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A Future Free of Cervical Cancer

Color

When the clock struck midnight on New Year’s Eve in the United States, most people found joy in that moment. But, for 4,000 families, the night brought a fresh wave of grief as they mourned the loved ones they lost that year to cervical cancer. 

Cervical cancer deaths are almost entirely avoidable, and the current death rate represents a persistent failure of our healthcare system. The tragedy of these unnecessary deaths drove the team at Color to find new, non-invasive ways to detect cervical cancer risk earlier. Building on our expertise in developing human-centered population health solutions, we’ve designed a revolutionary approach to get us all one step closer to a future free of cervical cancer.

Advanced cervical cancer is largely preventable. The Centers for Disease Control and Prevention estimates that 93% of advanced cervical cancers wouldn’t occur if the disease were caught earlier and managed effectively. Roughly 3,700 people would be alive today were their cancers detected in time to intervene. 

The healthcare system has not made sufficient progress on this problem. Even with improvements in early detection and treatment, the rate of cervical cancer deaths in the United States has remained steady over the last decade after a promising improvement in survival rates from 1992-2012. The problem might even be getting worse. The percentage of women falling behind on life-saving cervical cancer screening has increased over the past decade.

While early-stage cervical cancer affects all populations and can strike anyone, diagnoses and deaths from advanced cervical cancers are not distributed randomly. Like many adverse health outcomes in the US, people of color are significantly more likely to suffer from advanced cervical cancer and die from the disease. According to the American Cancer Society, “American Indian and Alaska Native, Hispanic and non-Hispanic Black individuals have the highest incidence of cervical cancer. Black individuals are more likely to die from the disease than individuals of any other race or ethnicity.” This inequity is not due to biological differences but rather the systemic injustices of a two-class system of healthcare access and the compounding effects of the social drivers of health. Researchers also find that people in rural areas are more likely than their urban counterparts to die from cervical cancer, adding to the hypothesis that access to timely, appropriate health care drives a large part of the inequities.  

Human papillomavirus, otherwise known as HPV, causes almost all cervical cancers. HPV is a common virus–the CDC estimates that approximately 42 million people in the US have the types of HPV that can lead to cervical cancer. Current guidelines recommend that all people with cervixes aged 25-65 get screened for high-risk strains of HPV every five years. But HPV screenings are severely underutilized among the people who need them the most, and inequities in screenings explain a large proportion of the racial and ethnic differences in cervical cancer. For example, an October 2022 study found that even after controlling for income, women of color were significantly less likely to receive adequate HPV screening. 

Put simply, the people who die from cervical cancer are the people who can not or do not access recommended HPV screening. To abolish cervical cancer, we need to ensure that more people get screened for cervical cancer at the appropriate intervals. 

Traditional cervical cancer screening isn’t an experience most folks look forward to. Cervical cancer screening traditionally involves a fairly invasive experience where a clinician physically swabs the cervix during a pelvic exam. Cells from that swab sample are then tested for the presence of HPV or visually inspected for signs of cancerous growth (called a Pap smear or test). Fear of a Pap smear is common among people who delay care. A 2019 study out of England found that 71% of those surveyed who skipped their recommended screening expressed “fear” and “discomfort” about the procedure as a contributing factor. For those who have experienced trauma–particularly sexual violence or other forms of abuse–the idea of a Pap smear may be too triggering, leading to a delay in cervical cancer detection. Certain populations with religious or cultural concerns about invasive procedures can also be reluctant to participate. 

Even among those who are not uncomfortable with the Pap smear itself, there are genuine barriers to timely cervical cancer screening– primarily the time, expense, and inconvenience of the procedure. A pelvic exam costs, on average, ~$330, can take weeks to schedule, and involves hours at an in-person visit. We see these concerns reflected in the feedback from our clients and partners. Nearly 60% of people we’ve talked to had skipped or delayed a pap test at some point. The reasons cited were difficulty getting an appointment at a convenient time and needing clarification about the recommended testing frequency. One participant in our poll said, “As a young woman, I was never made aware of when or how often to have Pap smears done. My provider has no proactive reminders, and I’m left guessing when my last one was and when I need the next one.”

Another one of our friends told us, “[my experience] was difficult because I had gotten it in late Feb 2020. I think with the world shutting down I wasn’t notified properly and found out in August 2020 I had abnormal results six months ago when I went to schedule my next appointment and had to rush in for the follow-up testing. I felt pretty scared about the whole thing.”

We can reduce deaths from cervical cancer now. This is where Color comes in.

We can save lives by being present in the communities most affected, by providing convenient access to accurate clinical HPV testing, and by making sure that the people identified as carrying a high-risk strain of HPV get evaluated for early-stage cervical cancer. 

Color has a strong history of providing access to compassionate, high-quality, clinically useful care services at scale. So we set out to find new ways to apply this model to the problem of cervical cancer. We imagined a world where testing for HPV could happen at home or in community settings using self-administered collection methods that are as robust as clinic-based methods. We envisioned integrating screening programs into clinical protocols, ensuring that the people who need in-person care are guided and supported in accessing it. We set out to catch and treat early cervical cancer across the US, eliminating the unnecessary tragedy of this terrible disease.

We’re proud to announce that our vision is now a reality and is available as part of our comprehensive preventive care solution. Using a non-invasive urine collection method that screens for high-risk HPV infections, this innovation is a promising first step in creating a world without cervical cancer. Studies for the last decade show that HPV detection in self-collected urine has equivalent analytic and clinical sensitivity to HPV testing via clinician-collected cervical swabs. Like all Color products, our team ensures that results are easy to understand and that nobody falls through the cracks due to a lack of follow-up. We ensure that identification leads as seamlessly as possible into timely next steps. Our care navigation experience then helps to answer questions about what HPV is and its relationship to cervical cancer. Our team also helps them find in-person care that is appropriate for their insurance situation, arranges transportation if they need it, and reminds them of upcoming appointments. Early results from a pilot in a traditionally medically underserved population were promising, with 20% of individuals testing positive for HPV. We are committed to ensuring that this simple, innovative way to keep people safe gets into as many communities as possible. We know that this can make a massive difference in the world. 

We are excited to play our part in a comprehensive, global strategy to eradicate this disease. At Color, we design and build products for real people at a population scale. Our work is fueled by a future where skin color and zip code don’t determine the length of our life. This mission demands that we continue to push the boundaries of what is possible, bringing extraordinary care to everyday places. 

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