The story started with a picture.
Electra Paskett looked at the sheet of paper that contained an image of the state of Ohio and saw a lot of red. The color didn’t represent a particular political party or that of her new employer, The Ohio State University. What it did symbolize was the prevalence of women who had cervical cancer living in Appalachia. Paskett, PhD, Marion N. Rowley Professor of Cancer Research and professor of epidemiology in OSU’s College of Public Health, presented her work at the year’s first University of Illinois Cancer Center Distinguished Lecture Series.
“The red here is bad,” said Paskett, who also serves a director of the Center for Cancer Health Equity at the James Cancer Hospital and associate director for population sciences and program leader of the Cancer Control Program in the Comprehensive Cancer Center of The Ohio State University. “The highest death rates of white women are from cervical cancer and I want to understand why.”
Cervical cancer is a sexually transmitted disease cause by human papilloma virus (HPV). According to the Centers for Disease Control, HPV is the most common STD in America. About 12,000 women are diagnosed with cervical cancer each year, and about 4,000 women die of the disease. However, it is virtually 100% preventable through behavioral and lifestyle choices. Other risky behaviors that contribute to cervical cancer are smoking and a lack of a Pap test.
A cultural region of 420 counties in 13 states located in the eastern part of the U.S., Appalachia stretches from the Southern Tier of New York State to northern Alabama and Georgia. Home to about 25 million people, Appalachia contains both urban and rural areas, and is less racially diverse than other parts of the U.S. It has a higher rate of poverty and lower percentage of formal education compared to other areas of the U.S.
Appalachia is a traditionally underserved area in terms of health care, Paskett said. Cancer and heart disease is the leading causes of death, and many factors contribute to health disparities in the region, including poor socioeconomic status, lack of medical care facilities and health care providers, poor health behaviors and poor communication with health care providers. Six out of the 32 counties in Ohio that have a high incidence of cervical cancer have no mammography clinics, and four counties had no grocery store.
Paskett initially began studying cervical cancer in Appalachia when she arrived in Columbus, Ohio, in 2002 from Winston-Salem, N.C., where she served on the faculty of Wake Forest University. During her first five years of conducting research, Paskett led a program entitled CARE (Community Awareness Resources Education) Ohio, to understand why Appalachian Ohio women have a high incidence – and high mortality rate – of cervical cancer.
The program, Paskett said, initiated several interventions led by community health advisors – to increase the number of women receiving Pap smears; to help women stop smoking; and predict abnormal cervical cytology.
Paskett recalled facing numerous roadblocks when the initial program was developed, but she was not to be deterred. The area is conducive to having a high incidence of smoking; many friends and family members smoke, the area where people traditionally walk is lined with stores advertising smoking and people standing outside smoking, and people working in environments where breaks are taken throughout the day to smoke.
“A lot of primary care providers never ask their patients if they smoke,” Paskett said. “And as we know smoking is a leading cause of cervical cancer. Also, you can’t say the word ‘cancer’ in the African American community because they think it’s a death sentence. Women also don’t talk about their cervix. How do you research something when you can’t say the word cervix?”
The research was so successful that the grant was renewed and expanded to include new programs such as learning about HPV immunization response and stress; smokers and their social networks; and educating parents to increase HPV vaccination rates among young girls and adolescent females ages 9 to 17. Paskett was recently successful in obtaining a new P01 grant to begin CARE 3.
Watch Paskett’s presentation below.