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. 2014 Mar;132 Suppl 1(0 1):S33-40.
doi: 10.1016/j.ygyno.2013.12.004. Epub 2013 Dec 10.

Application of the Carolina Framework for Cervical Cancer Prevention

Jennifer L Moss  1 , Schatzi H McCarthy  1 , Melissa B Gilkey  2 , Noel T Brewer  3
Affiliations

Application of the Carolina Framework for Cervical Cancer Prevention

Jennifer L Moss et al. Gynecol Oncol. 2014 Mar.

Abstract

Objective: The Carolina Framework for Cervical Cancer Prevention describes 4 main causes of cervical cancer incidence: human papillomavirus (HPV) infection, lack of screening, screening errors, and not receiving follow-up care. We present 2 applications of the Carolina Framework in which we identify high-need counties in North Carolina and generate recommendations for improving prevention efforts.

Methods: We created a cervical cancer prevention need index (CCPNI) that ranked counties on cervical cancer mortality, HPV vaccine initiation and completion, Pap smear screening, and provision of Pap tests to rarely- or never-screened women. In addition, we conducted in-depth interviews with 19 key informants from programs and agencies involved in cervical cancer prevention in North Carolina.

Results: North Carolina's 100 counties varied widely on individual CCPNI components, including annual cervical cancer mortality (median 2.7/100,000 women; range 0.0-8.0), adolescent girls' HPV vaccine initiation (median 42%; range 15%-62%), and Pap testing in the previous 3 years among Medicaid-insured adult women (median 59%; range 40%-83%). Counties with the greatest prevention needs formed 2 distinct clusters in the northeast and south-central regions of the state. Interviews generated 9 recommendations to improve cervical cancer prevention in North Carolina, identifying applications to specific programs and policies in the state.

Conclusions: This study found striking geographic disparities in cervical cancer prevention need in North Carolina. Future prevention efforts in the state should prioritize high-need regions as well as recommended strategies and applications in existing programs. Other states can use the Carolina Framework to increase the impact of their cervical cancer prevention efforts.

Keywords: Cancer prevention; Cervical cancer; Health disparities; Human papillomavirus (HPV) vaccine; Pap test.

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Conflict of interest statement

Conflict of Interest Statement

NB has received grants or served on paid advisory boards for GlaxoSmithKline and Merck Sharp & Dohme Corp.

Figures

Figure 1
Figure 1
North Carolina counties with high cervical cancer prevention need scores.
See this image and copyright information in PMC

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