As the month of January comes to a close, we’re thinking about women’s health and the value of preventive screenings and vaccinations. Nearly 13,000 women in the United States are diagnosed with cervical cancer each year, but the disease is preventable with vaccination and a Pap smear screening. According to the most recent data available (2018) 1.8 million women received a pap screen at a Community Health Center.
Accessing vaccinations and screenings are typically difficult for impoverished and disenfranchised people, which is why there are places like Southside Community Health Services in Minneapolis, MN. The health center has one of the highest cervical cancer screening rates in the state, despite serving a patient population of largely low-income, uninsured patients, the majority of whom are immigrants and refugees. There are interpreters on staff for patients, but the universal language spoken within the health center’s walls is trust. Every patient is treated with dignity and respect and staff work hard to ensure patients understand why preventive screenings are so vital to their health.
“While most women know they are supposed to get cervical cancer screening, the majority do not know what it is checking for, and even fewer women know what HPV is,” says Sheila Kennedy, a Nurse Midwife at Southside Community Health. “I ask my patients, ‘Would you like me to tell you more about Pap smears?’ They are usually quite engaged. I show patients how a speculum works, I let them feel the brush that will be used during the Pap smear. I love outreach and education, and trust that if women are provided with the knowledge and tools, they will make the best decisions for their health and their bodies.”
To boost cervical cancer screening rates, the health center also pays keen attention to the date of a patient’s last Pap smear, even if they are coming in for some other ailment, such as a sore throat. Staff are especially focused on identifying women who have not had a cervical cancer screening in many years. “We look at their chart and ask them to return within two weeks for an annual and Pap,” says Kennedy. “And, since I give them that brief information on what the screening is and the importance of it, nearly everyone returns.”
Kennedy hits on an important point — that women often don’t realize how cervical cancer is a serious health risk and a simple Pap smear can save their life. Part of the problem is the sensitive topic of reproductive health.
“One of the challenges I’ve noticed with the specific patient population at Southside is that many of them are very hesitant to talk about reproductive health. There are a lot of references to ‘down there.’ I try to normalize talking about one’s body, and even put a positive spin on it if I can. Just yesterday I saw a patient who came in to see me because she was worried that she had an ovarian cyst and wanted a Pap smear to find out. Her partner was with her. We had a lovely discussion about women’s reproductive organs, and when we would want to do specific tests or images. They asked great questions and were so appreciative. At the end of the visit, the patient said, ‘I’m going to send all my friends to talk with you so they can learn about this too!’ And I hope they come!”
All women are at risk for cervical cancer but it most often occurs in women over age 30, according to the Centers for Disease Control and Prevention. The risks for cervical cancer include certain types of human papillomavirus (HPV) and now there’s a vaccine for it. Kennedy says there is a state program that makes it easier for parents to vaccinate their children against HPV, but it’s not easy to come by. “The HPV vaccine is quite expensive and is not covered by any discount for people over the age of 18.”
Cervical cancer is highly preventable in most Western countries because screening tests and a vaccine to prevent HPV infections are available. If cervical cancer is detected early, it can be highly treatable and associated with long survival and good quality of life. The idea that saving a life can be as simple as reminding people there is an affordable place to get screened is what drives the staff at Southside.
“I have never worked with a more dedicated team in my life. We all work together to give high-quality care,” says Kennedy. “Not to meet metrics, but because our patients deserve it. The medical assistant with whom I work on a daily basis asks patients about their last screening, tracks down records, etc. Every single person in our clinic — from the front desk to the nurses to the social workers — works extremely hard every day to make sure every patient that comes to our clinic gets top-notch care. It is truly a team effort to reach outcome goals.”