Cervical-cancer screening declined in pandemic, UK study finds

A Pap test (Photo by Rabizo, iStock/Getty Images Plus)

By Elizabeth Chapin

University of Kentucky

New research at the University of Kentucky reveals concerning declines in cervical cancer screening rates among women in the U.S. during the Covid-19 pandemic, especially in rural areas.

The study, led by UK Markey Cancer Center researcher Ty Borders, analyzed nationally representative survey data from the National Cancer Institute to examine Pap test screening rates before and during the pandemic. A Pap test (or Pap smear) is a screening method that can detect cervical cancer or cell changes that may lead to cervical cancer, allowing for early detection and treatment.

The analysis showed that the odds of a woman receiving a Pap test in the past year were 30% lower in 2022 compared to 2019, before the pandemic began.
research published in JAMA Network Open 

The substantial decline is concerning, given that cervical cancer is largely preventable with regular screening and early intervention says Borders, a professor in the UK College of Nursing and director of the Rural and Underserved Health Research Center.

The study also found increased disparities in screening rates between rural and urban women. In 2022, only 48.6% of rural women reported receiving a Pap test in the past year, compared to 64% of urban women.

Women from rural areas have historically had higher rates of cervical cancer incidence and mortality, so a widening urban-rural gap in screening during the pandemic is particularly troubling, Borders says.

“The findings point to a need to expand access to cervical cancer screenings among all women, but especially those residing in rural areas, to prevent a possible uptick in future cervical cancer incidence and mortality,” said Borders.

Disruptions to health care services during Covid-19 lockdowns likely contributed to the declines in screening, as many clinics temporarily suspended or scaled back routine procedures like Pap tests.

Based on the results, health care providers may want to consider extra measures to ensure patients are up to date with recommended screenings, including expanding the availability of appointments for cervical cancer screenings and reminding patients of screening due dates.

The research was published in JAMA Network Open, a publication of the American Medical Association. 

UK hosts national meeting to raise immunization rate for vaccine against cervical and other HPV cancers, in which Ky. leads U.S.

Kentucky Department for Public Health illustration

By Melissa Patrick

Kentucky Health News

Kentucky leads the nation in the rate of cases of and deaths from cervical cancer, a disease that is largely preventable by a vaccine.

The vaccine targets the human papillomavirus, which can cause cancers of the cervix, genitals, anus, neck and head. Kentucky also leads the nation in cancers caused by the HPV.

"The good news is that the HPV vaccine can prevent the vast majority of those cancers, but not everybody knows about it," said Pamela Hull, associate director of population science and community impact for the University of Kentucky's Markey Cancer Center. 

Between the HPV vaccine and cervical screening, cervical cancer could be virtually eliminated, Hull said. The combination wouldn't prevent all cases, she said, but "Within the next few decades, we can eliminate cervical cancer as a public-health threat in this country." 

Cervical cancer screening is done through a pap smear, which looks for cancerous cells on the cervix, which connects the uterus and vagina. It can also find precancerous changes that have not yet developed into cancer. Screenings usually begin at age 21 or three years after the first sexual intercourse.

The HPV vaccine protects against six cancers: cervical, anal, penile, vaginal, vulvar and head or neck. According to the Centers for Disease Control and Prevention, it can prevent over 90% of sexually transmitted cancers caused by the HPV from ever developing, 

Hull said these cancers cause 36,000 new cancer cases every year in the U.S. in men and women, but only about half of Kentucky teenagers have received it because state law does not require it.

The vaccine's greatest obstacle appears to be that that it is associated with a sexually transmitted disease. Researchers have said improving the vaccination rate depands on changing the perception that the vaccine is something that prevents STDs to the knowledge that it primarily prevents cancer.

Conference discusses anti-HPV strategies

Raising awareness about the importance of HPV vaccination was the focus of a national conference held in Lexington on April 16-17 by the Markey center and the National Cancer Institute. 

Hull, who spke with reporters before the conference, said researchers all over the country are collectively working to answer this question: "How can we work with health-care providers and community organizations and parents to make sure more and more kids get vaccinated to protect them from cancer as they grow older?" 

A "social organization" program called "Operation WIPE OUT Cervical Cancer Alabama" aims to do just that through a program that involves a number of community partners, Isabel Scarinci of the University of Alabama at Birmingham told attendees at the conference in Lexington. 

Scarinci said the program first engaged the support of the Rotary Club of Birmingham and the state health department. Together, they launched a program to increase HPV vaccination rates in the Alabama county that had the highest rates of cervical cancer in the state.

She said through the involvement of groups in the county and the local school superintendent, they started an education program in the school system that resulted in the students organizing an HPV vaccination campaign, which has become part of an official plan for the state. 

Scarinci said there is no official funding for the program because they "want this to belong to everybody." Thus, funding comes from a number of sources. 

According to a post on the Alabama health department website, the program offers free HPV immunizations for children and adults; provides free cervical cancer screenings for low-income and uninsured women; and provides follow-up tests for those who need it. All services are offered through county health departments.   

HPV vaccines and Kentucky

While the HPV vaccine is not required in Kentucky, it is given around the time students enter middle school and are required to get an initial vaccine for meningitis and a booster for diphtheria, tetanus and pertussis (more commonly known as whooping cough), collecitvely called TDaP.

The timing of the two required vaccines and the HPV vaccine create a good opportunity to include it in the children's immunizations. "Even though it's not required," Hull said, "we really, really strongly encourage it because it's one tool that parents can use to prevent cancer for their children."  

Two doses of the HPV vaccine are recommended for all 11- and 12-year-olds, but the series can begin at 9. It is also recommended for those 13 to 26 if unvaccinated; three doses are recommended for people who get their first dose at 15 or later, and for people with certain conditions that weaken immunity.

In addition, it is also recommended that anyone between 27 and 45 who is not vaccinated should talk to their health-care provider about their risk of infection and the benefits of getting vaccinated.

Asked why boys and girls as young as 9 should get the vaccine, Hull said they have a better immune response than older chuildren. As a person gets older, she said, they need an extra dose of the vaccine for protection against the cancers because it takes more of the vaccine to build up their immunity.

"We really want to see our rates of HPV vaccination go up in Kentucky," Hull said. "Right now, just over half of teenagers have gotten the vaccine, all the doses of the vaccine, and we really want to get that up to, closer to, 80% or even higher." 

In 2022, Kentucky ranked 44th in HPV vaccination, with only 55% of teens 13-17 having received all recommended doses, according to America's Health Rankings. That was a decline from the 57% reported in 2021 and well below the national average of 63%.

"What I like to explain to a parent is . . . you're not going to put your seatbelt on after you get in a car accident, you have to have it on before," Hull  said. "So age for the vaccine is really important to get it early, build up the body's defenses so then one day when the body is exposed to the virus, it is ready to fight it." 

Hull said there is an emphasis on getting more people vaccinated in rural areas because HPV vaccination rates are lower in rural areas, and they have higher rates of HPV cancers.

UK gets $11 million grant to decrease cervical cancer in Eastern Ky. with focus on risks: smoking, HPV and low rates of screening

The University of Kentucky has been awarded a five year, $11 million grant to work toward reducing the rates of cervical cancer in Eastern Kentucky, a region that has some of the highest rates of incidence and deaths from it in the nation.

The research will address three of the risk factors that contribute to these high rates -- smoking, the human papillomavirus (HPV) and low rates of cervical-cancer screenings among women in the region, according to the news release.

The first project in the program will work to reduce smoking among women in rural communities through various interventions, including strategies to help women who are not quite ready to quit, the lead investigator of this project told Alex Acquisto of the Lexington Herald-Leader.

"Instead of ignoring the smokers who are not ready to quit today, we're going to work with them anyway," said Jessica Burris, an assistant professor of psychology and a member of UK's Markey Cancer Prevention Control Program.

Eastern Kentucky has some of the highest rates of smoking in the nation, which contributes to its likewise high rates of cervical cancer. Smoking not only causes cancer almost anywhere in the body, it can also block your body from fighting it once you have it, says the federal Centers for Disease Control and Prevention. And women who smoke are about twice as likely as non-smokers to get cervical cancer, according to the American Cancer Society.

Mark Dignan, professor in the UK College of Medicine and co-leader of the Markey Cancer Prevention and Control Program, will lead two projects that focus on the human papillomavirus, or HPV, which the CDC attributes to 90 percent of all cervical cancers.

"We really shouldn't have cervical cancer," Dignan told Acquisto. "We know what causes it, we can detect it, and we can treat it." It is the only cancer for which there is a vaccine, but Kentucky's children are among the least vaccinated for HPV, one of the most common sexually transmitted diseases.

The grant will fund a project to improve HPV vaccination rates among people between 11 and 26. The other will mail HPV self-testing kits to women in the region who are not being screened for cervical cancer or are "underscreened."

In addition to cervical cancer, HPV can also cause cancers in the vagina, vulva, penis, anus, rectum and the back of the tongue and throat. Among these cancers caused by HPV, more than 90% could be prevented by the vaccine, according to the CDC.

Burris and Dignan told Acquisto that they expect around 70,000 Kentuckians to be impacted by their project, which is scheduled to start in a couple of months.

The project is funded by the National Cancer Institute and involves a collaboration by the Markey center with Ohio State University, the University of Virginia and West Virginia University. It will involve 10 health systems in Appalachia, including two in Kentucky: Big Sandy Health Care, which operates seven clinics in Eastern Kentucky, and Juniper Health, which has locations in Wolfe, Lee, Breathitt and Morgan counties.

Ky. children among least vaccinated for cancer causing human papillomavirus; state has highest rate of HPV-related cancers

Did you know there's a vaccine that can prevent certain types of cancer? Many Kentuckians don't know. As part of a statewide effort to educate them, a Bardstown woman told her story to a group in Louisville about being told at age 30 that she would have to have her uterus removed because she had cancer of the cervix, Darla Carter reports for Insider Louisville.

Jessica Saxe, a Kentucky mother who was diagnosed with
cervical cancer at age 30, promotes the HPV vaccine.
(Saxe provided this family photo to Insider Louisville.)

Jessica Saxe told those attending the Louisville event that her son, Charlie, was 9 months old at the time of her diagnosis. She recalled thinking, “I don’t know if I’m going to live to see him walk. … I don’t know if he will remember me,” her voice breaking. “That was the hardest part as a mother, knowing that I might not be able to be there for my son.”

Charlie is now 6. Carter reports that Saxe has since become an advocate for encouraging others to get vaccinated against the sexually transmitted human papillomavirus, often referred to as HPV.

She was speaking at an event sponsored by the American Cancer Society, along with the Kentucky Department for Public Health and others, to promote HPV vaccines, which are effective in preventing cervical cancer and genital warts. They will be traveling around the state over the next few months to promote the life-saving vaccine.

HPV is one of the most common sexually transmitted diseases, and Kentucky's children are among the least vaccinated for it. HPV can cause cancers in the cervix, vagina, vulva, penis, anus, rectum and the back of the tongue and throat. Among these cancers caused by HPV, more than 90 percent could be prevented by the vaccine, according to the Centers for Disease Control and Prevention.

“Kentucky has the highest cancer burden for HPV-related cancers in the nation, so morally we have to” take action, Elizabeth Holtsclaw, the state and primary-care systems manager for ACS, said at the event. She said the goal of their outreach is to increase vaccine rates by 8% in the next 12 months.

In 2017, about 38% of Kentucky youths 13 to 17 were up-to-date on HPV vaccinations, meaning they’d received the full series of doses, according to the CDC, which is providing funding for the meetings. That was up from 34% in 2016 but well below the U.S. rate of nearly 49%.

The HPV vaccine is recommended for girls and women starting around age 11 until 26. For boys, it’s recommended starting at age 13 until 21. Until 12, children receive two doses of the vaccine at least six months apart. Those 15 and older get three doses. The earlier the vaccine is given, the better the immune response. It is important to note that the vaccine is the only one known to prevent any form of cancer.

The vaccine is proven to be a safe and effective way to protect against the HPV virus, but can be a tricky sell to parents, Carter reports. “Part of it is nobody wants to admit that this 12-year-old is ever going to have sex, which is a fantasy,” Connie White, senior deputy commissioner of the health department, said at the event.

Another contributor to the state's low HPV vaccination rate is that health-care providers don't seem to be promoting it strongly enough, Carter reports. Studies show a "clear, same-day recommendation" from a physician to a parent is the most important factor in whether a child gets vaccinated or not. That also means doctors must carry the vaccine in their offices, but many don't. The vaccine is not on the list that must be administered to incoming students or sixth graders.

“Somehow, we are treating the HPV vaccine as an ‘other’,” Holtsclaw said at the event. “Whether it’s because it’s not mandatory, we don’t know. But other states are doing all right without a mandate. … The doctor needs to feel comfortable and confident making that strong recommendation.”

Another reason for getting the vaccine when young is that it is supposed to be given before exposure to HPV, so ideally, before the person becomes sexually active, according to the CDC. “It’s a cancer vaccine; it’s not a sex vaccine,” Saxe said.

Saxe, who recently had a second child with the help of a surrogate, told the group that it’s critical for cancer survivors to share their stories to help persuade more people to get their children vaccinated and prevent other women from getting cervical cancer, Carter reports.

“We can stop this, but we can’t do it alone,” she said. “We need the doctors and the nurses and the pharmacists. We need the people in public health. We need policymakers. We need you guys to stand with us on this. We need you to make this a priority.”

In a state thick with cancer, leaders of screening and research organizations targeted for cuts make cases for state money

Mammograms are a screening for breast cancer. (WTVQ image)

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin's proposed budget for the next two fiscal years calls for cuts to five cancer research and prevention programs, including screenings for breast, colon, cervical, lung and ovarian cancer, and for research on lung cancer, all of which plague the state.

The programs are included in a list of 70 that Bevin proposed to eliminate to save the state $85 million, or less than 1 percent of the overall budget. He has said these cuts are necessary to help fund the state's ailing pension system.

Dr. Whitney Jones, a Louisville gastroenterologist and founder of the Kentucky Cancer Foundation, which provides funds for colon-cancer screening, said he recognizes the challenges of balancing a state budget, but hopes the state will reconsider eliminating the colon cancer screening and prevention program. He said of Bevin, "We hope this is just his first position."

Jones, who also founded the Colon Cancer Prevention Project in Louisville, called the state's improvement from 49th to 19th for colo-rectal screening in the past 15 years, "the best public health story" in Kentucky.

He added that this was only possible because the state offered screenings to uninsured and under-insured Kentuckians, expanded Medicaid to those who earn up to 138 percent of the federal poverty level, and has a unique, multi-partner screening program -- all of which he said makes Kentucky "the envy of most states in the nation."

But he also said there is still work to be done, because Kentucky still leads the nation in colon cancer and remains in the top 10 for colon-cancer deaths.

Doug Hogan, a spokesman for the state Cabinet for Health and Family Services, said the state's screening programs, including those for colon, breast and cervical cancer, are no longer needed because they are now covered by all insurance plans with no deductibles or co-payments.

Jones acknowledged that the program needs to be restructured because of the Medicaid expansion, but argues that it is still necessary for several reasons. He said Kentucky still has a large number of people without health insurance; the federal law that requires almost all Americans to have insurance or pay a tax penalty will be repealed at the end of the year; the coming work requirements and premiums in Medicaid will lead to some people going without coverage; and there will be a continuing need for education and outreach about cancer and screening.

"There has to be a better way to cut out the bad and support or maintain the good," Jones said. "And I would just suggest that the Kentucky Colon Cancer Screening Program is the baby, and not the bathwater."

Lung cancer research targeted in a state that has the most of it

Another program set to lose about $5 million is the Lung Cancer Research Grant Program, a collaboration between the University of Kentucky and University of Louisville that is funded by funds from states' 1998 settlement with cigarette manufacturers. UK's portion is $2.4 million, spokesman Jay Blanton said.

Dr. Mark Evers of UK's Markey Cancer Institute said this statewide initiative seeds a number of pilot projects and "spans the gamut" from new lung-cancer therapies and treatments to new clinical trials and prevention strategies, such as lung-cancer screening. He said such pilot programs are often used to help get larger grants from the National Institutes of Health and other sources.

Evers noted that the Kentucky Lung Cancer Education Awareness Detection Survivorship Collaborative (the Kentucky LEADS Collaborative for short), now funded by a $7 million Bristol-Myers Squibb Foundation grant, is a great example of how a pilot project from this research grant program was able to get a larger grant to further its work.

"It really is a valuable mechanism for us to provide pilot funding for investigators to get the initial data so that they can carry that forward in larger extramural grants," Evers said.

He also noted that the research grant program is responsible for the Kentucky Clinical Trials Network, which he described as another joint venture with U of L that "pushes out" clinical trials for lung cancer, which have been conducted in about 90 percent of Kentucky's counties.

Asked if the program could survive without the state funding, Blanton, who sat in on the telephone interview with Evers, said, "We're just trying to get our arms around the numbers right now."

Asked why the program is important, Evers pointed to the state's high smoking rate, second in the nation, and its No. 1 rank in number of lung-cancer cases. "We've got a terrible problem with this in the state," Evers said.

When Kentucky researchers made a pitch to the National Cancer Institute, Evers said, "The first words out of their mouth were, 'What are you guys doing about your smoking problem?' So, it's really incumbent upon us to be able to have the resources to attack this by screening, prevention and treatment."

While Kentucky LEADS is on Bevin's list of programs that would get no state funding in the next two fiscal years, it has never received any, said Jamie Studts, a UK professor of behavioral science and the lead investigator for the collaborative. He said it had been slated to get $10,000 in each year of the current budget, but that Bevin had "red-lined" the allocation.

Studts said that the cut "doesn't directly affect us in terms of dollars, but indirectly it does send a message that the governor and this administration is not interested in making those kinds of efforts to address Kentucky's burden of lung cancer."

Breast and cervical cancer: state squeezes local health departments

As for the screening programs for breast and cervical cancer, Hogan said that in addition to these screenings now being covered by insurance, they are also operated by federal funds, so elimination of any state funds would not impact them.

Allison Adams, president of the Kentucky Health Department Association, said that while it's true that the breast and cervical screening programs have not received any state dollars for several years and get some federal funds, most of their funding for these programs come from local tax dollars.

For example, she said that in the fiscal year that ended in June 2017, local health departments received about $607,000 in federal funding for breast and cervical cancer screening, and the rest came from $2.3 million in local dollars. The programs serve about 20,000 patients a year.

Adams said the real challenge for health departments to continue such programs, or any of the other initiatives that involves direct patient care, is that Bevin's budget has added $38.5 million to their annual pension liability. She said that will force the departments to provide programs that focus on overall health, safety and prevention and look for ways to spend $1 to affect 10 people, instead of $10 to affect one.

"Local health departments need to be working on the prevention piece, and less on the treatment and intervention," Adams said, but they "will have to do their own prioritization and determine which programs have the absolute most health benefit for all of Kentuckians. We really have to make some tough decisions of where we are going to spend our money that's going to have the greater impact over the health of Kentucky."

The Ovarian Cancer Screening Program is also slated to be cut. Linda Blackford of the Lexington Herald-Leader reports that this UK program offers free vaginal ultrasound screenings to women for ovarian cancer and has provided nearly 50,000 free screenings since its creation 30 years ago.

Blackford notes that the Pediatric Cancer Research Trust Fund, established in 2015 by Sen. Max Wise, R-Campbellsville, has been approved to receive $2.5 million in each year of the biennium to fund pediatric brain cancer research at UK and U of L. Bevin's budget calls for each of the universities to provide a minimum of $1.2 million a year for the program.

Bevin's budget boosts efforts against opioid abuse but would cut several health programs, including poison control center

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — Gov. Matt Bevin's proposed budget would boost programs that fight substance-use disorders and the state's over-burdened social-services system, but calls for cuts to other health-related programs, including the state's only poison control center and one that trains doctors in rural parts of the state.

Bevin's proposal to the General Assembly calls for an additional $34 million to fight the opioid epidemic, with a focus on helping pregnant women addicted to drugs. It also includes $24 million to hire more social workers and give raises to those already employed.

Medicaid, which covers about one-third of the state's population, is the state's largest health expense. The governor's budget recommendation for Medicaid is around $11.5 billion in the first year and $11.8 billion in the second year, mostly from federal funds. The Kentucky Hospital Association told Kentucky Health News that it was pleased with the numbers.

"It looked like there was just a minimal reduction so we were pleased that the budget maintained the funding for Medicaid," said Nancy Galvagni, senior vice president of the association. "We understand from talking with people at the Cabinet [for Health and Family Services] that they consider it funded going forward."

Administration officials told reporters at a Jan. 17 budget briefing that the Medicaid budget had been included in the governor's across-the-board 6.25 percent cuts, but the cut was taken from the projected need of the Medicaid program, not current funding.

The governor also proposed that 70 state programs lose all of their funding, with a projected savings of $85 million a year. At least nine of them related to health. Some haven't received state funding in recent years, but others have depended on it.

One of those is Norton Kosair Children's Hospital Poison Control Center, which is the state's only poison control center, serving all 120 counties. It received $729,000 in each of the past two fiscal years from the state, Joe Sonka reports for Insider Louisville.

Maggie Roetker, a spokeswoman for Norton Healthcare, told Sonka that the funding amounts to 43 percent of the poison center's $1.7 million annual budget. She said the federal government provides $234,000 and Norton makes up the rest.

Sonka reports that according to the center's current service contract with the state, it fields about 70,000 callers a year; saves Kentuckians more than $10 million a year by keeping people out of emergency rooms; and saves Kentuckians $3 to $5 million per year by consulting with patients who are already hospitalized by a poison, which decreases the length of their stay.

Another program set to lose funding is Madisonville's Trover Clinic, for a program that allows medical students from the University of Louisville to complete the last two years of medical school in rural communities. The Kentucky Center for Economic Policy reports that this program is scheduled to receive $910,000 in the fiscal year that ends June 30.

Two other health-related programs on the governor's chopping block include the Lung Cancer Research Grants Program at U of L and the University of Kentucky, which is getting $5,176,100 in the current fiscal year and the Autism Training Center, now getting $119,300, according to KCEP.

The budget would "eliminate state funding for five cancer research or prevention programs, including . . . screening programs for colon, breast, cervical and ovarian cancer," Linda Blackford reports for the Lexington Herald-Leader. But it includes $2.5 million each year in new money for the Pediatric Cancer Research Trust Fund, for brain-cancer research at the two universities, which would have to each provide $1.2 million to match the state appropriation.

The fund was created in 2015 by Sen. Max Wise, R-Campbellsville, whose son Carter, now 10, had cancer when he was six months old. Wise said he and the universities asked for $9.8 million over two years. "It shouldn't be a competition, but unfortunately it is," Wise told Blackford. "We were not trying to play priorities or favorites."

The screening programs for breast and cervical cancer are operated with federal funds, so elimination of any state funds would not impact it, said Doug Hogan, spokesman for the Cabinet for Health and Family Services. Hogan said the colon-cancer screening program had not received state funds for several years.

"Health screenings for preventive services are covered by all insurance plans and there are no deductibles or co-pays," Hogan said. "That applies to various preventive screens including those for colon, breast and cervical cancers."

Jaimie Studts, professor of behavioral science at the UK College of Medicine, said the Kentucky Lung Cancer Education Awareness Detection Survivorship Collaborative, also called the Kentucky LEADS Collaborative, has never received any state funding. He said it was slated to get $10,000 in each year of the current budget, but Bevin "red-lined" the allocation, saying the health secretary would need to determine how best to spend that money.

Including the program among the list of 70 to be cut "doesn't directly affect us in terms of dollars," Studts said. "But indirectly it does send a message that the governor and this administration is not interested in making those kinds of efforts to address Kentucky's burden of lung cancer."

Some other health programs on the list hadn't received any funding from the state for the past several years: ARC of Kentucky, a group that supports people with intellectual and developmental disabilities, and Madison County Early Intervention Services. They were not scheduled to get any funding in the 2018 fiscal year, according to KCEP. It has published a list of programs proposed for elimination and the current appropriation for each.

Bevin says his cuts are necessary to fully fund the state's pension obligations, with his budget setting aside about $3.3 billion, or 15 percent of state spending, for that purpose.

Opponents of the governor's budget cuts are calling for raising new tax revenue through comprehensive tax reform, which the governor said could happen in 2018. However, his office said in his budget news release that "He is calling for genuine tax reform that will make Kentucky more competitive with its neighboring states -- not merely a bump in the sales tax or an increase in the cigarette tax."

Ky. teens still far below average in getting vaccine that prevents cervical cancer, a disease more common here than most states

By Melissa Patrick
Kentucky Health News

Fewer than half of Kentucky's teenagers are getting the human papillomavirus vaccine, which is known to prevent several cancers, including cervical cancer -- a disease for which Kentucky leads the nation.

A federal Centers for Disease Control and Prevention report, using data from the 2016 National Immunization Survey for teenagers, found that 48 percent of Kentucky's teens between 13 and 17 received one or more doses of the HPV vaccine, but only 34 percent completed the recommended series of doses. Both rates were lower than the national average.

Nationwide, the report found that 60.4 percent of teens received one or more doses of the vaccine in 2016, up from 56.1 percent in 2015; by the age of 17, 43.4 percent had received all recommended doses.

"For a state recognized for high rates of all HPV-related cancers, it's troubling to see HPV vaccination rates among our adolescents lag behind the rest of the country," Dr. Robin Vanderpool, an associate professor at the University of Kentucky College of Public Health, said in an e-mail to Kentucky Health News.

Vanderpool said requiring the vaccine for entry to school would boost the HPV vaccination rates in Kentucky, but she also recommended state and local approaches to improve parents' knowledge of HPV vaccination as cancer prevention -- as well as efforts to increase health-care provider recommendations of the vaccine, a major obstacle.

Experts at an immunization conference last year placed most of the blame for the poor rate of HPV vaccinations on physicians, citing studies that show a "clear, same-day recommendation" from a physician to a parent is the most important factor in whether a child gets vaccinated.

"Through population-level HPV vaccination coverage, a whole generation of Kentucky youth could be protected from ever developing cancer," Vanderpool said. "What a tremendous public health achievement Kentucky could be a part of!"

HPV causes more than 90 percent of anal and cervical cancers; 70 percent of vaginal, vulvar and middle-throat cancers; and more than 60 percent of penile cancers. And two of the HPV strains are associated with more than 90 percent of anal and genital warts.

The report says that every year, an estimated 31,500 newly diagnosed cancers in men and women are attributed to HPV, and approximately 90 percent could be prevented by the HPV vaccine, which protects against nine different strains. Kentucky ranks in the top 10 states for cervical cancer incidence, and the top 20 for deaths from it.

Another obstacle to vaccination is the need for more than one dose. New CDC guidelines recommend a two-dose series if given before the age of 15 and a three-dose series if given after 15. The vaccine is recommended between 11 and 12, but can be given to females up to 26 and males as old as 21.

HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through intimate skin-to-skin contact.

The report found that HPV vaccine is becoming more common among boys. Nationally, 65 percent of girls received the first dose of HPV vaccine in 2016, compared to 56 percent of boys, a 6 percent increase from 2015 for boys and about the same rate for girls. In Kentucky, 55 percent of girls received at least one dose of the HPV vaccine in 2016, compared to 42 percent of boys.

It also found that HPV vaccination rates were lower in rural areas (50.4 percent) compared to urban areas (65.9 percent).

The CDC news release says that since the introduction of the first HPV vaccine over 10 years ago, "infections with HPV types that cause most of these cancers and genital warts have decreased by 71 percent in teen girls and 61 percent in young women."

UK center promotes at-home test for colorectal cancer, reports on efforts to get young women vaccinated for cervical cancer

More people in Appalachian Kentucky die from colorectal cancer than in any other region of the state. A screening project of the Rural Cancer Prevention Center at the University of Kentucky is working to decrease those rates.

Cancer Registry maps show in color Kentucky counties served by the Appalachian Regional Commission,
and rates for invasive cancer and cancer mortality in Appalachian Kentucky and the balance of the state.

In July 2014, the center received a $3.75 million, five-year grant renewal from the federal Centers for Disease Control and Prevention for a colorectal cancer at-home screening prevention project in Central Appalachia and other rural areas. The UK Center is one of 26 CDC-funded Prevention Research Centers in the country.

Tom Collins, associate director of the RCPC, gave an update on its project at a Center for Clinical and Translational Science clinical research update meeting at UK Oct.18. Robin Vanderpool, associate professor in the College of Public Health, discussed the results and successes of its completed cervical-cancer screening project.

Early screening and prevention are key to surviving colorectal cancer. The CDC says that most deaths caused by colorectal cancer could be prevented if everyone over the age of 50 got screened. And if detected early, treatment for colorectal cancer is highly effective.

In 2013, the last year for which data is available, Kentucky ranked first in colon cancer and fourth in colon-cancer deaths, according to the Colon Cancer Prevention Project.

The project's title and motto is "I did FIT." FIT stands for fecal immunochemical test, an at-home test that allows a person to collect a small stool sample in the privacy of their home and mail it in a provided kit to the lab for testing. The FIT test must be done every year.

Since June 2015, the UK center has distributed more than 700 kits, with a 60 percent return rate in the eight-county Kentucky River Health District. Those with a positive test result, about one in six, have been offered a colonoscopy with follow-up; the rest have been invited to be part of the research, which is ongoing.

To help determine the best way to get people to do a yearly test, researchers divided the volunteer participants into two groups: one that gets social media and personal messages about it along with the traditional standard of care and another that gets standard of care alone. A year and a half remains in this portion of the research.

Cervical cancer and the HPV vaccine

Collins said they are trying to build on the success of the UK Center's previous prevention program for cervical cancer prevention and screening, called "1-2-3 Pap."

Prevention Research Center graphic; click on it to view a larger version

This UK center study promoted the human papillomavirus vaccination to prevent cervical cancer in Appalachia, which also has a higher incidence and mortality rate for cervical cancer than the rest of the state.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for all adolescent girls and boys 11 and 12 years old. It is approved for females between 9 and 26 and is nearly 100 percent effective in preventing pre-cancers and noninvasive cervical cancers caused by two strains of the virus.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.3 percent of boys aged 13-17 vaccinated as of 2014.

An earlier study of adult Appalachian women aged 18-26 that were offered the first HPV vaccination free found that 45.1 percent got the first dose, 13.8 percent got the second dose and only 4.5 percent got all three doses. This and other formative research prompted the UK Center to start a two-stage HPV vaccine promotion program for women aged 19-26 in the Kentucky River Health District.

First, researchers launched a marketing campaign to recruit the women in for the first dose. Then, participants were asked to participate in the study, which was designed to promote adherence to doses two and three. The volunteer participants were randomly separated into two groups; one participated in an informational video-based intervention that was made using local people along with the traditional standard of care; the other was offered standard of care alone.

The study found that 43.3 percent of the young women who watched the DVD completed the three-dose HPV vaccine series, while 31.9 percent of the women in the comparison group completed the series.

Vanderpool said the "take-home message" was that women were two and one-half times more likely to complete the series if they watched the DVD.

Since the completion of the study, 18 Kentucky health departments now use the DVD to promote completion of the three-dose HPV series, and it has also been adapted for use in North Carolina and West Virginia.

Kentucky leads the nation in cancer deaths, but falls short on policies to prevent cancer, especially when it comes to tobacco

Kentucky ranks first in deaths from cancer and has for several years, but falls short in its fight against cancer when it comes to supporting policies and passing legislation to prevent it, according to an American Cancer Society report released Aug. 11.

The latest edition of "How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality" found that Kentucky followed ACS policy recommendations in only two of the 10 issue areas ranked, and showed some progress in two areas, but fell short in six.

How Kentucky measures up.
Red: Falling short  Yellow: Some progress  Green: Doing Well

“We’ve made tremendous progress in the way we diagnose and treat cancer across the country. But to leverage this progress, Kentucky legislators must take advantage of the opportunities to pass evidence-based laws and policies that are proven to save lives and money,” Erica Palmer Smith, Kentucky government relations director at ACS, said in a news release.

The report used a color-coded system to rate states in 10 specific areas of public policy that can help fight cancer, including smoke-free laws, tobacco tax levels, funding for tobacco prevention and cessation programs, cessation coverage, funding for cancer screening programs under Medicaid and restricting indoor tanning to minors.

The report also looked at whether or not a state had increased access to health care by expanding Medicaid under federal health reform to people who earn up to 138 percent of the federal poverty level, had passed laws to increase patient quality of life, had passed laws to ensure oral chemotherapy drugs are covered by insurance the same as intravenous chemotherapy, and whether the state offered a well-balanced approach to pain medications.

Green shows that a state has adopted evidence-based policies and best practices; yellow indicates moderate movement toward the benchmark and red shows where states are falling short.

Kentucky fell short for all four tobacco policy measures in the report.

"Tobacco use remains the number one preventable cause of death, so Kentucky’s biggest opportunity to save lives and reduce health care costs starts with addressing the state’s current tobacco control policies," says the release.

The report found that Kentucky's cigarette tax, at 60 cents per pack, is less than 50 percent of the national average of $1.65 per pack. The report recommends increasing cigarette taxes by at least a $1 per pack, and then to use that money to pay for tobacco prevention and cessation program. It also recommends similar increases for all tobacco products.

"Evidence clearly shows that raising tobacco prices through regular and significant excise tax increases, encourages tobacco users to quit or cut back and helps prevent young people from ever starting to use tobacco," says the report.

Kentucky has also been unable to pass a comprehensive statewide smoke-free law and isn't likely to do so under the leadership of Republican Gov. Matt Bevin, who doesn't support a statewide ban on smoking, saying the issue should be decided locally.

That being said, about a third of Kentucky's population is covered by local comprehensive smoke-free policies, and another 10 percent or so live in places that have ordinances with varying exceptions. Kentucky has one of the nation's highest smoking rates, 26 percent.

American Cancer Society map; click on it for a larger image and a more readable legend

Two-thirds of Kentucky adults support a comprehensive statewide smoking ban, according to the latest Kentucky Health Issues Poll, and have since 2013.

"Smoke-free laws reduce exposure to secondhand smoke, encourage and increase quitting among current smokers and reduce health care, cleaning and lost productivity costs," says the report. "Smoke-free laws also reduce the incidence of cancer, heart disease and other conditions caused by smoking and exposure to tobacco smoke."

Kentucky's tobacco-cessation policies also fell short. The report noted that while all Medicaid programs offer some tobacco-cessation coverage, most have varying restrictions that create barriers, like limits on the length of time a person can use certain services.The report says such barriers reduce utilization.

In addition, the amount of money Kentucky spends on tobacco prevention and cessation programs is only 4.4 percent of the amount recommended by the federal Centers for Disease Control and Prevention. In 2016, Kentucky allocated $2.5 million for tobacco prevention; the CDC recommends the state spend $56.4 million.

"For every $20 Big Tobacco spends on marketing their deadly products, states spend just $1 on programs to reduce tobacco use and save lives," says the report. "States with sustained, well-funded prevention programs have cut youth smoking rates in half or even more, saving lives and reducing state health-care costs."

In Kentucky, high school smoking rates are 56 percent higher than nationwide, and the adult rate is 74 percent higher. The report blames that on lack of "statewide tobacco-control policies" and says the higher rates cost the state more than $2.7 billion a year in health-care costs.

Kentucky also fell short on its control of indoor tanning, ACS said. The report says Kentucky lawmakers missed out on an opportunity in 2016 to pass legislation to protect minors from the dangers of indoor tanning beds. A bill cleared the Senate Health and Welfare Committee, but wasn't heard in the Senate.

The other area in which the state fell short, in ACS's opinion, was state appropriations for breast and cervical cancer screening programs.

Kentucky scored best on policies that centered around access to care. The report said the state has made some progress with its cancer pain control and palliative care policies and was ranked as doing well in the areas of oral chemotherapy fairness and expanding access to care through Medicaid.

Ky. leads nation in cancers that are caused by a virus for which there is a vaccination, but most kids don't get the vaccinations

By Melissa Patrick
Kentucky Health News

Kentucky has the highest overall rate of cancers associated with the human papillomavirus, and among females is tied for highest with West Virginia, while at the same time falling in the bottom 10 states for vaccinations that can keep the virus from causing cancers, according to a federal Centers for Disease Control and Prevention report.

"Kentucky faces many challenges when it comes to encouraging parents, adolescents and providers to understand the importance of the HPV vaccine," Dr. Ardis Hoven, infectious-disease specialist for the  state Department for Public Health, said in an e-mail to Kentucky Health News.

Speakers at a recent HPV conference in Lexington placed most of the blame for the poor uptick of HPV vaccinations on physicians, because many of them still don't strongly recommend it. They cited a study showing that a "clear, same-day recommendation" from a physician to a parent is the most important factor in whether children get vaccinated.

The speakers offered several reasons for the lack of such recommendations: The vaccination isn't required by law, many physicians don't realize its importance, some falsely believe that it takes too much time to explain, and the vaccine treats diseases that pediatricians don't deal with. They also noted that the vaccine's greatest obstacle is that it is associated with a sexually transmitted disease.

“In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer,” Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center in Columbus, told HealthDay News. “Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe,”

HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through any skin-to-skin contact.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for 11- and 12-year-old boys and girls, though it can be given through age 26 for females and age 21 for males. It is recommended at an early age because adolescents have the best immune response to the vaccine, are more likely to keep coming in for annual visits and most are not yet sexually active and therefore not likely to have been exposed to the virus.

HPV infections cause more than 90 percent of anal and cervical cancers and 70 percent of vaginal, vulvar, penile and middle throat cancers, and two of the HPV strains are associated with more than 90 percent of anal and genital warts.

The CDC report found that there were almost 39,000 annual cases of HPV-related cancers in the country between 2008-12, a 16 percent increase from the previous five year period. Most of these cases were oral cancers in men and cervical cancers in women, 12.638 and 11,771 respectively.

The data showed that almost 80 percent of the cancers were caused by two strains of the virus that are covered by all of the commercially available vaccines and 10 percent were caused by five other HPV strains that are covered by the newer nine-valent vaccine.

In Kentucky, only 37.5 percent of its girls and 13.2 percent of its boys aged 13 to 17 were vaccinated as of 2014. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized, and vaccination coverage did not increase substantially from 2011 to 2014.

Hoven said that Kentucky is working to improve its HPV vaccination rates. She noted such efforts as its HPV initiative team, which has created a comprehensive statewide plan to prevent and control HPV infections; a statewide media campaign last summer to encourage parents to get their children vaccinated; ongoing outreach to universities and colleges about the need to immunize students; and a current survey of knowledge among teens and adults about the importance of HPV vaccinations.

The state health department "has taken up the challenge of improving vaccination rates in the state, and will continue this effort going forward," Hoven said.

There's a vaccine for young people that prevents cancer, but most of them don't get it because most doctors fail to recommend it

By Melissa Patrick
Kentucky Health News

The human papilloma virus vaccination is proven to prevent cervical cancer and genital warts, but many pediatricians and family doctors still don't strongly recommend it, and they need to do better.

That was the main message at an HPV conference in Lexington June 21, where more than 100 people, mostly health-care providers, came to learn about the cancer-causing virus and the under-utilized vaccine that prevents it.

Dr. Alix Casler, medical director of pediatrics at Orlando Health Physician Associates in Florida, stressed the importance of teaching everyone in a health-care organization about why HPV vaccinations are so important.

"Every year that we fail to reach our goal, there are thousands of children who are going to go on to develop cancer," Casler said. "It is one of the most lifesaving things we do," but because it isn't mandatory and the diseases that it causes aren't ones pediatricians deal with, it often falls to the bottom of providers' priorities, she said.

Studies show that a "clear recommendation" from a physician is the most important factor in whether children get the HPV vaccine. Casler noted that a 2013 survey found that 80 percent of mothers who received a same-day recommendation had their son or daughter vaccinated that day.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for 11- and 12-year-old boys and girls.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.2 percent of its boys aged 13 to 17 vaccinated as of 2014. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized, and vaccination coverage did not increase substantially from 2011 to 2014.

HPV is spreading. About 79 million people in the United States are infected with it, and about 14 million more become infected each year. It is estimated that half of these new infections occur in people 15 to 24 years old.

Though most HPV infections will clear up on their own, the most persistent strains of the virus are directly linked to 27,000 new cancers a year. About 30 women per day in the U.S. are diagnosed with cervical cancer caused by HPV, and every year, there are about 324,000 new cases of genital warts caused by the virus.

Lois Ramondetta, a gynecologic oncologist at MD Anderson Cancer Center in Houston, who is on a mission to educate health-care providers about the vaccine, told clinicians in southern Texas, “If you are not recommending the vaccine, you are not doing your job. It’s the equivalent of having patients in their 50s and not recommending a colonoscopy — and then having them come back with cancer.” So reports Laurie McGinley for The Washington Post.

HPV infections cause more than 90 percent of anal and cervical cancers and 70 percent of vaginal, vulvar, penile and middle throat cancers, and two of the HPV strains are associated with more than 90 percent of anal and genital warts.

HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through any skin-to-skin contact, including genital contact of any kind or simply kissing.

Doctors and parents alike have struggled with the idea of giving young children a vaccine for a sexually transmitted disease. And some parents hesitate because they say the vaccine encourages sexual promiscuity, though research says otherwise.

Caslir said that just like putting on a seat belt to protect yourself before you turn on the engine, the most effective time to vaccinate for the cancer causing HPV virus is prior to exposure. In addition, it is important to vaccinate pre-teens early because they have the best immune response to the vaccine and are more likely to keep coming in for annual visits.

Dr. Daron G. Ferris, a speaker at the conference who works at the Georgia Cancer Center in Augusta, said that a mother of a 21-year-old woman with cervical cancer caused by HPV asked him, "So you mean if my daughter had received the Gardasil shots, she probably would not be having this surgery today?" and that he told her, "Yes. She would not have been there if she had been vaccinated."

Kirk Forbes, whose daughter Kristen died at the age of 23 from cervical cancer caused by a high risk strain of HPV, told the story of his daughter's battle. He and his wife have founded the Kristen Forbes EVE Foundation, whose mission is to eradicate cervical cancer and significantly reduce HPV infection rates. One of the foundation's efforts is a nationally acclaimed documentary that profiles five women, including Kristen, called "Someone You Love: The HPV Epidemic."

"We have the means to stop 90 percent of cervical cancers and who know how many versions of oral cancer, anal cancer, penile cancer... and could literally wipe out genital warts," Forbes said."We've got all the tools we need, now we've got to go out and get the job done."

Conference on cancer-causing HPV in Lexington June 21

The Kentucky Rural Health Association is sponsoring a summit on the human papilloma virus, "HPV - You ARE the Key!" June 21 at the Embassy Suites in Lexington.

The HPV vaccine is nearly 100 percent effective in preventing pre-cancers and noninvasive cervical cancers caused by two strains of the virus, but most parents in Kentucky and the nation are still not getting their adolescents vaccinated. Kentucky falls in the bottom 10 states for HPV vaccination, with 37.5 percent of its girls and 13.3 percent of boys aged 13-17 vaccinated as of 2014.

The conference will host several keynote speakers, including:

• Kirk Forbes, who co-founded the Kristen Forbes EVE Foundation in honor of his 23-year-old daughter, Kristen Forbes, who passed away after a yearlong battle with HPV caused cervical cancer;
• Dr. Daron G. Ferris, professor and director of the Gynecologic Cancer Prevention Center at the Medical College of Georgia;
• Dr. W. Michael Brown, associate director and the director of pediatrics at the Bayfront Family Medicine Residency Program in St. Petersburg, among other positions; and
• Dr. Alix Casler, medical director of the Department of Pediatrics for Orlando Health Physician Associates, among other positions.

The conference is also sponsored in collaboration with the Kentucky Immunization Program and the Division of Women's Health.

The event will last from 8 a.m. to 5 p.m. June 21 and costs $40 thru June 1, and $55 after that date. Continuing education credits will be offered. Click here to register and here for the draft agenda.

Kentucky is in the bottom 10 states for cancer-preventing HPV vaccination, probably because it has to do with sex

The human papillomavirus vaccination is nearly 100 percent effective in preventing precancers and noninvasive cervical cancers caused by two strains of the virus, but most parents in Kentucky and the nation are still not getting their adolescents vaccinated.

HPV is a group of more than 150 related viruses, which together are the most common sexually transmitted infections in the U.S.

An estimated 79 million Americans are infected with HPV and about 14 million more become infected each year, according to the federal Centers for Disease Control and Prevention. And while most HPV strains cause no symptoms and go away on their own, 10 percent of HPV infections lead to cancers of the cervix, vagina, vulva, penis, anus and throat.

The HPV vaccination was approved by the federal government 10 years ago and is recommended for all adolescent girls and boys 11 and 12 years old. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.3 percent of boys aged 13 to 17 vaccinated as of 2014.

The vaccine can be given to females as old as 26 and males as old as 21, but early vaccination is important. The vaccine is less effective if a person has already been exposed to the virus, because it works to prevent HPV before exposure, and not to treat existing HPV infections or associated diseases. Vaccinating adolescents better protects them before they are likely to become sexually active and exposed to the virus.

And therein lies the key reason health experts say most parents don't get their children vaccinated and health providers are hesitant to push this potentially life-saving vaccine: It has to do with sex, Michael Ollove reports for Stateline.

But guess what? Almost 42 percent of Kentucky's high-school students say they have had sexual intercourse, and almost one-third of them say they are currently sexually active, according to the 2015 Kentucky Youth Risk Behavior Survey. And, almost 10 percent of the state's middle-school students say they have had sex.

Opponents of the vaccine being given to adolescents argue that it encourages them to engage in sex because it removes the fear of contracting HPV, but at least one study shows no increase in sexual activity in girls who have been immunized, Ollove reports.

Health officials often lament that the vaccine wasn't originally sold to the public as an anti-cancer vaccine rather than one to prevent a sexually transmitted disease, Ollove reports.

“It should have been pushed out as an anti-cancer drug,”Walt Orenstein, a professor of medicine at Emory University and the former director of the National Immunization Program at the CDC, told Ollove. “People didn’t understand why their children needed this drug when they were still years away from being sexually active.”

Ollove notes other reasons for low vaccination rates: Health-care providers often don't stress the importance of the vaccine; many don't promote the vaccine because they aren't comfortable talking about sex with their young patients or their parents; and many providers feel the vaccine is not urgent because most adolescents in middle school are not sexually active. Another barrier is that the the HPV vaccine requires three inoculations over several months; the CDC shows a dramatic drop-off between the first and last doses.

Citing Noel Brewer, who does research on immunizations at the University of North Carolina and has studied parental and provider attitudes toward HPV, Ollove writes, "Contrary to what doctors may believe, parents are interested in the vaccine and a strong recommendation from a physician correlates highly with youngsters getting the full course of vaccinations."

Ollove notes that mandatory HPV immunizations have not proven to be successful. “Mandates are a last resort after you’ve built consensus that they are a good thing to do,” Orenstein told him.

Health policy researchers say that "reminder and recall" notices are the best way to keep patients up to date on vaccinations, and yet this is not a common practice, Ollove reports.

Insurance will cover the cost of the HPV vaccine and the Vaccines for Children Program will cover the vaccine at no cost for children who don't have insurance and are younger than 19. Call 800-232-4636 for more details.

The Kentucky Rural Health Association in collaboration with the Kentucky Immunization Program and the state Division of Women's Health will be hosting Kentucky's HPV Summit, "HPV: You ARE the Key!," at the Embassy Suites in Lexington June 21. The cost is $40 until June 1 and $55 afterward. Click here to register.

Kentucky ranks first in deaths from cancer, a longtime fact given big play on the Sunday front page of The Courier-Journal

Kentucky has led the nation in cancer deaths for several years, but that fact hasn't been trumpeted on the front page of a major newspaper in quite the way The Courier-Journal did Sunday, publishing a long story by Laura Ungar that explains the problem in the state and ways to address it.

"The biggest culprit is lung cancer, which strikes and kills Kentuckians at rates 50 percent higher than the national average," Ungar writes, noting the state's high smoking rate. "But Kentucky’s death rates also rank in the Top 10 nationally for breast, colorectal and cervical cancers."

“It’s really been driven by three major things: obesity, smoking and lack of screening,” Louisville gastroenterologist Dr. Whitney Jones told Ungar. “Our state is completely inundated with risk factors.”

How most states rank in cancer deaths (C-J chart)

Other causes include poverty and limited education among many Kentuckians. That makes them less likely to be screened for cancer, and more likely to die from it because it is discovered too late. "Federal figures analyzed by the American Cancer Society show 46.8 percent of Kentucky women 40 and older got a mammogram and clinical breast exam in the past year, compared with around 60 percent in states with the best rates," Ungar writes.

Efforts to increase screening have had the most success against colon cancer. Since the Colon Cancer Prevention Project started 11 years ago, "The screening rate has more than doubled to 69.6 percent, and colorectal cancer deaths are down more than 25 percent statewide," Ungar notes.

A screen for lung cancer has been developed only recently, "and today’s preventive low-dose CT scans for longtime smokers are far less routine than tests like mammograms or colonoscopies and are not always covered by private insurance," Ungar reports.

While smoking is generally blamed for lung cancer, the disease can also be caused by environmental factors, and "up to 20 percent of those who succumb to lung cancer are non-smokers," Ungar notes. "The risk of lung cancer is much higher for smokers exposed to carcinogens such as radon, asbestos, arsenic or chromium. The U.S. Environmental Protection Agency classifies a wide swath of Central Kentucky as having the highest potential for indoor radon gas, the second-leading cause of lung cancer." Research has shown high rates of arsenic and chromium in Appalachia.

"Shortages of doctors and cancer screening and treatment facilities make things even worse," Ungar reports. "A workforce capacity study conducted for the state by Deloitte Consulting in 2013 found that Kentucky needed 3,790 more doctors just to meet pre-ACA demand and would need many more by 2017. Complicating matters, rural Kentuckians often live long distances from specialists and cancer centers, and may face transportation problems as well. . . . The longer the drive to medical facilities, the later cancer is diagnosed."

Lifestyle and environment matter most when it comes to cancer, study suggests; Kentucky leads the nation in cancer deaths

Lifestyle choices and environment may matter most when it comes to your likelihood of getting cancer, according to a new study in the journal Nature, Jen Christensen and Kevin Flower report for CNN.

"Environmental factors play important roles in cancer incidence, and they are modifiable through lifestyle changes and/or vaccination," the authors write.

Basically, the study is a reminder that many of the things people have control over -- smoking, sun exposure, poor diet, use of tanning beds, air-pollution exposure, radiation exposure, and decisions to be vaccinated for a virus that causes cervical cancer -- can play a role in whether a person might get cancer or not.

Kentucky leads the U.S. in cancer deaths, and consistently leads the nation in lung cancer deaths, which kills Kentuckians at a rate 50 percent higher than the national average. It also is ranked in the top 10 nationally for deaths from breast, colorectal and cervical cancer.

“It’s really been driven by three major things: obesity, smoking and lack of screening,” Louisville gastroenterologist Dr. Whitney Jones, told Laura Ungar of The Courier-Journal in recent story about cancer and Kentucky. “Our state is completely inundated with risk factors.”

The good news is that Kentuckians have control over some of the external factors mentioned in the study. The World Health Organization says nearly half of cancers could be prevented if people changed their lifestyle or reduced their environmental exposure to cancer-causing agents.

The study builds on another released earlier this year in the journal Science that said many of the cancers people get are due to "bad luck," which set off a controversy. The authors of  the study have said they were "merely talking about a variety in cancers in 31 different tissue types," CNN reports.

The latest research, although still in its early stages, concluded that only 10 percent to 30 percent of cancers start because of the "bad luck" factor and that the greatest majority of cancer might be due to outside factors.

Kentucky is among states with low rates of screening for cancers of the private parts, and thus has a higher death rate from them

Poor, minority and rural residents are less likely to be screened for breast, colorectal and cervical cancers and more likely to have high mortality rates from the diseases because they are detected too late, says a state-by-state study by USA Today and the North American Association of Central Cancer Registries, Laura Ungar reports for USA Today. (USA Today maps)

Kentucky and most other Southern states have some of the highest rates of deaths from screenable cancers, Ungar writes. "While the Affordable Care Act has brought insurance coverage to millions, it hasn’t solved the myriad other problems impeding access to care, such as transportation difficulties, lack of education, inability to take time off from low-wage jobs for medical appointments and shortages of doctors, hospitals and cancer-screening facilities," Ungar writes. "It hasn’t made all doctors 'culturally competent' to effectively care for minority patients."

And it isn't expected to get better any time soon, she writes. "Federal funding for cancer screening is in flux. A nationwide program that has provided more than 12 million mammograms and Pap tests for low-income women since 1991 lost $8 million in federal funds in the last five years. And President Obama’s proposed budget for next year cuts $42 million from breast, cervical and colorectal cancer-screening programs on the assumption the ACA will improve access to screening. A bipartisan spending deal hasn't yet determined specific allocations for particular programs, but previous House and Senate bills restored at least some of the money."

States with large poor, minority and rural populations need more local programs like one in Kentucky where "a local gastroenterologist with a passion for preventing colon cancer started the nationally renowned Colon Cancer Prevention Project, which raised money and awareness of the disease and pushed for programs such as free screening for low-income, uninsured residents," Ungar writes. "Since the group started 11 years ago, the screening rate has more than doubled to 69.6 percent—and deaths are down more than 25 percent." (Read more)

State says many screenings of Medicaid patients more than doubled after program was expanded under Obamacare

Countering assertions that Kentucky's Medicaid expansion doesn't guarantee health care, state officials have presented data showing that "Kentuckians on Medicaid were far more likely to get cancer screenings, physicals and dental check-ups after the state expanded the government program for the poor and disabled," Laura Ungar reports for The Courier-Journal.

The Department for Medicaid Services presented the data during the Aug. 5 meeting of the oversight team for a state effort to reduce deaths from chronic disease and improve the state’s health, Ungar reports.

"Kentucky ranks poorly on numerous health measures, and has some of the nation’s highest rates of cancer, diabetes and cardiovascular disease," Ungar writes. "The new data shows that the number of Medicaid recipients receiving several types of preventive care rose sharply in 2014," when Medicaid was expanded under federal health reform.

Breast cancer screenings rose 111 percent, to 51,292; cervical cancer screenings rose 88 percent, to 78,281; and colorectal cancer screenings rose 108 percent, to 35,633.   "More Medicaid recipients got cholesterol screenings, flu shots and diabetes screenings," Ungar adds.

Preventive dental services also more than doubled, by 116 percent, to 159,508; and physical examinations were up 187 percent, to 63,888.

The numbers include Kentuckians in the traditional Medicaid program and those added to it through the expansion, which made households with incomes up to 138 percent of the federal poverty level eligible for Medicaid benefits. All Medicaid services are free to clients.

"The expansion has been controversial, with some opponents arguing it’s simply too costly and doesn’t ensure poor patients get care because many doctors won’t take Medicaid given its notoriously low reimbursement," Ungar notes.

Those critics, led by Republican gubernatorial nominee Matt Bevin and some legislators, have offered no data to support their assertions. Democrats, led by Beshear, have defended the expansion as a way to get health care to those who lacked insurance and improve the state's overall health status.

“I have said from day one that giving every Kentuckian access to affordable, quality health care coverage will help us tackle our ongoing abysmal health outcomes,” Beshear said. “I’m excited about the enormous gains we’re seeing and even more excited about the long-term implications for our state’s health.”

Hospitals argue that they lose money on Medicaid patients because the program reimburses hospitals at only 82 percent of cost, but Beshear administration officials note that hospitals have to write off much less care as charity because people who once got it are now insured. They say 82 percent is better than 0 percent, but some hospitals said the Medicaid losses have forced them to cut payrolls.

Feds fund Ky. campaign to promote shots for human papilloma virus, the most common sexually transmitted disease

By Melissa Patrick
Kentucky Health News

Lt. Gov. Crit Luallen joined public health officials in Frankfort July 13 to launch Kentucky's new "Stop HPV Campaign," to encourage parents to get their children vaccinated against the human papillomavirus, which is known to cause cervical, oral and anal cancer.

"Experts tell us that this vaccine, which is safe and highly effective against the most common cancer-causing strains of the virus, should be a routine part of adolescent health," Luallen said. State laws and regulations to not require the immunization, which is recommended for 11-and 12-year-old boys and girls, but Luallen said, "It is the smart thing to do. It is cancer prevention."

The campaign will feature television, print and online advertisements throughout the state that will promote the benefits of the HPV vaccine. It is funded by a $500,000 grant from the federal Centers for Disease Control and Prevention.

An estimated 79 million Americans are infected with HPV and about 14 million people become newly infected each year, according to the CDC. It is the most common sexually transmitted disease in the U.S.

"According to the 2010 census data, there are about 26 million girls under the age of 13 in the U.S.," Luallen said. "If none of them receive the HPV vaccine, over 168,000 will develop cervical cancer and more than 54,000 of them will die."

Luallen is chair of the Kyhealthnow initiative, which includes as part of its strategy to reduce cancer deaths by 10 percent and increase rates of HPV vaccination by 25 percent.

Health Commissioner Stephanie Mayfield said that she hopes the campaign will contribute to the eradication of the cancer causing HPV virus, as the polio and smallpox vaccines have done.

Mayfield not only called on health-care providers to talk to their patients about the health benefits of this vaccine, she said parents should ask their providers about it if they don't bring it up.

"By getting your child vaccinated with the HPV vaccine, you are preventing the spread of a virus and protecting your child from developing one of the HPV-related cancers," she said.

Kentucky has a high vaccination rate for school-required vaccinations, but only 27 percent of Kentucky's girls complete the full three dose HPV series and only 19 percent of its boys complete the series. The national average is 38 percent.

"The health of our citizens suffers from this type of inaction," Mayfield said. "We want all kids who are 11 or 12 years old to get the three dose series of HPV vaccine."

Insurance will cover the cost of the HPV vaccine and the Vaccine for Children Program will cover the vaccine at no cost for children who don't have insurance and are younger than 19. Call 800-232-4636 for more details.

Mayfield noted that there has been a 56 percent reduction in HPV infections in teen girls in the U.S. since 2006 because of this vaccine, and called on Kentuckians to get their children vaccinated.

"Each year about 17,500 women and 9,300 men are infected by HPV related cancers," Mayfield said. "Let's stop this and eradicate these infections."