January is Cervical Cancer Awareness Month! This episode is all about screening and prevention of cervical cancer; and The Docs take an in-depth look into how access to health education and medical care (or lack thereof) can affect specific regions and populations.
January is Cervical Cancer Awareness Month! This episode is all about screening and prevention of cervical cancer; and The Docs take an in-depth look into how access to health education and medical care (or lack thereof) can affect specific regions and populations. Cervical cancer is caused by the Human Papillomavirus (HPV). As Dr. Tiffany referenced from the article, "Nobody should die of cervical cancer" as it is one of the most preventable and curable cancers.
Cervical cancer prevention occurs in multiple stages:
Black women die of cervical cancer at a higher rate than any other race or ethnicity. One of the contributing factors is lack of access to gynecologists in their surrounding area and lack of knowledge of what to symptoms to look out for. These social determinants of health have a negative impact on outcomes for Black patients with cervical cancer. Additionally, while there are programs that provide aid for cancer screening, that aid often falls short of providing additional resources for diagnostics and treatments.
For more on HPV vaccination, check out our Episode 3: Iatrophobia and Vaccines
If you'd like to read the article Dr. Tiffany was referencing: It Should Not Happen: Alabama’s Failure to Prevent Cervical Cancer Death in the Black Belt
For more information on whether you or your loved ones are eligible for free or low-cost breast and cervical cancer screenings and follow-up via the Breast and Cervical Cancer Control Program (BCCCP), visit https://www.cdc.gov/cancer/nbccedp/ or https://bcccp.ncdhhs.gov (for NC residents).
Squamous Intraepithelial Lesion (SIL) is the abnormal growth of squamous (cancerous) cells on the surface of the cervix.
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Dr. Karen Winkfield
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Dr. Zanetta Lamar
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Dr. Tiffany
I was reading something the other day and it was actually about Alabama's Black Belt which is sort of the middle part of the statevwhere it was called the Black Belt because of the soil, the very fertile soil, the black top soil there. Yeah,
Dr. Zanetta
I was like I don't know what that is. I've never heard of it. I thought it was some massacre that I've never heard of
Dr. Tiffany
No, no. It was because of the fertile soil in Alabama. But now, it marks one of the, one of the places that has the worst, you know, health outcomes in the state. And the reason it came up was because as we know, January is cervical cancer awareness month. And so there was an article about how, at least in 2018, Alabama had the highest rate of women dying from cervical cancer.
Dr. Zanetta
Oh no,
Dr. Tiffany
And so this article that was focused on this area called the black belt of Alabama, which is sort of where the disparities were coming from, in terms of, like the rest of the country, black women are dying from cervical cancer, they're more, you know, on the order of almost two to one, kind of like the rest of the country. So they did this fascinating breakdown of, I mean, it was like, you know, disparities in action, because they talked about it being a history. Yeah, in like, like, health care, resources, lack of education. But the interesting part was, it was just, you know, quote, unquote, lack of education in terms of like, people knowing about the cervical cancer vaccine, and those sorts of things. The other thing that they pointed out, which I found fascinating, and actually never thought about, was the sexual education for the kids in the public school system. So, as you know, one of the main symptoms in cervical cancer is abnormal bleeding, you know, abnormal blood vessels bleeding, particularly after sex. And so they were talking about how the sexual education that have been mandated by the state, which didn't deal so much in actual facts around sex, were kind of neglecting this. And were an area where they could make some inroads in terms of actually educating teenagers, kids about their bodies, about sexually transmitted diseases about symptoms that you could see, things like that. So it was just a really kind of overarching article that put everything into perspective. And one thing they said that kind of stood out to me was, you know, there was a quote by one of the gynecologists there. First of all, there aren't many gynecologists, there was something like, they provided a statistic on the lack of gynecologist and like 100 mile radiuses in this particular place, so, you know, access issues. Again, there's insurance, but there's also Is there anyone there to actually provide services for you to have pap smears, to have screening or to follow up? If you have abnormal test, but there was a quote that said, "Really, no one should die of cervical cancer". And we say that we say that a lot about a lot of cancers where their screenings, right? But then I thought about it, Hell is like, it's really true for cervical cancer, because you have a vaccine, right? You have,
Dr. Zanetta
You can prevent it.
Dr. Tiffany
Right? You have different screening tests, right?
Dr. Zanetta
You can catch it early and cure it.
Dr. Tiffany
and if you catch it early, right, there are interventions, you know, things you can do at a very early stage, when you just start to see changes that could lead to cancer.
Dr. Zanetta
Right
Dr. Tiffany
you can eliminate those, so that you really never have to get you know, you really never have to develop it. Um,
Dr. Karen
and third, you can prevent, because it's a sexually transmitted disease.
Dr. Tiffany
Right. And which comes into the education piece, which I've never think about in terms of sexual education. And the other thing they were talking about in terms of sexual education, it was not only just the use of condoms, but also emphasizing the skin to skin contact there too. You know, so that there is transmission from just skin the skin contact, which is why the vaccine becomes all the more important to get people vaccinated before they have any exposure
Dr. Zanetta
I see what you mean
Dr. Tiffany
And so it was kind of like, everything that we talk about in what, right, like social determinants of health, access to care, access in terms of insurance coverage, but also do you actually have doctors in your area, hospitals in your area?
Dr. Karen
And you bring up that point, because what you're saying is that part of health care starts with education, right. And we will be talking about something as simple or as basic as sex education, which, you know, in some states, it's not really looked upon favorably, anyway, as a whole. And that happens to be in some of the states in the south, where they're a little prudish, or try to act like they're prudish, even though, you know, you know, the Dirty South. But anyway,
Dr. Tiffany
come on.
Dr. Karen
But, you know, this is where, like you're saying the social determinants of health, that education where people live, and where they're educated, where they work, it all comes to bear when it comes to health. So we talk all the time about how to fix these things, how to change these things, but you know, how do you go back and change somebody's sexual education? Like, you know, how far back do you need to go? Why aren't the parents have these conversations with their children, right? Like, when Ashley started, like having little buds, I was like, okay, child time to sit down, we've got to have a convo. And she reminded me, I actually took her to go get a little bra and panty set, and like we talked about stuff, you know, I don't remember this. I tell you, I blocked stuff out.
Dr. Zanetta
You blocked that out
Dr. Karen
Not trying to have this convo.
Dr. Zanetta
It's done. It's the trauma
Dr. Karen
Yeah. But you know, I, I made it clear, look if you ever want to be sexually active, let's have a conversation, I want to make sure you're protecting yourself, we can get you birth control, whatever it is, and protect yourself from sexually transmitted diseases. And we've had a previous podcast, it's probably almost- not a year ago. It was when we first started those like sometime in June maybe, where we did a podcast on the HPV vaccine that you would have,
Dr. Zanetta
I think I that was like our first or second. It was very early on. Yeah,
Dr. Karen
Very, very early on. So hopefully, folks will check that back out. But, you know, that vaccine is against one of the particular strains- there are over 100 different types of HPV strains. And there are several, though, that we know are more carcinogenic. But what's fascinating, again, to your point, Tiffany, that does it is intercourse, but their skin to skin.
Dr. Zanetta
And that's an important point,
Dr. Karen
It's important point. And this is why when you look at sub groups of women who have cervical cancer, you look at lesbian or bisexual where they actually have a really high risk of developing cervical cancer or dying of it, because oftentimes, it's not taught that skin to skin or oral, you know, kind of sex can actually lead to these infections as well. And again, this is a preventable sexually transmitted disease, you know, that can be prevented through measures that, you know, certainly abstinence, but even just protecting yourself using condoms or dental dams and that sort of stuff, but then also making sure that you get screened regularly. Right.
Dr. Zanetta
And vaccination.
Dr. Karen
Yeah, vaccination and screening. So
Dr. Tiffany
And here was a fascinating point. And I was like, I'm not gonna tell Karen. But I'ma tell you anyway, I was like, I sound like Karen in my head now. I was like, Oh, God.
Dr. Karen
YASSS
Dr. Tiffany
Karen is rubbing off on me. I don't know how to feel about this. So look, check this out, there was a part of the article right, you know, because there are funds for most for the states, there are funds for pap smears.
Dr. Karen
Right, the BCCCP program.
Dr. Tiffany
Exactly. So I saw it in my mind again, okay, well, but you know, cervical cancer screening pap smears are paid for? Well, what they pointed out in the article was when you find high risk lesions that require Colpo, right, colposcopy, which is like, getting a better look at the cervix so they can look for changes and get biopsies and cells and in some situations, depending on what the lesion is, you might need like repeat Colpos or you know, follow up in that way. But that's not covered. And I'm like why does that make any sense?
Like "what the heck?" Correct.
Dr. Karen
I mean so why are we finding this stuff if then you can't get it covered. And then I said, Oh, I sound like Karen. And then I said, I'm not saying anything
Dr. Zanetta
These are all conversations that you're having with yourself
Dr. Tiffany
These conversations are going on in my head with myself.
Dr. Karen
With herself
Dr. Zanetta
What am I saying next?
Dr. Tiffany
Right, right, which
Dr. Zanetta
I don't agree with Myself,
Dr. Karen
We have to take a break, we'll be right back. Like what you hear. Make sure you rate and subscribe. 3 Black Docs is available wherever you get your podcasts
Dr. Tiffany
But really, you know, and so you start to kind of dig into this and you're like, well, this is this is messed up. Because really, those are the steps. the steps are: get vaccinated as a kid, right 11 or 12, before you get an exposure at that age is to deal with this. And then have your screenings, which are pap smears. And you know, at some points looking for HPV itself; Which is the same procedure as your pap smear. So it's not an extra thing. It's just another test they get when they're out there scraping stuff.
Dr. Karen
Wow.
Dr. Zanetta
Scraping? Sounds so, traumatic.
Dr. Karen
Wow.
Dr. Tiffany
Come on. We've all had them.
Dr. Zanetta
You said scraped..
Dr. Karen
but that's why colonoscopy it is easier
No its not, but anyway, go ahead.
Dr. Tiffany
Anyway, um, nobody asked but this is fine
Dr. Zanetta
You're disagreeing with yourself again.
Dr. Karen
Oh, there you go. You were talking about the Colpo
Dr. Tiffany
Then when you find a lesion. Right. So you know, if you get a pap smear and then find a lesion that needs follow up, then you have to have the
Dr. Zanetta
A lesion is just any abnormal area. Right.
Dr. Karen
So I wanted to explain that a little bit,
Dr. Tiffany
So if that's not covered, then there is a big gap.
Dr. Karen
But this is why even with lung cancer, or even with colorectal cancer screening, it was a big deal for me when I was in North Carolina to say I refuse to do a lot of education around the importance of screening, unless we have a mechanism for people to get screened. And then go on to diagnostic testing, should it be required, right? It's important to make sure there's holistic medicine, because what's the point of telling somebody they have something that may be cancerous? give them that information? And then what? And then what they're, they're non compliant? Is that what you're going to label them non compliant? "Oh well they knew they had a lesion" Right?
Dr. Tiffany
Yes.
Dr. Karen
Anyway, that's a whole other issue. But I do want to talk a little bit about, you know, you talked about the cervical cancer screening. So that's the Pap test, right? That's what the Papanicolaou?
Dr. Zanetta
Papanicolaou
Dr. Karen
It's been around for more than 50 years now. And this test is where, during the time when a woman has her routine, vaginal exam, they go in, they take a few cells, and they make a slide out of it and look at it under the microscope. And there are a couple of things that can be observed that are atypical. so Zanetta had mentioned that, you know, or it was describing when Tiffany said a lesion, a lesion does something that looks abnormal. The abnormalities that they see on the microscope, are essentially, you could have high grade what is it called?
Dr. Zanetta
dysplasia?
Dr. Karen
Yeah. Hi. What's it called? SIL- What does HSIL stand for? Has it been that long?
Dr. Tiffany
Squamous Intraepithelial Neoplasia
Dr. Karen
Go girl!
Dr. Zanetta
She got her CME
Dr. Karen
I love it. I love it. Yes, you're absolutely right. Seriously, I don't remember those things
Dr. Zanetta
Look, it's been a minute...
Dr. Tiffany
As you were
Dr. Karen
You're right. So there's a squamous intraepithelial lesion. And you can either have a high grade or a low grade, the low grade has to be followed kind of less frequently, but the high grades can actually be suggestive of the development of possibility of developing cancer. So it needs to be watched. And then if they see it again, then that's when you go to colpo and you may need to get other things done and procedures. And so what what Dr. Tiff is talking about is the fact that you know, the BCCCP program so BCCCP is essentially a government program run through the CDC. That is the Breast and Cervical Cancer Control Program. So that's BCCCP, that's what BCCCP stands for. And they did the same thing with with breast cancer to where they will cover the screening. But here's the caveat, though Tiff, with breast cancer, if there's a cancer that's found, patients are then eligible for emergency Medicaid.
Dr. Tiffany
Right
Dr. Karen
Right? But they have to have a cancer that's found.
Dr. Tiffany
That's right.
Dr. Karen
And so to your point, if you're trying to prevent cancer, or cancer by doing the colpos and doing that kind of stuff
Dr. Zanetta
Wait....so even if you have something that is a high grade dysplasia because it's not... *gasp*
Dr. Tiffany
it's crazy.
Dr. Karen
It's not cancer
Dr. Zanetta
I am shocked and appalled.
Dr. Tiffany
I was shocked and appalled. Then I thought to myself, has Karen me right this whole time.
Dr. Karen
Were you shocked by that??
Dr. Zanetta
that can't be true. Wow.
Dr. Karen
Wowness.
Dr. Zanetta
Oh my goodness.
Dr. Karen
I know you're not shocked says the same thing with colonoscopy
Dr. Zanetta
I know it is but still
Dr. Karen
Cause colonoscopy if you do a screening colonoscopy and they find a polyp and they remove the polyp because it's cancerous, and then it becomes a diagnostic that is no longer covered. Right?
Dr. Tiffany
It boggles the mind.
Dr. Karen
boggles. boggles
Dr. Tiffany
It really does boggle the mind
Dr. Zanetta
I am in a state of consternation. This is I- I really am. Guys, I was like, what we gonna talk about with cervical cancer. That's really what I was thinking. I was I was like, What can we talk about that we hadn't talked about already? But oh, my goodness, this is terrible.
Dr. Karen
Policy implications
Dr. Tiffany
It's a problem. this is really a big problem.
Dr. Karen
Yes.
Dr. Tiffany
Because this is one of the few times when we can find high grade lesions that are not yet cancerous
Dr. Zanetta
You can fix it
Dr. Tiffany
This is not a situation of finding an early stage cancer, and finding it early. And curing. This is like finding cell cells on the way to becoming cancer is, right, which is a whole other ballgame.
Dr. Karen
Prevention. And guess who has the highest risk of developing cervical cancer? Guess which race or ethnic group? It's Blacks, and Hispanics. Now Hispanics have a very high risk. And a lot of it again, has to do with education, Tiff. So you're right on point, right. So remember, we have a growing immigrant population that's Latinx. And so they're not necessarily as familiar with the health care system in the United States. But even amongst Latinx populations that have been in the United States for a while, there's still some education that needs to be done, because a lot of this is related to socioeconomic status. To your point, the individuals who live in poverty, tend to have less education, but also don't have the same amount of access. And so when you look at it, the people who are developing cervical cancer tend to be the black and brown people, so Black Americans and Latinx Americans. But once again, guess who's dying at much higher rates? Yeah, it's black people. Right?
Dr. Tiffany
And so here's, here's the thing, too. So again, they can find lesions before they're even cancerous. But then if they diagnose cancer, stage one, the five year survival rate is, you know, over 90%, around 95%, stage four or five year survival rate is 15%. So once again, is this idea of if you're going to have it catching it early access issues, or in this case, having the appropriate follow up for a precancerous lesion? Yeah, before, you know, but again, so this part, you know, so one of the main symptoms is bleeding, particularly with sex. if you have the cancer there,
Dr. Karen
but that means you already have a nodule
Dr. Tiffany
that means you already have it.
Dr. Zanetta
That's far along
Dr. Tiffany
So then the symptoms of like, you know, we've talked about this before, to have kind of being open and not so taboo with what's going on with your body
Dr. Zanetta
And being specific, right? How many people have said, "Oh, she has a female cancer," right?
Dr. Tiffany
Right.
Dr. Zanetta
What does that mean?
Dr. Tiffany
or something's going on?
Dr. Zanetta
Right? Like, oh yeah, just down there.
Dr. Karen
Right. But that also means that people need to have a primary care provider or someone is doing female exams, or who would be willing to so they have to have a rapport with a clinician, so that when they do have those experiences that they can say something, right? they may be less inclined to say something to a family member, or they may say something to a family member, and they'd be like, Oh, you just were have a rough sex and not necessarily bring it up. Look, I went to my annual physical exam. At the end of December, I had a list. I was like, Okay, I got this thing on my eye.
Dr. Zanetta
Alright with your list!
Dr. Karen
Literally I was, like I said, Here, I have two things that I'm not concerned about what I want you to take a look at. And I have two other things that I'm a little bit concerned about, because I'm in pain, right? So I had my list. And he did his little check and did everything. It was like, okay, you're going to see the eye doctor, I'm going to do tomorrow. But, you know, it was great. I could I could tell him all the things that may not have been a concern. So similarly, if somebody had had a rapport with a doctor, they could say, you know, I've been having a little bit of bleeding, you know, after intercourse Is that normal? Just that simple. That simple. And you don't have to be afraid to say that now. Here's the thing. Tiffany mentioned early stage cervical cancer, and the treatment for early stage Cervical Cancer is usually a hysterectomy. Okay, so taking the uterus out all right. One of the challenges for black and brown women is sometimes they get cervical cancer at much earlier ages. And so they may still be interested in having children. And so, you know, if you say, well, you can take the uterus out, people get nervous about that they want to keep their uterus. But I tell you, there are other alternatives, hence the reason to find things early or to prevent. Because if things are small enough, they may be able to go and do an extension, just, you know, take out the tumor with a margin around to allow you to retain your uterus so that you could, you know, complete your family. So this is why it's important to have knowledge, it's important to know that A. this is preventable by several means, including getting the Pap test, and if there's an abnormality going and getting that followed up on, but part of it is to preserve your parts, you know.Hysterectomy is a big deal.
Dr. Zanetta
That's a big deal.
Dr. Tiffany
Yeah. Yeah. That's a great point. And I think the other thing, you know, again, as a mom with boys, is this is not just a girl issue, right? because HPV causes cancers is elsewhere. Head and neck, back of the throat anus. Yes.
Dr. Zanetta
Yeah You want those prevented?
Dr. Karen
Yeah. Yes, you do. Because the treatment is no joke, right?
Dr. Tiffany
Yes, yes. And so also with the boys is preventing cancers in them as well, and also preventing them from spreading, right?
Dr. Zanetta
They could spread HPV.
Dr. Tiffany
And so it's a recommendation for both boys and girls to be vaccinated. Again, early before they're they're exposed to HPV. So that's why the ages are what they are, like 11 to 12. I just wonder, and this is- I don't know what the uptake has been around the- and maybe you know, Karen - and what the uptake has been of the HPV vaccine in Black and brown communities. Have you read anything about that or... the reason, why I'll tell you where I'm going. I'm just I'm wondering if the whole everything that's going on right now around vaccination in terms of the Coronavirus, right. And all the stuff that's coming up with people kind of falling into one or two camps either being all in for the Coronavirus vaccine or totally against it. I just wonder how that will impact other vaccinations when we're out of the pandemic or if it will.
3 Black Docs is not intended as medical advice. All opinions our own. 3 Black Docs is produced by Winkz Productions. Make sure you rate and subscribe. 3 Black Docs is available wherever you get your podcasts.
Transcribed by https://otter.ai