BeRana Divine wears a pair of teal and white ribbon-shaped earrings that are engraved with the word "Surviving."
“It's an acceptance,” Divine said. “It was a shock at first, then it went from shock to being flat, to a little anger, but now I'm at, 'Let's just get this over with.'”
Divine’s roller coaster of emotions began a little over a month ago when she received a call from her longtime gynecologist. He told her she had cancer.
“I just froze, and was like, 'Are you freaking kidding me?'” Divine said. “But ultimately, you have to find a way to accept what you can't change, because that is the key to your healing.”
Now the teal and white of her earrings represent cervical cancer awareness.
According to the Centers for Disease Control and Prevention, cervical cancer used to be the leading cause of cancer deaths for women in the United States. Regular screenings, or Pap smears, have resulted in a significant decline in cases and deaths over the past 40 years. This is because the human papillomavirus, or HPV, which is directly linked to cervical cancer, can be detected during regular screenings.
But there’s been a recent sharp decline in screenings, particularly among African American women, which the CDC attributes to the COVID-19 pandemic. Divine said being a full-time caregiver for her daughter, who has a rare form of epilepsy, along with the restrictions of the pandemic, caused her to miss her regular screenings.
“It just got pushed back more than it should have,” Divine said.
Dr. Maryann Wilbur, a physician at UR Medicine's department of obstetrics and gynecology, said prioritizing screenings is usually a struggle for marginalized women who often have greater familial and financial responsibilities.
“Getting a Pap smear is not necessarily as big a priority as getting rent paid, getting the kids to school, and getting the kids fed,” Wilbur said.
She said cervical cancer is more commonly found -- and more often caught in a later stage -- in women of color and those of lower socioeconomic status. Wilbur said this particular cancer progresses slowly and can be caught before it becomes a clinical problem, but women must first prioritize their wellness screenings.
“Those missed screenings actually are missed opportunities,” Wilbur said. “If we get these women back in, we could overcome some of the losses.”
Dr. David Adler, an emergency physician at Strong Memorial Hospital, is seeking to make that happen by leading a clinical trial designed to market screenings to women who aren’t getting them. He said women with no health insurance, women of color, immigrants and those who use the emergency department as their usual source of care are his target audience.
“We care disproportionately for people who experienced barriers to care for a multitude of different reasons,” Adler said. “So this presents us with an opportunity to try to overcome some of those barriers.”
Adler said the trial involves sending a direct text message with a link to schedule a screening. He said the text's language is rooted in the behavioral theories of planned behavior and self-determination.
"The text says something to the effect of, 'Nationally, 80% of women get regular cervical cancer screenings, you can too at your own convenience by contacting (blank),' and the contact links are provided," he said.
Adler said if a person gets the sense that Pap smear screenings are normal, they’re more likely to schedule an appointment.
The pilot study generated a 20% increase in cervical screenings, which resulted in Adler and his team receiving a $1.5 million grant from the National Cancer Institute to conduct the trial on a larger scale.
If a woman's screening results appear normal and no HPV is detected, her doctor may recommend visits every 3 to 5 years.
As for Divine, her doctors are recommending a hysterectomy. She said she has learned one important thing through all of this.
“When this is all said and done, I am going to put more time into myself,” Divine said.
