPV persists, and can lead to cervical cancer. To eliminate cervical cancer, we must fight HPV.

In 2006, the U.S. Food and Drug Administration approved the first vaccine preventing HPV infection. The vaccine is effective against HPV types that cause approximately 70 percent of cervical cancers. Armed with this new HPV vaccine, we can achieve the moment when we know our goal - eliminating cervical cancer death and suffering - is in reach.

Charge

Women in Government, a non-profit, bi-partisan organization of women state legislators, launched the Challenge to Eliminate Cervical Cancer Campaign in 2004. Through this initiative, Women in Government urged "state legislators to address cervical cancer prevention by increasing access to advanced and appropriate screening and preventive technologies, particularly for underserved women, and improving education about this disease and its cause, the human papillomavirus." The Texas Legislature responded to this challenge in 2005.

To achieve the goal of eliminating cervical cancer in Texas, the 79th Texas Legislature directed the Department of State Health Services (DSHS) to develop the Texas Cervical Cancer Strategic Plan (HB 2475 by Delisi), in cooperation with the Texas Cancer Council.

In response, DSHS and the Texas Cancer Council created a Steering Committee and three work groups to research and make recommendations regarding barriers, access to care, new screening technologies, best practices and opportunities for collaborations and partnerships.

Many individuals and organizations were involved in developing the Texas Cervical Cancer Strategic Plan, including more than 50 physicians, nurses, epidemiologists, researchers, social workers, health educators, public health experts and other health care professionals from a wide range of organizations, such as medical schools, government public health agencies, community-based organizations and advocacy organizations.

The first meeting took place in December of 2005. Three work groups addressed the areas outlined in the legislation - technology, education and policy. The work groups were charged with researching barriers; confirming information in other reports and the relevance to Texas; and using the state's Texas Cancer Plan and Action Plan on Breast and Cervical Cancers to identify potential strategies and pertinent information. The work groups met intensely from January to June 2006 through face-to-face meetings and conference calls, developing proposed objectives, strategies and recommendations. Participants researched and provided supporting documentation for all components, laying the foundation for the Texas Cervical Cancer Strategic Plan.

Challenges

Eliminating cervical cancer mortality requires HPV vaccination and support for routine cervical cancer screening and treatment for every woman in the state. By addressing access issues for prevention, screening, early detection, and treatment of cervical cancer, Texas can make dramatic strides toward being the first state to reach the goal of eliminating this disease by 2015.

Yet, HPV vaccination and screening are only one component in the fight. Texas leads the U.S. in the number of uninsured residents. The reality of more than 5 million uninsured Texans poses the greatest challenge to eradicating cervical cancer deaths because we must expand access to comprehensive cervical cancer care. One current venue includes the existing DSHS-administered Breast and Cervical Cancer program. Breast and Cervical Cancer contractors provide cervical cancer screening and diagnostic services to qualified women. This program is the gateway to cancer treatment services funded by the Medicaid Treatment Act as authorized by the Texas Legislature in 2001. The Family Planning programs administered by DSHS and The Health and Human Services Commission also provide routine cervical cancer screening services and referrals for diagnostic tests, if appropriate, to eligible women. Increased funding and support for this program and other public screening and early detection programs can lead to improved incidence and mortality rates for cervical cancer.

Cervical Cancer Strategic Plan

The Texas Cervical Cancer Strategic Plan is a comprehensive guide to statewide activities, unifying public and private efforts to reduce this disease's impact throughout Texas. Recommendations are provided for public agencies to establish a clear state priority and commitment to address the problem of cervical cancer in Texas. The Strategic Plan also includes goals, objectives and strategies to provide a framework and guide for health care providers, advocacy groups, nonprofit organizations, health and human service agencies, state and community leaders and all Texans to aid in planning and implementing actions to eradicate cervical cancer in Texas within the next decade. - Texas Department of Health