Shement Jones knew something wasn’t right. His back hurt. She felt pain during sex.
She said she kept telling the doctor something was wrong.
The doctor told her: Just wash your underwear in Dreft, Jones said, referring to a brand of detergent.
A few months after her 2016 appointment, Jones, who lives in suburban Jackson, Mississippi, was diagnosed with stage 3 cervical cancer. She underwent a hysterectomy and then weeks of radiation therapy.
I ended up fine, said Jones, now 43. But what about all the other women?
The question is especially pertinent in Jones’ home state, which had the nation’s second-highest age-adjusted cervical cancer death rate, 3.4 deaths per 100,000 women and girls annually from 2016 to 2020, trailing only Oklahoma. , according to data from the National Cancer Institute. And for non-Hispanic black women like Jones, the rates in the state are even higher, at 3.7 deaths per 100,000 people. All of this translates to about 50 preventable deaths of Mississippi women due to cervical cancer every year in this largely rural state.
Health experts said such a high death rate from a cancer that is preventable, detectable and successfully treatable when caught early is a warning sign about the overall state of health care in Mississippi.
They desperately need help there, said Otis Brawley, a professor of oncology at the Johns Hopkins School of Medicine and an expert on health disparities. Political leadership is critically important to turn this situation around, and in Mississippi, political leadership doesn’t care.
Despite Mississippi’s beauty, from the hills of the Natchez Trace to the white sand beaches of the Gulf of Mexico, and the cultural fame of its famous musicians and storytellers, the state’s reputation is marred by its high rates of poverty. The people who live there are used to being the butt of jokes, but it hurts.
Mississippi is often misrepresented, said Mildred Ridgway, an obstetrician and gynecologist at the University of Mississippi Medical Center in Jackson.
Recently, the state has been recovering from crisis after crisis. As late as March, tornadoes and other severe weather conditions killed more than two dozen people and caused extensive damage. Last year, water in Jackson, the state capital, was unpalatable for months due to treatment plant failures.
By virtually any measure of health, Mississippi is near or last. Nationally, an estimated 10% of people under age 65 do not have health insurance, but in Mississippi it is about 14%. Deaths from cardiovascular disease, diabetes, cancer and many other diseases are among the highest per capita in the country.
High poverty rates contribute to high cervical cancer mortality, health experts say. About 19% of Mississippians (nearly 1 in 5) live in poverty, while nationally it is about 13%.
If I had to pinpoint the source of this, it would be lack of education, Ridgway said, referring to a lack of knowledge about regular cervical cancer screening, which the US Preventive Services Task Force recommends every third years for women between 21 and 65 years.
But it likely goes far beyond that, many health experts said. Physicians may be less likely to emphasize preventive care for women with less education and women of color, studies suggest.
There’s a big difference in the quality of care, said Rajesh Balkrishnan, a professor of public health at the University of Virginia who has extensively studied cancer care in the Appalachians and other underserved areas.
In her case, Jones said, she was unable to get the doctor’s office to return her calls in a timely manner. She was worried about her symptoms.
I felt like I wasn’t heard. I called her more than she called me, Jones said of her doctor. I was going to my appointments and I was ignored.
And it can be difficult to gain access to any kind of care, let alone quality, culturally competent care, from providers who recognize a patient’s heritage, beliefs and values during treatment.
Most of the state’s 82 counties are rural. The average travel distance to a grocery store is 30 miles, and half the population lives in a county that is considered medically underserved, said Letitia Thompson, vice president for Mississippi for the American Cancer Society.
Low-income rural residents often lack reliable transportation, she said, and even if they do own a vehicle, they can’t afford gas. They often cannot find or pay someone to take care of their children so they can go to the doctor. Women in low-paying jobs often don’t have the time to drive to a clinic in a distant city, or the ability to leave work without losing pay.
Women who work and care for children often have an enormous burden of responsibility, Ridgway said. They don’t have the time or money.
Many are also uninsured. Although the Affordable Care Act has reduced Mississippi’s uninsured rate, it is estimated that an additional 88,000 Mississippi residents could be covered through Medicaid if the state expanded eligibility for the federal state insurance program for low-income Americans. But the state is one of 10 that have not agreed to expand coverage to more adults.
Mississippi Governor Tate Reeves, a Republican running for re-election this year, opposes the expansion. His Democratic opponent, Brandon Presley, second cousin of music legend Elvis, is in favor. Polls show Presley trailing Reeves.
Without Medicaid expansion, low-income people are often left to decide whether to forego insurance and purchase a policy through the Affordable Care Act market if they are unable to obtain insurance through employment. Even if they qualify for subsidized market plans, they could face high deductibles or copayments for visits, health experts said. This often means going to the doctor only when you are sick. Preventive care becomes a luxury.
You save your money on health care for when you’re sick or when your kids are sick, said Thompson of the American Cancer Society.
But regular medical care can make all the difference in treating cervical cancer. Pap smears have long helped detect abnormal cervical cells that can become malignant. Brawley said the test is one of the best cancer screening tests because of its accuracy.
In 2006, vaccines to prevent cervical cancer were first approved by the FDA. Vaccines protect against the common sexually transmitted infection called human papillomavirus, which causes nearly all cervical cancers. The HPV vaccine is most effective when given before a person becomes sexually active; the federal recommendation is to get vaccines at age 12.
Only a few places in the US, including Hawaii, Rhode Island, Virginia, Puerto Rico and the District of Columbia, require vaccinations to attend school. California has legislation pending that would initially require high school students to get the vaccines, but the bill has been watered down to recommend them.
Mississippi does not require the vaccine, and the state has had the lowest share of fully vaccinated teens by a large margin for years. Fewer than 39% of teens were up to date on their HPV vaccinations in 2022, according to the CDC, compared to an estimated 63% nationally.
Thompson said he thinks many parents are hesitant to vaccinate their children because they believe it would encourage sexual activity.
This is an anticancer vaccine, Thompson said.
Krista Guynes, director of the Mississippi State Department of Health’s women’s health program, said the state has several efforts underway to better inform women about their need for screening. It also has clinics for uninsured women. In partnership with the National Cancer Institute and the University of Mississippi Medical Center, she said, the health department is conducting a study to assess risk and look for new biomarkers in women undergoing screening for cervical cancer.
As for Jones, she considers herself lucky to have survived stage 3 cancer.
I would just like to say to all women: get the vaccine. The vaccine will make a difference, so you don’t have to tell them, I’m sorry, you have cancer.
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