View El Rio Community Health Center Locations in a larger map Hispanic women in Arizona are twice as likely to die of cervical cancer as Caucasian women, according to Dr. Francisco Garcia, director of the University of Arizona Center of Excellence in Women’s Health (WCOE), and co-director of the Cancer Health Disparities Institute of the Arizona Cancer Center.
Cervical cancer is caused by certain forms of the human papillomavirus (HPV). While there are more than 100 forms of HPV, approximately 13 are associated with infection of the lower genital tract and lead to an increased risk for developing cervical cancer, Garcia said.
“Unfortunately, this is a disease that affects poor people and women of color, and people who don’t have good access to health care,” he said.
HPV is a family of viruses and the most common sexually transmitted infection. It is so common that at least 50 percent of sexually active men and women get it at some point in their lives, said Rachel Powell, spokeswoman for the Centers for Disease Control and Prevention (CDC).
In 90 percent of cases, the body’s immune system clears HPV naturally within two years. However, when people aren’t able to get rid of the infection, it can be associated with the development of pre-cancer and cancer of the cervix, Garcia said.
Latinas have higher rates of cervical cancer for several reasons, but mostly because of the lack of access to good health care. Latinas are one of the groups least likely to have health insurance, said Martha Monroy, program director of Racial and Ethnic Approaches to Community Health (REACH) at the WCOE.
Garcia agreed.
“That’s why, from my standpoint, it’s a really important sort of health equity issue,” he said. “All these cases of cervical cancer deaths could have been avoided because we have the capacity to prevent them.”
Monroy detailed other “social determinants of health,” including a lack of linguistically-appropriate and community-specific information, cultural barriers related to sexuality, individual embarrassment and lack of understanding the importance and resources surrounding the issue.
According to the National Latina Institute for Reproductive Health, Latinas have the second highest mortality rate from cervical cancer because of the low rate of Pap smear screenings.
Monroy also pointed out that some members of the Hispanic community say they feel they are treated differently because of their lack of insurance and possible immigration status.
The WCOE’s REACH program focuses on providing free educational opportunities, like HPV and cervical cancer prevention forums. In addition to educating anyone willing to listen, REACH trains health care providers and provides one-on-one outreach programs.
The REACH program stresses the importance of screening services in the form of Pap smears for women and preventative services like the HPV vaccination for their kids. HPV prophylactic vaccination is for young women who are not yet sexually active or who have just recently become sexually active.
“This is where you have to be clear about the vaccine, because for most adults, the vaccine’s not going to do anything,” Monroy said. “The vaccine is for before you get exposed. For adults, it’s really about getting screened and catching stuff early.”
The program also helps people understand subsidized services to ensure women get to the centers for care.
“These women are worried about their kids, worried about their families first, and they generally think of themselves last,” Monroy said. “So part of it is getting them to the services and breaking down those barriers.”
Community health advisors for the REACH program, or promotoras, are central to providing a link between the community and the health care system. The promotoras give group presentations, help people navigate the health system, obtain health insurance and schedule medical appointments.
“The Latina woman will do a lot of things before she puts herself first, so this may be one of the reasons that cervical cancer is being detected in Latinas,” promotora Lorena Verdugo said. “They would rather put food on the table for their children before paying a co-pay for a Pap smear, or they would rather spend time caring for their family before scheduling a medical appointment. They tend to leave everything for tomorrow, and tomorrow may be too late.”
Promotoras also ensure that women get crucial screening and prevention services that are financially affordable. People on AHCCCS are eligible for screening and for the HPV vaccination of their children under age 19.
For uninsured women, the Pima County Health Department offers screening for cervical cancer and cervical cancer precursors at a free or reduced cost, Garcia said.
“I always tell my Latina women, you have to love yourself before you can love others,” Verdugo said. “We are the pillars of our home and if mom is not healthy, no one is healthy.”
