Ask the expert: Q&A with Fox Chase Cancer Center’s Suzanne Miller, Ph.D.

Cervical cancer is a highly preventable cancer. In 2018, the World Health Organization (WHO) announced a global call to action to eliminate cervical cancer within the next century, with achievable goals to be reached by 2030.

Although many strides have been made in cervical cancer prevention, there is a long way to go, particularly among urban, medically underserved women who are less likely to get follow-up care after a cervical cancer screening requiring follow-up care. Cervical cancer can be prevented or controlled if it is detected in its earliest stages (when treatment is most likely to be successful). That’s why Suzanne Miller, Ph.D. of Fox Chase Cancer Center and a 2022 Prevent Cancer Foundation research grant awardee is analyzing a 21st century approach—text messaging—to encourage follow-up care.

We caught up with Dr. Miller during Cervical Cancer Awareness Month to discuss her ongoing research, what she’s learned so far and how prevention can play a role in everyone’s lives:

Q&A with Cervical Cancer Expert Suzanne Miller, Ph.D.

Your research project involves using culturally tailored text messaging to reduce urban cervical cancer disparities. What gave you the idea for this unique project?

As a clinical health psychologist, my attention has been drawn to the dramatic achievements being made in cervical cancer prevention. Yet, cervical cancer remains the fourth most common cancer and the fourth most common cause of cancer deaths in women globally. In the United States, Black and Hispanic women are diagnosed and die from cervical cancer at significantly higher rates than white women.  Despite efforts to increase cervical cancer screening and HPV vaccination, the number of women  diagnosed with advanced stage cervical cancer has been increasing and is particularly high among Black women. More than half of women who receive an abnormal test result from their cervical cancer screening do not attend their recommended follow-up appointment—a critical step to identify precancerous or cancerous cells.

Our research team found that a telephone call to patients to discuss the importance of attending the follow-up visit dramatically increased appointment attendance. But we were disappointed to learn that once the research ended, our telephone counseling program had not been integrated into routine clinic care.

We puzzled and agonized over learning that despite our scientifically based program, underserved women continued to experience barriers to attending their follow-up appointments. So, we dedicated ourselves to finding a better way of delivering our individually tailored messages . That’s when we had the “aha” moment: We decided to use text messaging, instead of staff-intensive telephone counseling, to deliver appointment reminder and interactive messages to help women attend their appointments and thereby improve cervical health inequities.

Women wanted culturally sensitive messages, so the messages were reviewed and edited based on our patients’ feedback. They have also been translated into the appropriate Spanish dialects of our patients.

One year into your research, what has surprised you the most? What have you learned?

One year into the research, we continue to be amazed by the richness of the data we have collected. This past year, we focused on learning more about the underserved patients who showed up for their follow-up appointments and asked for their thoughts on what had helped them attend. We learned that women who had attended their appointments had faced barriers  that made it difficult to come in, but they were able to find solutions to deal with these barriers.

Common barriers included securing transportation to the appointment or finding babysitters for their children. These women found solutions by reaching out to their friends and family to get the support they were lacking. They also used calendar alerts to remind them of the date and time of their upcoming visit. Women who attended the visit believed it was important to give ideas for solving these practical problems to those who had not been able to overcome the challenges to receiving recommended follow-up.

We learned that women who were unable to keep their appointments had the same challenges as those who came to the appointments. However, they had not yet found the solutions to overcome their challenges. It is our hope that, through the texting program, we can help these women deal with these challenges so they can receive the follow-up care they need.

What are some of the unique barriers urban, underserved individuals face when it comes to cervical cancer, and how is your research addressing these barriers?

In addition to practical barriers, there are three main barriers urban, underserved individuals face when it comes to cervical cancer:

(1) Not understanding that even though they might not have symptoms, there can still be cancerous cells in the cervix.

(2) Anxiety about dealing with an abnormal test result and what it might mean for their health.

(3) Not having skills for dealing with high anxiety or practical barriers (e.g., transportation, childcare, and scheduling issues).

Our program helps patients address these issues. For example, if a patient tells us that they have no symptoms, we send a text message to let them know that most early cervical cancers do not have symptoms. If a patient is anxious, we let them know that an abnormal Pap smear does not mean they have cervical cancer, but that regular follow-up is important for managing any problems.

Cervical cancer is a highly preventable cancer. In 2018, the World Health Organization (WHO) announced a global call for action to eliminate cervical cancer within the next century, with achievable goals to be reached by 2030. What needs to happen to meet these goals?

The medical care is there: what is needed are tailored, cultural strategies to help women to take full advantage of this care. That is where our telephone and texting programs come into play. These programs are designed to assess and address the barriers to follow up for an abnormal cervical test result. We have shown that our programs work: they increase follow-up attendance, allowing for more timely prevention and management interventions so that cancer risk is lowered.

What else can people do to incorporate preventive practices into their lifestyles to reduce their risk of cervical cancer?

People can prevent cervical cancer by getting the human papillomavirus (HPV) vaccine and receiving Pap tests and HPV testing as recommended by their doctor and attending any needed follow-up appointments. They can use calendar reminders, psych themselves up about these preventive practices by knowing they are doing the right thing for their health and their families, find ways to cope with their anxiety, reward themselves and come up with practical solutions to transportation, childcare and/or time challenges.

*Note: The Prevent Cancer Foundation seeks to use language that is inclusive of all and avoid unnecessary expressions of sex or gender. However, text that is based on research findings which specify gender, for example, uses the language dictated by the research. Guest authors, including researchers, medical experts and cancer survivors, may use the language they utilize for their work or are most comfortable with for their personal story.