Access to healthcare prevents deaths.

Cervical cancer (invasive carcinoma) is a mostly preventable disease, but only if people have access to regular health care. The use of Pap smear screening has already dramatically reduced the incidence of cervical carcinoma in countries with robust health care systems. The introduction of the HPV vaccine adds a second, extraordinary public health tool that promises to further reduce this form of cancer!  Sadly, despite these interventions there are a significant number of preventable deaths from cervical cancer.  

Today’s New York Times reported new estimates of deaths from cervical carcinoma (I’ve not been able to find a working link to the e-publication, but will post when available). The cited study, which excluded women with hysterectomies (and men), demonstrates mortality from cervical carcinoma at 4.7 per 100,000 white women and 10.1 per 100,000 for black women.  The study did not investigate the cause of the disparity, although previous work (also cited by the NYT and available here) indicates that deaths from advanced cervical cancer are associated with a lack of access to care, particularly for poor and non-white women.  

In Kenya, we’ve already seen quite a bit of invasive cervical carcinoma (see explanatory images and a discussion of “cancer” in this related post).  Kenyan women have limited access to routine screening with Pap smears, tend to present with more advanced disease, and have low survival compared to Western countries; these trends are associated with poverty and lack of access to care (Reference). Alarmingly, the death rate from cervical cancer for black women in the US (10.1 / 100,000 women) was comparable to that seen in low-income countries, just like Kenya.  Nicole is working on a similar project, tracking how the type and severities of cases we see in the Kijabe Hospital Pathology Department has changed overtime; she and Rochelle hope to compare these to a similar set of cases at our home institution.

This phenomena is not isolated to non-white women, or women in the developing world.  Poverty and lack of access to medical care are scourges that ignore color, race, and religion.  In some of the poorest areas of the US, in Appalachia, death rates from all forms of cancer are ~8% greater than the rest of the country (Reference).   The 13 states analyzed in this study, and their most Appalachian counties, were significantly more white (90.6% vs 71.8%), ~20% poorer, and had fewer high school graduates (22.2% vs 19.9%) than the non-Appalachian controls (37 states and the District of Columbia).  

I draw these distinctions because deaths from cancer cut across the lines that separate us: race, class, education, and language or nation of origin.  That said, poverty, living in rural areas, or otherwise lack of access to medical care puts people at higher risk of death.  Not just illness, but death.