Talking cervical cancer awareness and health equity with Masonic Cancer Center's Dr. Rahel Ghebre

Cervical cancer was once a leading cause of cancer death for women in the United States. Thanks to screening and prevention measures, today, the impact of this form of cancer has been greatly reduced. However, nearly 14,500 women in the U.S. still received a diagnosis of cervical cancer in 2021. That same year, more than 4,200 died from the disease, according to the National Cancer Institute. 

For Cervical Health Awareness Month this January, Rahel Ghebre, MD, MPH, sat down with us to answer a handful of questions about cervical cancer. Dr. Ghebre is associate director for diversity, equity, and inclusion at the Masonic Cancer Center, a professor in the Department of Obstetrics and Gynecology at the University of Minnesota Medical Center, and a practicing gynecologist at M Health Fairview. Let's jump in to hear from Dr. Ghebre about the importance of quality care and broad health equity in the prevention, screening, treatment and survivorship of cervical cancer. 

Q: What is cervical cancer and how is it diagnosed?

Dr. Ghebre: Cervical cancer is associated with human papillomavirus (HPV) infection. This cancer starts in the cervix, which is the lower part of the uterus that connects to the vagina. HPV, a sexually transmitted infection, is the cause of almost all cervical cancers in women. It is important to know that most sexually active individuals have HPV at some point, usually in their teens and early 20s. For most people, the immune system regulates HPV and prevents the virus from causing healthy cells in the cervix to develop into cancer. Persistent infection with HPV leads to developing pre-cancer cells within the cervix which then can progress into cervical cancer. Generally, this process develops slowly over time. 

Early stages of cervical cancer often cause no symptoms, so regular cervical cancer screening is the most effective way to detect it. More advanced cervical cancer can present with vaginal bleeding, watery bloody vaginal discharge, pelvic pain, or bleeding or pain during intercourse.

Q: How can I lower my risk of developing cervical cancer?

Dr. Ghebre: In 2020, the World Health Organization launched a Global Strategy to Accelerate the Elimination of Cervical Cancer. There are multiple risk factors for cervical cancer, including smoking, having multiple sexual partners, sexual activity at an early age and having a weak immune system. However, cervical cancer is one of the most preventable cancers, and there are several ways to reduce your risk.

• Cervical cancer screening tests such as the HPV test and Pap test—also called a Pap smear or cervical cytology—help prevent cervical cancer by detecting pre-cancer changes. Talk to your health care provider about these types of cervical cancer screening tests.
• The HPV vaccine is very effective at reducing the risk of cervical cancer. A two-dose HPV vaccine is recommended for all children to start at age 11 or 12; 15- to 26-year olds can also receive three doses of the vaccine. Persons who have received the HPV vaccine should still continue to get regular cervical cancer screening.
• Don't smoke, because smoking is a risk factor for cervical cancer. If you do smoke, ask your health care provider for help quitting.

Q: What health disparities exist in regard to cervical cancer?

Dr. Ghebre: Nationally, cancer health disparities result in increasing cancer burden among racial and ethnic minorities, sexual and gender minorities, recent immigrants, and medically underserved populations including those living in certain urban and rural areas.

In Minnesota, we see a similar pattern. However, we need more data looking at multiple identities to fully understand how the interaction of several factors contribute to cancer health disparity. As researchers, we seek to identify cancer health disparities and understand systems that contribute to health inequities, but what our communities need now are solutions to reduce health disparities and improve their health. That’s why better screening access is so critical while we continue to deepen our understanding of effective models to expand access to cervical cancer prevention. Even with the need for more data, cervical cancer is currently designated as a priority health area in Minnesota for eliminating health disparities with free cervical cancer screening available at 475 clinics across the state.

Q: What are the treatment options for cervical cancer?

Dr. Ghebre: The U of M Medical School is a leader in the treatment of cervical cancer, which continues to evolve. Through excellence in our clinical care, education and research, we are partnering with our community to provide equitable, quality, and advanced cervical cancer treatment to women throughout Minnesota.

Optimal treatment outcomes for cervical cancer depend on early and timely diagnosis. Cervical cancer treatment may require a combination of treatment approaches, such as cancer-specific surgery, chemotherapy, and radiation therapy. Our oncologists work in a patient-centered model that integrates gynecological oncology surgical and chemotherapy services, radiation oncology, pain palliative care medicine, psychology, cancer rehabilitation, social work, and interpretive services to tailor cancer care to each woman diagnosed with cervical cancer. Our goal is to help women live a healthy life as cancer survivors.

Q: What work is being done to advance cervical cancer care and research? 

Dr. Ghebre: The Masonic Cancer Center (MCC) is has been designated as an "Outstanding" national Comprehensive Cancer Center by the National Cancer Institute. In my role as the associate director for diversity, equity, and inclusion, I help ensure that cervical cancer is one of our priority cancers for reducing health care disparities across Minnesota. We are working with the U of M Medical School to support researchers who are doing work in cervical cancer through initiatives that increase HPV vaccine uptake, expand pathways to innovative cervical cancer screening, and advance the newest treatment within therapeutic clinical trials. We work alongside our community engagement core in providing education in cervical cancer prevention and supporting access to cervical cancer screening, such as with the SAGE program. More broadly, in all cancer areas, our program is working to expand the diversity and inclusion of students, trainees, and researchers working within MCC. We are accelerating our work in cancer care and research to meet the needs of our community by upholding our core mission to diversity, equity, and inclusion.

Still have questions about cervical health and awareness? Tune into this 2022 Fireside Chat, brought to you by MCC's Office of Community Outreach and Engagement, featuring Dr. Rahel Ghebre. 

Rahel Ghebre, MD, MPH is a professor at the University of Minnesota Medical School and a practicing gynecologic oncologist at M Health Fairview. Dr. Ghebre also serves as associate director for diversity, equity and inclusion for the Masonic Cancer Center. She is an expert in the surgical and medical management of women diagnosed with ovarian, endometrial, cervical, and vulva or vaginal cancers.