Could the FDA's recently approved Pap smear alternative reduce racial disparities in cervical cancer deaths?
January marks Cervical Health Awareness Month. Around 11,500 Americans are diagnosed with cervical cancer each year, according to data from the Centers for Disease Control and Prevention, and in 2022, over 4,000 people died from the disease despite it being considered highly preventable.
White women are more likely to be diagnosed with cervical cancer than any other group, CDC data shows. However, a 2022 study published in the Journal of Clinical Oncology found greater rates of diagnosis were mostly due to higher levels of screening. Black women have the lowest screening rates, the study found, "strongly driven by insurance and site of care, underscoring the value of addressing systemic inequity."
For decades, a Pap smear has been the standard way to detect cervical cancer. The uncomfortable and, for some, painful procedure entails using a small brush or spatula to lightly scrape the cervix to gather cells. Cells are then examined under a microscope for precancers or other abnormalities. This procedure also tests for the human papillomavirus, which can cause cell changes on the cervix that lead to cancer if not treated early.
But soon, a self-swab approved in May 2024 by the Food and Drug Administration might help people avoid the invasive procedure—and save lives. Patients will be able to use an at-home kit to swab their vaginal walls and send it to a lab to be tested for HPV. It's part of the National Cancer Institute's Cervical Cancer 'Last Mile' Initiative, which will study the accuracy and effectiveness of self-testing at 25 clinical sites nationwide. Participant enrollment began this past summer.
"Self-collection can expand access to screening and reduce barriers, which will give more people the opportunity to detect, treat, and ultimately survive cancer," Karen E. Knudsen, CEO of the American Cancer Society, said in a press statement after the announcement.
Northwell Health partnered with Stacker to explore disparities in cervical cancer deaths and what a new testing mechanism could mean for prevention. Data is from the Centers for Disease Control and Prevention.
Pap smears are a cervical cancer screening tool and are recommended for people with cervixes, not all of whom identify as women. In this article, we have used gender-neutral terms when possible. We use gendered language in the characterization of data to stay true to how sources collected and presented the information.
Early detection is the key to preventing cervical cancer deaths. Yet, data spanning June 2016 to May 2019 published in the American Journal of Preventive Medicine in October 2023 suggests that only two-thirds of at-risk people are up-to-date on screenings. For Black people, that number drops to about half.
One factor that impacts screening rates includes whether people have insurance coverage. A 2022 KFF Women's Health Survey found that 42% of uninsured women had received a cervical cancer screening in the past year, compared to 64% with private insurance and 56% of those with Medicaid. However, even when screening rates are equal, disparities in care and delays in treatment have contributed to lower survival rates among those who are diagnosed with cancer.
Within the health care system, racial bias and discrimination contribute to disparities in mortality rates. Differences in the quality of screening techniques and a lack of representation of people of color in the development of screening guidelines and clinical trials are just a few forms of systemic bias.
Research from the American Cancer Society released in January 2020 showed that even when adjusting for age, sex, and stage of diagnosis, Black people are 33% more likely to die from cancer than white patients. For American Indians and Alaska Natives, the risk of dying from cancer is 51% higher.
Where a patient lives can also affect screening rates. In 2022, less than half of rural residents received a Pap smear in the prior year, compared to about 2 in 3 urban residents, according to another study published in the Journal of the American Medical Association, which looked at data from 2019 to 2022.
The hope is that self-collection will improve screening rates among underserved populations in the U.S. Similar strategies have been adopted in Denmark, Sweden, and the Netherlands to much success. In Australia, more than 315,000 people have opted to self-collect since an initiative was launched in 2022. By March 2024, more than 1 in 4 screenings were done using collection kits in Australia.
In 2022, there were about 21 cervical cancer deaths for every million women living in the United States, according to the CDC. Broken down by race, Native Hawaiians and Pacific Islanders have the highest rates of cervical cancer deaths in the U.S.
Again, lack of access to quality care plays a role. Because Native Hawaiian and Pacific Islanders get tested less frequently, they are more likely to receive a late-stage cancer diagnosis, according to American Cancer Society research. This is particularly true among Native Hawaiians. While screening rates are generally similar across the state of Hawai'i, in 2022, just 79% of Native Hawaiian women between 25 and 65 years old were up-to-date on cervical cancer screenings, compared to 88% of white women.
The problem is most acute in the six U.S. territories in the Pacific Islands, which includes Guam, American Samoa, and the Federated States of Micronesia, according to data analysis on more than 400 cervical cancer cases published in 2024 in JAMA Oncology. Researchers found nearly 7 in 10 cervical cancer cases were diagnosed at a late stage from 2007 to 2020.
Black and Indigenous women also have elevated death rates from cervical cancer due to a lack of follow-up care after an abnormal screening. While insurance coverage and socioeconomic factors are at play, medical distrust also plays a role. This is particularly true in the field of gynecology, which the medical community built on the backs of enslaved people in the Antebellum South.
J. Marion Sims is widely credited with developing many of the modern-day tools still used in gynecology today, including the speculum, a hinged tool inserted into the vagina and expanded to get a better view of the cervix. The first version was made of bent metal spoons, which Sims used while examining enslaved people in Montgomery, Alabama.
In recent years, many have reevaluated Sims' legacy in the field, largely due to the inhumane treatment of his Black patients, whom he rarely gave anesthesia during painful procedures. His studies reinforced the false belief that Black patients have higher pain thresholds, leading to pain being dismissed and downplayed even today.
This history is a testament to the importance of culturally competent care, the ability to communicate and collaborate with people from different backgrounds and understand how their identity and culture play a role in their views and understanding of health care A case study of 40 Black and Hispanic women in Texas found when provided with culturally competent education and a self-sampling kit for HPV, screening rose from about 6 in 10 to 9 in 10 among both groups.
In the Lower 48, cervical cancer deaths are higher in states with large uninsured populations and a high percentage of Black residents.
In Mississippi, which has the highest poverty rate in the nation, there are about 4 cervical cancer deaths per 100,000 women. The state health department's Breast and Cervical Cancer Program provides free Pap screenings at some clinics for uninsured people between the ages of 40 and 64. Kentucky, which has the third-highest cervical cancer rate in the country, runs a similar program for those 21 and older who do not have insurance and whose household income is less than 250% of the federal poverty level. Over 16% of the state's population lives below the poverty line.
However, while self-screening will undoubtedly increase early detection, it is just one factor in curbing cervical cancer deaths. Other preventative measures need improvement, including HPV vaccination rates, which have proven to be one of the most effective tools in reducing cervical cancer.
Globally, cervical cancer rates are higher in low- and middle-income countries. In 2020, the World Health Organization launched the Cervical Cancer Elimination Initiative, which includes the goal of vaccinating 90% of girls worldwide for HPV by the age of 15.
Self-exams don't replace pelvic exams, and encouraging follow-up appointments after an abnormal test is also important. A study of more than 160,000 women in New Mexico published in Preventative Medicine found that between January 2015 and August 2019, only half who tested positive for cancer-causing HPV cells followed guidelines and received a biopsy within six months. Three in 10 had not followed up within 18 months.
While it's clear continuous care and monitoring are necessary to prevent cervical cancer deaths, a holistic approach valuing the importance of self-care in cancer prevention is also vital.
Story editing by Alizah Salario. Additional editing by Kelly Glass. Copy editing by Kristen Wegrzyn.
This story originally appeared on Northwell Health and was produced and distributed in partnership with Stacker Studio.
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Scientific American
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- Scientific American
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Results again revealed the same link of immunotherapy resistance to HG-T. "Checkpoint immunotherapy has become the mainstay in cancer care in the past decade, especially for those with metastatic melanoma, but until now it has never been clearly explained why nearly half will not respond to treatment," said study co-lead investigator and epidemiologist Kelsey Monson, PhD. "Our study results offer the first scientific evidence of a genetic biomarker, or presence of a mitochondrial mutation known as MT haplogroup T, to help explain why and identify those metastatic melanoma patients who are most likely to not respond to immunotherapy for the disease," said study co-lead investigator and molecular biologist Robert Ferguson, PhD. 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Researchers traced this poor differentiation to increased resilience to reactive oxygen species (ROS), chemicals commonly linked to inflammation, suggesting that HG-T conferred some form of ROS protection that stunted T cell attack. Kirchhoff says that further experiments are needed to determine the precise role played by mitochondrial genetics, ROS metabolism, and antitumor T cell immunity in cancer therapy. The more immediate next step is a prospective clinical trial to assess whether non-HG-T patients fare better on immunotherapy than patients with HG-T, and whether this applies to other mitochondrial haplogroups and cancers. Funding for the study was provided by National Institutes of Health grants R01CA227505, F99CA274650, P50CA225450, and P30CA008748, with additional support from Melanoma Research Alliance grant MRA-686192. Further funding support was provided by Italian Ministry of Health Ricerca Corrente grants M2/2 and L1-2. Both drugs used in the CheckMate trial are manufactured by the pharmaceutical company Bristol Myers Squibb, which sponsored the trial and provided the patient specimens and data used in the analysis. Besides Monson, Ferguson, and Kirchhoff, NYU Langone researchers involved in this study are co-investigators Joanna Handzlik, Leah Morales, Jiahan Xiong, Vylyny Chat, Sasha Dagayev, Alireza Khodadadi-Jamayran, Danny Simpson, Esther Kazlow, Anabelle Bunis, Chaitra Sreenivasaiah, Malid Ibrahim, Iryna Voloshyneya, Yuting Lu, Yongzhao Shao, Michelle Krogsgaard, Janice Mehnart, and Iman Osman. Other study co-investigators are Wouter Ouwerkerk and Rosalie Luiten, at Amsterdam University Medical Center in the Netherlands; Mariaelena Capone, Gabriele Madonna, and Paolo Ascierto, at the National Tumor Institute Fondazione G. Pascale in Naples, Italy; Anna Pavlick and Hao Tang, at Weill Cornell Medicine in New York; John Haanen, at the Netherlands Cancer Institute in Amsterdam; Sonia Dolfi and Daniel Tenney at Bristol Myers Squibb in Princeton, New Jersey; Thomas Gajewski, at the University of Chicago; Stephen Hodi and Osama Rahma, at Dana-Farber Cancer Institute in Boston; Keith Flaherty and Ryan Sullivan, at Massachusetts General Hospital and Harvard University in Boston; Kasey Couts and William Robinson, at the University of Colorado in Aurora; Igor Puzanov, at Roswell Park Comprehensive Cancer Center in Buffalo, New York; Marc Ernstoff, at the National Cancer Institute in Bethesda, Maryland; Michael Postow, at Memorial Sloan Kettering Cancer Center in New York; and Jason Luke, at the University of Pittsburgh in Pennsylvania. About NYU Langone Health NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone No. 1 out of 115 comprehensive academic medical centers across the nation for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation. NYU Langone offers a comprehensive range of medical services with one high standard of care across seven inpatient locations, its Perlmutter Cancer Center, and more than 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise. Media ContactDavid STUDY DOI:10.1038/s41591-025-03699-3 STUDY LINK: View original content to download multimedia: SOURCE NYU Langone Health System
Health Line
an hour ago
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12 Causes of High Blood Pressure (and How to Prevent It)
Key takeaways Most cases of hypertension are primary (essential), meaning there's no specific cause but rather multiple factors, including genetics, age, lifestyle, and diet. Only about 5% to 10% of cases are secondary hypertension with a specific identifiable cause. Key modifiable risk factors include having overweight or obesity (which accounts for 65% to 78% of primary hypertension cases), lack of physical activity, high sodium intake, heavy alcohol consumption, smoking, taking certain medications, and not getting enough high quality sleep. Your blood pressure is a gauge of how much pressure your blood flow creates in your arteries. If it's too high, it can damage your cardiovascular system. Hypertension (chronic high blood pressure) can also increase your risk of certain complications, such as heart attack or stroke. Nearly 50% of adults in the United States have hypertension, according to the Centers for Disease Control and Prevention (CDC). Many more have it and don't know it. So how do you know if you have high blood pressure? Per the American Heart Association (AHA) 2017 guidelines, your blood pressure is in the normal range when it's less than 120/80 mm Hg. Doctors consider anything above that as elevated. Anything above 130/80 mm Hg falls into one of two stages of hypertension. Hypertension can be primary or secondary. Most cases of hypertension are primary (essential). That means there's no specific cause for your hypertension, and it's likely due to several factors, including genetics, age, lifestyle, and diet. About 5% to 10% of people with high blood pressure have secondary hypertension. It's attributable to a specific cause, such as hypothyroidism. You can often reverse secondary hypertension if you effectively treat the underlying condition. 1. Underlying health conditions While most cases of hypertension are primary (many-faceted), several underlying health conditions can contribute to or cause secondary hypertension. Treating these conditions can often reverse hypertension. They include: elevated blood pressure overweight or obesity diabetes chronic kidney disease pregnancy certain heart irregularities »MORE: Get a refill for your high blood pressure medication in as little as 15 minutes with Optum Perks Online Care. Optum Perks is owned by RVO Health. By clicking on this link, we may receive a commission. 2. Overweight or obesity Although obesity is an underlying health condition, it warrants its own spot on this list. A 2020 literature review estimated that obesity accounted for 65% to 78% of cases of primary hypertension. Being overweight or having obesity can cause you to develop high blood pressure. It can also worsen hypertension if you already have it. That's because having more fat tissue causes changes in your body. Those changes include hormonal and physical shifts in your kidneys and how they function. Carrying too much weight could also alter how your body uses insulin. This could lead to insulin resistance and type 2 diabetes —another risk factor for hypertension. If you're overweight or have obesity, losing 2% to 3% of your body weight could reduce your risk for heart disease and hypertension. But a healthcare professional may recommend aiming for 5% to 10%. They'll usually recommend a mix of diet, exercise, lifestyle changes, or other interventions. 3. Lack of physical activity Getting too little physical exercise can negatively impact you in many ways. It could aggravate mental health conditions like anxiety and depression and lead to being overweight. Exercising can help you maintain a moderate weight or lose weight if necessary. That can positively affect your blood pressure and give you more energy and a sense of well-being. The AHA suggests the following, based on guidelines from the Department of Health and Human Services: Aim for at least 150 minutes per week of moderate intensity aerobic activity or 75 minutes per week of vigorous aerobic exercise. Perform moderate to high intensity muscle strengthening resistance training at least 2 days per week. Spend less time sitting. Work up to more activity — at least 300 minutes (5 hours) per week. Gradually increase the amount and intensity of your exercise. Learn more about the benefits of regular physical activity. 4. Salt intake Eating less sodium can help you lower your blood pressure. Sodium is a component of table salt, aka sodium chloride. It's also a common addition to many packaged and processed foods to enhance taste. A 2019 study found that moderately reducing your sodium intake could lower your blood pressure, whether you have hypertension. Most people in the United States consume too much sodium. According to the Food and Drug Administration (FDA), the average daily intake for adults is 3,400 milligrams (mg) — 48% higher than the recommended limit. The FDA suggests a limit of 2,300 mg per day, or about one teaspoon, for people ages 14 and up. The World Health Organization (WHO) suggests an even lower limit of 2,000 mg. The AHA recommends lower still — no more than 1,500 mg daily, especially if you have hypertension. Learn more about a low sodium diet. 5. Alcohol Heavy alcohol consumption can harm your overall health, including your cardiovascular health. It can contribute to or worsen hypertension. It can also increase your risk of diabetes and several cancers. The AHA recommends limiting alcohol consumption to two drinks per day for males and one for females. A drink is: 12 ounces of beer 4 ounces of wine 1.5 ounces of 80-proof spirits 1 ounce of 100-proof spirits But even moderate alcohol consumption has its drawbacks. A 2019 study of more than 17,000 people suggests that moderate consumption (7 to 13 drinks a week) can substantially raise your risk of hypertension. A 2020 study also found a link between moderate alcohol consumption and high blood pressure in people with type 2 diabetes. Learn more about how you can reduce your alcohol consumption. 6. Caffeine Up to 90% of people in the United States consume some form of caffeine each day. According to the AHA, caffeine isn't terrible for blood pressure unless you have too much. The AHA also acknowledges a possible link between drinking coffee and a lower risk of chronic illnesses, such as cancer and heart disease. Drinking 3 to 4 cups of coffee a day is safe for most people with high blood pressure, according to a 2017 review of studies and a 2021 study. But drinking much beyond that can lead to anxiety and heart palpitations. The FDA suggests a daily limit of 400 mg of caffeine for healthy adults. For reference: An 8-ounce cup of coffee contains 80 to 100 mg of caffeine. An 8-ounce cup of tea has 30 to 50 mg. An 8-ounce energy drink has 40 to 250 mg. A 12-ounce can of soda has 30 to 40 mg. If you're concerned about your caffeine intake, it's best to check in with a healthcare professional. As caffeine is known to elevate blood pressure, wait 30 minutes before taking a blood pressure reading. An inaccurate reading can impact your care, according to a 2022 study. 7. Smoking Smoking is the leading cause of preventable death in the United States. Smoking can contribute to many life threatening conditions, including heart attack, stroke, lung disease, and several cancers. That said, the relationship between hypertension and smoking isn't yet clear. But smoking does lead to temporary spikes in blood pressure. It also contributes to atherosclerosis, the hardening of your arteries. Stiff arteries cause an increase in blood pressure. 8. Medication Some medications can increase your blood pressure. A 2021 study of 27,599 adults found that 18.5% of people with high blood pressure take medication that could raise their blood pressure further. Medications that might increase your blood pressure include: steroids nonsteroidal anti-inflammatory drugs (NSAIDs) decongestants antipsychotics birth control pills If you have high blood pressure, it's best to discuss all medications you're taking, including any over-the-counter (OTC) drugs, with a healthcare professional. 9. Not enough sleep According to the CDC, most people older than 18 years need at least 7 hours of sleep a night for optimum health. But many people don't get enough. That can affect your health, especially if you have high blood pressure. That's because when you sleep normally, your blood pressure goes down. That gives your body a break. Having insomnia or other sleep problems, or regularly getting too little sleep, means your body doesn't get as much of a break. You can get enough rest by practicing good sleep hygiene. The CDC offers the following tips: Go to bed at the same time each night and get up at the same time each morning, including on the weekends. Get enough natural light, especially earlier in the day. Get enough physical activity during the day. Try not to exercise within a few hours of bedtime. Avoid artificial light, especially within a few hours of bedtime. Use a blue light filter on your computer or smartphone. Don't eat or drink within a few hours of bedtime; avoid alcohol and foods high in fat or sugar. Keep your bedroom cool, dark, and quiet. 10. Pregnancy Hypertension that develops during pregnancy is called gestational hypertension. If you have it, it's imperative to manage it to avoid harm to you and your baby. Doctors generally define it as blood pressure at or over 140/90 mm Hg. There are several possible causes of high blood pressure during pregnancy. They include: being overweight or obese not getting enough physical activity smoking drinking alcohol having a first-time pregnancy having a family history of pregnancy-related hypertension carrying more than one child being 35 years or older having assistive reproductive technology, such as in vitro fertilization (IVF) having diabetes or certain autoimmune diseases You can help prevent high blood pressure in pregnancy by managing risk factors you can change — those that are related to lifestyle, such as being overweight, smoking, and alcohol use. Talk with a healthcare professional as soon as you think it may be a concern. 11. Age High blood pressure typically becomes more of a concern as you age. The CDC reports that from 2017 to 2018, hypertension was more common in older adults. Age range (years) Prevalence of hypertension 18–39 22.4% 40–59 54.5% 60+ 74.5% All adults 45.4% The National Institute on Aging (NIA) states that high blood pressure risk increases with age because your body's vascular system, or network of blood vessels, changes as you age. Your arteries can get stiffer, causing blood pressure to go up. That's true even for people with healthy habits. The NIA recommends the same practices for older adults as younger ones, including modifying essential lifestyle factors like smoking (if you smoke), drinking (if you drink), exercise, and a balanced diet. They also recommend you take prescribed medications if needed and check in with a doctor regularly. Learn more about managing your blood pressure as you age. 12. Genetics If your parents have high blood pressure, you're more likely to develop it. Hypertension tends to run in families. This may be due to family members sharing similar habits, like exercise and diet. But there appears to be a genetic component as well. Genetic factors may contribute to 30% to 60% of cases of irregular blood pressure. Some genetic variants can lead to syndromes that feature high blood pressure, including: hyperaldosteronism Gordon syndrome Liddle syndrome Other genes or combinations of genes might lead to an increased risk of high blood pressure. Research from 2019 suggests that a variation in the ARMC5 gene may explain the increased prevalence of hypertension in Blacks and African Americans. Still, it's not yet known how much having a family history of the condition increases your risk. More research is needed in this area. How can I prevent high blood pressure? According to the AHA, the ways to manage blood pressure are also ways you can help prevent it: Get regular physical activity. Don't smoke, or quit smoking if you do. Limit alcohol consumption. Maintain a moderate weight. Eat a balanced diet that's low in sodium. Manage your stress. Work with a healthcare professional. Takeaway Many factors contribute to your likelihood of developing hypertension. Some of them are within your control, such as your exercise habits, diet, and whether you drink alcohol or smoke. Others are not, such as genetics and age. If you already have hypertension, you're not alone. Nearly half of all adults do. You can lower your blood pressure by changing your habits and seeing your healthcare professional for appropriate medication if necessary. If you don't have hypertension, check your blood pressure regularly, especially if you have a family history of the condition. Many people, including those with healthy habits, don't know they have it. You can lower your risk by adopting a healthy lifestyle.
