Cervical Cancer Prevention and

Control in the United States: A

Review of Government Initiatives and
Their Effectiveness
Saba Kordi

Abstract

This paper examined the government's efforts to prevent cervical cancer in the United States,
evaluates its efficacy, and emphasizes the need of educating the public about risk factors and
preventative measures. According to the paper, cervical cancer is the fourth most frequent
malignancy among women in the US, making it a significant public health problem. The
study mainly examines federal government initiatives from 1990 through 2021, including Pap
tests, HPV vaccinations, and public awareness campaigns. The study evaluated cervical
cancer prevention programs using a methodical review of published articles and analysis of
statistical data. Although the article emphasizes the success of government interventions, it
also points out that there are still differences in results depending on race and ethnicity.

Keywords: cervical cancer, public awareness campaigns, risk factors, US government, Pap
testing, HPV vaccination
1. Introduction
The United Nations adopted the Sustainable Development Goals (SDGs) in 2015 as a
worldwide call to action to eradicate poverty, preserve the planet, and guarantee that all
people experience peace and prosperity (United Nations,2015a). Goal number 3 of the SDGs
focuses on promoting healthy lifestyles and fostering overall wellness, with Target 3.4.1
especially seeking to reduce noncommunicable disease (NCD) mortality by one-third by
2030(United Nations,2015b). Cervical cancer, a type of NCD, remains to be a severe burden
for many women, particularly in low- and middle-income countries with inadequate access to
preventative and treatment options. According to the American Cancer Society(2021a), there
were over 14,000 new instances of cervical cancer and over 4,000 deaths in the United States
as a high-income country in 2021. This highlights the important need of developing effective
solutions to minimize the burden of cervical cancer in the United States. Therefore, it is
critical to understand the epidemiology, risk factors, preventative measures, obstacles, and
treatments that have been implemented in the United States to minimize cervical cancer
incidence and mortality.

1.1. Background
According to the American Cancer Society (2021b), cervical cancer is the fourth most
common disease among women worldwide, with an estimated 600,000 new cases and
342,000 deaths per year. Cervical cancer is also a substantial health issue in the United
States (Watson et al., 2018). The human papillomavirus (HPV), a sexually transmitted
infection, is the leading factor of cervical cancer (Smith et al., 2020). Because there are
effective vaccinations and prophylactic strategies available, this cancer is one of the most
preventable malignancies. Cervical cancer has a significant economic burden, with an
estimated yearly cost of $2.2 billion in the United States (Largeron et al., 2018). Although
the majority of cervical cancer occurrences happen in low-income women who are uninsured
or underinsured, the government frequently bears the financial cost (Kohler et al., 2019). The
US government has taken initiatives to promote the HPV vaccine and cervical cancer
screening programs (Centres for Disease Control and Prevention [CDC], 2021a), leading to
an impressive reduction in cervical cancer incidence and mortality. However, the issue still
persists, with considerable variations in cervical cancer outcomes based on race and ethnicity
(Patel et al., 2021).
 Figure 1: A Bubble graph shows the relationship between cervical cancer death (per
100K) and female life expectancy from 1950 to 2019 (Gapminder, 2022).

According to Gapminder (2022), cervical cancer fatalities (y-axis) have declined substantially
over the previous 69 years. Meanwhile, life expectancy (x-axis) has greatly grown.
Considering that the death rate has dropped by more than 70% since 1950, the
implementation of the Papanicolaou test in the 1940s in America is mainly responsible
(Safaeian, Solomon,2009).

1.1.1. Delimitation

The time period covered by this study's delineation is precisely from 1990 to 2021, and it
focuses on analyzing the US government's recent efforts to prevent cervical cancer. This
research will not look at state-level or private-sector initiatives, policies, or programs for
preventing cervical cancer; rather, it will exclusively look at federal government programs.
The impact of HPV vaccination, Pap testing, and public awareness campaigns will also be the
main topics of this study.

1.2. Aim and purpose

The purpose of this research is to give a thorough summary of the steps the US government
took to prevent cervical cancer, including the difficulties they encountered, and to assess how
effectively these steps worked. In the interests of promoting early identification and
treatment of the illness, this study also aims to emphasize the significance of educating the
general population about the risk factors for cervical cancer and the different preventative
measures available. This paper seeks to enhance cervical cancer prevention and control in the
USA through a review of relevant studies and an analysis of statistical data.

1.3. Research question

What strategies does the United States government implement to prevent cervical cancer,
and how effective are these strategies in reducing the incidence and mortality rates of cervical
cancer?

2. Method
This research paper examines cervical cancer prevention initiatives in the USA using
descriptive analysis. Data and trends pertaining to the prevention of cervical cancer were
examined using a systematic evaluation of the published studies in the research. For the
review, relevant academic reports and publications were found by searching internet
databases like DOI. Between 2010 and 2021, papers concerning the prevention of cervical
cancer in the USA were found using specific search phrases. Articles and reports that focused
on cervical cancer prevention in the USA and were written in English were the only ones we
included. Studies that concentrated on cervical cancer therapies or other health outcomes
were not included. All of the sources utilized were original works that were consulted on
reputable websites.
3. Results
Cervical cancer often originates in the lower region of the uterus that connects to the vagina,
known as the cervix. According to the American Cancer Society (2022a), Cervical cancer is
the fourth most prevalent malignancy among women in the United States. With a predicted
13,960 new instances of invasive cervical cancer and 4,310 fatalities from the illness in 2023
alone, cervical cancer is a major public health problem in the United States (American Cancer
Society,2022b). As illustrated in the graph below, while it may afflict women of any age, this
particular type of cancer is most frequently discovered in those who are between the ages of
35 and 44.

Figure2: Rate of new cancers by age group (years), All Races and Ethnicities, Female
Cervix, United States, 2015-2019(Centres for Disease Control and Prevention [CDC],2022a)

Risk Factors for Cervical Cancer

Human papillomavirus (HPV) infection, smoking, a weakened immune system, prolonged

use of oral contraceptives, numerous sexual partners, and having a family history of cervical
cancer are risk factors for cervical cancer (Centers for Disease Control and Prevention,
2022b). Two HPV varieties, HPV-16 and HPV-18, are responsible for around 70% of cervical
cancer cases in the US (Schiffman et al., 2007). HPV is a common virus that is spread
through sexual contact. Smoking harms the DNA of cervical cells, and a compromised
immune system increases a person's susceptibility to HPV infections (Hariri & Unger, 2017).
These risk factors, however, do not guarantee that a person will get cervical cancer (Hariri &
Unger, 2017).

Prevention and treatment of Cervical Cancer

When identified early, cervical cancer is a condition that is highly curable and preventive
(American Cancer Society,2022c). For the goal of detecting pre-cancerous- cancerous or
cancerous cells and enhancing the treatment's efficacy, regular cervical cancer screenings,
including Pap tests and HPV testing, are crucial (Ismail & El-Sharkawy, 2020). according to
the American Cancer Society (2022d), Women are recommended to start having cervical
cancer screenings at age 25 and keep doing so until they reach 65. It may be required to begin
screening earlier or to check women more regularly if they have a history of cervical cancer or
certain other risk factors (American Cancer Society,2022e).

According to the Centres for Disease Control and Prevention (CDC) (2022c), In addition to
usual screening, receiving an HPV vaccination is crucial for preventing cervical cancer.
Although it can be administered as early as age 9, the HPV vaccination is advised for both
boys and girls from the age of 11 or 12(CDC, 2022d). Prior to being sexually active and being
exposed to HPV, vaccination is most effective (CDC, 2021b).

Surgery, radiation therapy, chemotherapy, or a combination of these may be used as

treatments if cervical cancer has been detected (National Cancer Institute, 2022a). The
method of treatment will be determined by cancer's stage and location, as well as other
variables including a woman's age and general health (National Cancer Institute, 2022b).

Disparities in Cervical Cancer Rates Across Racial and Ethnic Groups

Figure3: Cervical cancer Incidence rates (per 100k) by race and ethnicity,2015-2019
(American cancer society,2022f)

Cervical cancer incidence and mortality rates differ among racial and ethnic groups in the US,
reflecting various social and cultural factors. As depicted in Figure 3, Hispanic women have
the highest incidence of cervical cancer, with a rate of 9.7 cases per 100,000 women, followed
by black women (8.8), white women (7.2), and Asian/Pacific Islander women (6.1). Black
women are more likely than white women, Hispanic women, Asian/Pacific Islander women,
and American Indian/Alaska Native women to die from cervical cancer (National Cancer
Institute, 2022c). These discrepancies can be ascribed to a number of things, such as
socioeconomic level, insurance coverage, access to healthcare services, cultural attitudes and
practices, and language obstacles (CDC,2021c). For instance, a study by the National
Institutes of Health indicated that Hispanic women with limited English ability were less
likely than those with strong English skills to undergo cervical cancer screenings on time
(National Institutes of Health, 2016a). The study found that a significant barrier preventing
Hispanic women from getting preventative healthcare treatments, such as cervical cancer
screenings, is language problems (National Institutes of Health, 2016b). This emphasizes the
requirement for outreach and education initiatives that are culturally and linguistically
suitable in order to raise cancer awareness and screening rates across distinct cultures.

Cost of treating cervical cancer

The cost of treating cervical cancer can be significant, impacting both patients and healthcare
systems. Treatment costs are influenced by several factors, including the stage at which the
cancer is discovered, the type of therapy used, the location of care, and medical insurance.
For example, the average cost per patient in the US for stage I, II, III, and IV cervical cancer
treatment was $22,789, $32,788, $40,354, and $49,598, respectively (American Cancer
Society,2021c). In contrast, vaccination-based prevention is considerably less expensive;
according to the Centers for Disease Control and Prevention (CDC,2021d), the recommended
series of injections for the HPV vaccine costs around $300. Screening test costs may vary, but
are typically less expensive than treatment costs. Given the high costs associated with
treatment and the effectiveness of prevention and early detection, it is important to raise
awareness about cervical cancer and encourage vaccination and regular screenings.

4. Discussion
The paper’s results indicate how crucial early identification and prevention are to decreasing
the prevalence of cervical cancer. In the past several decades, the US government has taken a
variety of steps to improve access to screening and vaccination programs, which have helped
to significantly reduce the number of occurrences of cervical cancer.
According to the Centers for Disease Control and Prevention (CDC) (2018)., The percentage
of women aged 21 to 65 who reported having a Pap test during the previous three years went
from 78% in 2000 to 81% in 2015. Furthermore, the prevalence of HPV, the main cause of
cervical cancer, has decreased as a result of the introduction of the HPV vaccination in 2006.
According to the CDC, 72% of females aged 13 to 17 had at least one dose of the HPV
vaccination as of 2021 (CDC, 2021e).
In addition to these initiatives, the US government has also put policies into place to broaden
access to healthcare and educational opportunities. The majority of health insurance
companies must include free HPV vaccinations and cervical cancer screenings as a result of
the Affordable Care Act (ACA), which was implemented in 2010 (U.S. Department of Health
and Human Services, 2010). This has boosted access to these treatments, especially for those
with low incomes, and helped remove cost obstacles to preventative care.
Despite all of these achievements, as was noted in the results, women of racial minorities are
more likely to get cervical cancer and die from it. This is attributable to a number of factors,
including limited access to healthcare, inadequate health literacy, etc.
The US government has developed targeted measures to improve access to preventive care
among these communities in order to alleviate these discrepancies. For instance, the 1990-
founded National Breast and Cervical Cancer Early Detection Program (NBCCEDP) gives
low-income, uninsured, and underinsured women access to public services for breast and
cervical cancer screening (CDC, 2021f). Improved screening rates and early cancer detection
are the results of the program's effectiveness in reaching marginalized groups.
The US government's efforts to widen access to screening and immunization programs can be
partly blamed for the drop in cervical cancer incidence in the country. To combat inequities
in cervical cancer incidence and death, particularly among marginalized and minority
communities, more has to be done. Targeted initiatives like the NBCCEDP should be
expanded to include more people at risk for cervical cancer since they have demonstrated the
potential in enhancing access to preventative treatments.

4.1. Conclusion
In conclusion, the US government has invested considerably in the fight against cervical
cancer via a variety of initiatives, such as legislative reforms, screening and treatment
facilities, and education and vaccination campaigns. The country's cervical cancer rates have
improved as a result of these efforts, as evidenced by declining incidence and fatality rates
over the previous few decades. To guarantee that all women, regardless of socioeconomic
level, have access to these treatments and receive adequate care, however, there is still
considerable work to be done.
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