Minorities, Rural Residents at Greater Risk for Cervical Cancer in Texas, Study Finds

A report by the Texas Department of Health Services found that minority women and women who live in rural counties in Texas have a greater risk of developing cervical cancer, but requiring a human papillomavirus vaccination for all middle school-aged girls in the state could help eliminate the disparity, the Houston Chronicle reports (Elliott, Houston Chronicle, 3/12). Merck's HPV vaccine Gardasil and GlaxoSmithKline's HPV vaccine Cervarix in clinical trials have been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases. FDA in July 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine. Texas Gov. Rick Perry (R) on Feb. 2 signed an executive order mandating HPV vaccination for sixth-grade girls beginning in September 2008 (Kaiser Daily Women's Health Policy Report, 2/23). The Texas House is scheduled on Tuesday to debate a bill that would overturn the order. Health officials and supporters of the mandate will defend the measure with findings from the report. According to the new report, "Cervical Cancer in Texas," cervical cancer rates are highest in the state among Hispanics, and mortality rates are highest among blacks. Cervical cancer incidence and mortality also are higher in rural counties. In addition, 82% of women in the state have had a Pap test in the last three years, but rates are significantly lower for minority women and women living in rural counties and areas that border Mexico, according to the report. The report stated, "Eliminating cervical cancer mortality requires HPV vaccination and support for routine cervical cancer screening and treatment for every woman in the state." State Rep. Jessica Farrar (D), who supports the executive order, said she is concerned that without the mandate, minority women, Hispanics in particular, would not receive the vaccine, which costs $360, because of lack of health care access and cultural issues. Ciro Sumaya, dean of Texas A&M University's School of Rural Public Health and a member of the federal panel that recommended the HPV vaccine, said that if the vaccine is required, 90% of girls in the state would obtain it. Without the mandate, state health officials expect one-quarter of girls in the state would receive the vaccine, according to the Chronicle. Critics of the order oppose inoculating young girls against a sexually transmitted infection. State Rep. Dennis Bonnen (R), who wrote the bill to overturn the order, said, "Not every 11-year-old girl in Texas should necessarily be getting the vaccination. And you're actually missing a huge number of older girls who, on consultation with a doctor, should receive it." Critics also have said that the order is designed to increase sales for Merck, which has donated $6,000 in campaign contributions to Perry since 1995. In addition, Perry chaired a fundraiser for the Republican Party that received $50,000 from Merck. Perry has said that the executive order was the result of his desire to eradicate cervical cancer, not because of the donations (Houston Chronicle, 3/12).