Infectious Disease

COVID-19 exacerbates the variations in cervical most cancers within the Appalachian Mountains

March 04, 2021

3 min read

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Paskett does not report any relevant financial information.


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In the midst of the COVID-19 pandemic, people postpone care, let self-care strategies slip and fall back into unhealthy habits as they spend more time isolated and at home.

At Ohio State University, we see the potential long-term effects of COVID-19 every day. And at Ohio State University’s Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC) – we are particularly concerned about how the pandemic is driving the differences in cervical cancer in Appalachia, a region where rates are among the highest in the USA belong, could worsen.


Source: Shutterstock.

I hope that today, on HPV Awareness Day, we can not only draw attention to the global impact of the disease, but also focus on those populations who are fighting HPV due to the inequalities affecting health care across the world Burden the world, not receiving adequate support.

Electra Paskett, PhD

Electra Diane Paskett

I am co-director of the Cancer Control Program and Director of the Center for Cancer Health Justice at OSUCCC – James, where our work serves as a model for examining the elimination of disparities in cancer health. We use a team science approach to understand and intervene in issues that range from cancer prevention to screening to making sure people with cancer get the care they need.

Our research aims to prevent or reduce the burden of cancer through intervention strategies that we hope will change behavior and allow patients to take control of their own health. This is a particularly important target for populations who are typically underserved and do not have adequate access to health care.

To make significant changes in this area, investigators from OSUCCC – James and the University of Michigan launched the CARE program in 2003, the acronym for Community Awareness Resources and Education.

The initiative focuses on reducing the incidence and mortality of cervical cancer by addressing three main issues: HPV infection, early detection of cervical cancer, and smoking cessation.

Cervical cancer rates are higher in Appalachian, Ohio, Kentucky, West Virginia, and Virginia than the rest of the United States. In this population we also see lower HPV vaccination and screening rates, as well as higher smoking rates.

The Appalachian region suffers from geographic isolation, above-average poverty rates, low household incomes, and below-average education levels, making it a prime area for misinformation, limited access to health care, and unhealthy behaviors such as tobacco use.

The research of the CARE program is based on four basic principles:

  • the social determinants of the health framework;
  • community-based participatory research;
  • Multilevel framework (as we like to say: “From cells to society”); and
  • a transdisciplinary team of researchers and community members.

Studies are conducted in community settings that represent the underserved female population in the area. The studies benefit from the advisory boards, community partners and participating clinics of the OSU Center for Cancer Health Equity.

The third phase of the program, CARE 3, which began in 2018, will initiate clinic-specific implementation plans in four states to address three areas of cervical cancer prevention: tobacco use, HPV vaccination, and early detection of cervical cancer.

The populations we work with have their own barriers and solutions. Therefore, we use a tiered approach in our work.

We target local health systems by setting up automatic reminder and follow-up systems. We teach providers what to do. how to assess smoking, offer screening and vaccination; and how to deal with hesitation. We provide culturally appropriate materials to patients that answer many of their questions and address concerns about smoking cessation, vaccine, and screenings.

Many of the reasons for non-compliance can be traced back to a lack of funding in communities like those in Appalachia. Over the past year, the COVID-19 pandemic has exacerbated these challenges.

COVID has also caused people to pay less attention to recommended screening and vaccination and to increase smoking. Both factors are elevated in Appalachian Mountains, where vaccination rates are lower, screening numbers are low, and smoking rates are high. Any of these factors can lead to a higher rate of cervical cancer in the years to come.

And regardless of COVID, many people in these regions still don’t know that the HPV vaccine can be given to both men and women between the ages of 9 and 45.

With the development of an effective vaccination and our continued understanding of the risk factors and prevention methods for cervical cancer, we are making progress in our fight against the disease in places like Appalachia. However, as is currently the case in many medical fields, the tangential effects of the pandemic could set back the advances we have made.

As we recognize HPV Awareness Day, I hope that we consider populations as we see them in our CARE program and remember that the advances we have made on cancer death rates should lead to better outcomes for all , not just for those who live in our own communities.

At OSUCCC – James, we are calling on other health systems to rise to this challenge and use their resources to improve outcomes for patients and community members living in underserved and vulnerable areas. Together we can make progress towards a cancer-free world for all people.

For more informations:

Electra D.Jannes Paskett, PhD, can be reached at [email protected].


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