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january is cervical health awareness month: take this opportunity to highlight the importance of screening and hpv vaccination 

women Each year more than 11,000 women in the United States are diagnosed with cervical cancer. While cervical cancer mortality in the U.S. decreased 12% comparing 2000-2004 and 2010-2014, Delaware's mortality rate increased 3% for this same period. This increase reveals a need and an opportunity for Delawareans to reverse this trend. Fortunately, effective prevention and reliable screening methods are readily available to combat the spread of human papillomavirus (HPV) and incidence of HPV cancers. 

Cervical Health Awareness in January is a chance to share information about how women can protect themselves from human papillomavirus (HPV) and cervical cancer. As a provider, you play a key role in reversing this trend and Quality Insights is here to support your efforts.
where does delaware rank?: Cervical Cancer by the numbers

Healthy People 2020 calls for increasing the rate of women who received cervical cancer screening based on most recent guidelines. The objective is 93.0% of women to be screened within three years.  Delaware ranked 29th in the nation for the percentage of women reporting a Pap test within three years, according to the Behavioral Risk Factor Survey, 2016. The National Institutes of Health- National Cancer Institute has collected the data reported below for cervical cancer as well as a myriad of other cancers. Check out Delaware's State Cancer Profile here.

Women ages 21-65 with Pap test in past three years
Cervical cancer incidence rate, 2012-2016, per 100,000
Cervical cancer age adjusted mortality rate
Cervical cancer new cases, 2016
  • The lowest screening rates for cervical cancer are for women who reported annual household income of $25-35K per year
  • Across the nation, cervical cancer incidence by race/ethnicity per 100,000 women for 2016 is:
    • Hispanic - 9.8%
    • Black - 8.7%
    • White - 7.5%
    • Asian/Pacific Islanders - 5.8%
know when to screen: 2018 cervical Cancer Screening Gu idelines

female icon The United States Preventive Services Task Force (USPSTF) updated its cervical cancer screening guidelines in 2018. To summarize, with an A grade recommendation, USPSTF recommends:
  • Screen for cervical cancer every three years with cervical cytology alone in women aged 21-29 years
  • For women aged 30-65 years, screen:
    • Every three years with cervical cytology alone,
    • Every five years with high-risk human papillomavirus (hrHPV) testing alone, or
    • Every five years with hrHPV testing in combination with cytology (cotesting)
The Centers for Disease Control and Prevention (CDC) published a comparative listing of cervical cancer screening guidelines for average risk women that includes American Cancer Society, USPSTF, American College of Obstetricians and Gynecologists and the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology.

dr. sobel Quality Insights Recorded Presentation: Screening for Cervical Cancer
Dr. Edward Sobel, Quality Insights Medical Director, presented an online learning session earlier this year entitled, Screening for Cervical Cancer. In this presentation, Dr. Sobel discussed  the 2018 USPSTF screening guideline updates and the importance of HPV vaccination. He also highlighted resources healthcare providers can use to help improve vaccination rates within their patient population, plus resources for uninsured or under-insured patients.  You can access the recording of this presentation here .
HPV Vaccination is Cancer Prevention

Vaccine vials imagepack According to the CDC, 79 million Americans, most in their late teens and early twenties, are infected with HPV. Virtually all cases of cervical cancer are caused by carcinogenic types of HPV. Vaccination against HPV is effective in preventing HPV infection in HPV-naïve individuals. The HPV vaccine protects against the types of HPV that most often cause not only cervical cancer, but also vaginal, vulvar, anal, and oral cancers. The HPV vaccine is effective cancer protection.

To protect against vaccine-preventable diseases, including HPV-associated cancers, routine immunization of adolescents aged 11-12 years is recommended by the Advisory Committee on Immunization Practices (ACIP). Since HPV vaccine introduction in 2006 for females and 2011 for males, coverage has increased gradually for females and more rapidly for males. However, HPV coverage has not reached the tetanus, diphtheria and acellular pertussis vaccine (Tdap) and meningococcal conjugate vaccine (MenACWY) coverage.

NEW in 2019: Updated HPV Vaccination Recommendations
The CDC Advisory Committee on Immunization Practices updated its recommendations on HPV Vaccination for Adults as follows:
  • Routine recommendations for HPV vaccinations of adolescents have not changed.
  • Catch-up vaccination is now recommended for all persons through age 26 years.
  • For adults aged 27-45 years, shared clinical decision making is recommended.
  • View the full set of recommendations in the CDC Morbidity and Mortality Weekly Report dated August 16, 2019.
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Working Together to Increase HPV Vaccination Rates in Delaware
Quality Insights is spearheading an exciting new training program for medical providers to increase HPV vaccination rates in Delaware. As part of this program, our team will engage providers and staff in interactive, collaborative discussions on the HPV vaccine, including cancer prevention, immunogenicity, safety, guidelines, addressing parental concerns, and workflow assistance. Please consider joining us in this important initiative at NO COST to your practice. Download the project flyer  to learn more.
easing the burden: delaware programs offer financial coverage for cancer screenings and treatment 

money icon The Delaware Screening for Life program will pay for cancer screening for eligible residents who do not have insurance coverage or have insurance that doesn't cover screening. More information can be found at the Screening for Life website or by calling 302.744.1040.

The  Delaware Cancer Treatment Program  provides free cancer treatment for up to two years for those who can't afford treatment or if insurance doesn't cover treatment. Cancer Care Coordinators help guide patients through treatment, scheduling visits with doctors and making sure patients get the care they need.
e-learning opportunities: education at your fingertips

Webinar Series: Us vs. HPV  
Access Activity Here
The Global Initiative Against HPV and Cervical Cancer (GIAHC), in partnership with the American Medical Women's Association (AMWA) and Indiana University collaborated on a week-long educational webinar series on HPV prevention. Presented in January 2019 in honor of Cervical Health Awareness Month, the Us vs. HPV online webinar series covered a range of topics in cervical cancer prevention and included experts from a variety of partner organizations. The webinars are intended for members of the public, patients, healthcare providers, and anyone else who wishes to learn more about various aspects of HPV-related disease and HPV prevention, including HPV vaccination. 

Topics discussed in this webinar include:
  • HPV Vaccine Update
  • HPV and Cervical Cancer - A Global Perspective
  • HPV Prevention Week
  • Cervical Cancer Past Present and Future
  • HPV and Cervical Cancer Champions

C DC Web On-Demand Video: You Are the Key to HPV Cancer Prevention
A clinician recommendation plays a critical role in getting parents to accept HPV vaccination for their child. This presentation is intended to support you in making effective recommendations and answering parents' questions. It includes up-to-date information on HPV infection and disease, HPV vaccine, and ways to communicate with parents successfully about HPV vaccination. (Please note that you must email the CDC to request the slide deck.)

teen girl Free CME Webinar: HPV and Immunizations. A discussion about HPV from an Oncologist's Perspective. What can be Prevented with this Vaccination.
Thursday, January 9, 2020 -  3:00 p.m. to 4:00 p.m. 
In this one hour webinar, participants will learn about HPV from an oncologist's perspective. Participants will be able to discuss reasons why the HPV vaccination can lead to prevention of HPV-related cancers and describe the effects of HPV-related cancer in women. Healthcare providers will understand the burden of the HPV disease and the rationale for vaccinating youth at ages 11 and 12.

Challenge yourself and your care team with these questions from the  National Cervical Cancer Coalition.

HPV is common.
FACT: Current estimates are that 75-80% of all people will be infected with HPV over their lifetimes. Most produce no symptoms or illness.
An abnormal Pap means a woman is at high risk for cervical cancer.
MYTH.  Although Pap tests are important screening tools, abnormal results can also be caused by factors other than the presence of a high-risk HPV type. Pap is a very effective system of protection when women take responsibility for getting screened at regular intervals.
Lesbians don't need regular Pap tests.
MYTH.  The most recent evidence found evidence of genital HPV infections among lesbian women, even in those who have never had sex with a man.
Genital warts lead to cervical cancer.
MYTH.  Genital warts are almost always benign and do not usually lead to cancer, turn into cancer, or predispose a person to cancer. Women exposed to genital warts, or any other STI, should have regular Pap tests since HPV is very common.
Condoms reduce, but don't eliminate, the risk for HPV.
FACT.  Used correctly, condoms are effective against STIs such as gonorrhea and HIV that are spread through bodily fluids. They are likely to be less protective against STIs that are spread through skin-to-skin contact such as HPV and herpes because they do not cover the entire genital area of either sex. Contact between these areas can transmit HPV. However, condom use can lower the risk of acquiring HPV infection and reduce the risk of HPV-related diseases, as well as help prevent other STIs and unintended pregnancy.
contact information

For more details about the Cancer Screening Quality Improvement Projects being led by Quality Insights , please contact Sarah Toborowski.

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This publication was supported by the Cooperative Agreement Number NU58DP006349-02 from the Centers for Disease Control and Prevention. 
Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease 
Control and Prevention. Publication number DEDPH-CS -121319