From Palliation to Prevention: The Role of Pharmacists in Reducing Cervical Cancer Burden in Iowa
Written by: Lorin Fisher, PharmD, BCACP | Clinical Assistant Professor, The University of Iowa College of Pharmacy
As a pharmacist practicing in a palliative care clinic, I routinely care for individuals living with cancer and its complications. Approximately 80% of the patients I see in clinical practice are affected by some form of malignancy, and my work centers on managing cancer-related pain and other distressing symptoms, clarifying disease trajectory, and supporting patients as they define and revisit their goals of care.
This perspective offers a sobering view of what cancer looks like when it is diagnosed at advanced stages or recurs despite treatment. It also reinforces a critical reality: many of the cancers we compassionately palliate could be prevented—or detected earlier—through effective, accessible public health strategies.
January is Cervical Cancer Awareness Month, a timely opportunity to highlight how pharmacists can meaningfully contribute to cervical cancer prevention in Iowa, particularly through HPV vaccination and emerging screening innovations in community pharmacy settings.
Cervical Cancer: A Preventable Disease with Ongoing Impact
Cervical cancer remains one of the most preventable cancers, yet it continues to affect thousands of individuals. In the United States, approximately 11,500 new cases of cervical cancer are diagnosed annually, and more than 4,000 people die from the disease each year. Persistent infection with high-risk types of human papillomavirus (HPV) is responsible for more than 90% of cervical cancer cases, making HPV prevention a cornerstone of cancer control.
In Iowa, HPV-related cancers represent a meaningful and preventable burden. According to the Iowa Department of Health and Human Services, HPV causes an estimated 262 cancers among Iowans each year, including cervical cancer. Despite the availability of effective preventive tools, cervical cancer incidence and screening participation remain ongoing concerns across the state, particularly in rural and medically underserved areas.
Vaccination and screening are highly effective preventive tools. HPV vaccination can prevent up to 90% of HPV-related cancers when administered according to recommended schedules. Cervical cancer screening, via Pap testing and primary high-risk (hr) HPV testing, allows for detection and treatment of precancerous lesions before invasive cancer develops.
The U.S. Preventative Service Task Force (USPSTF) recommends routine cervical cancer screening for individuals with a cervix aged 21 to 65 years. For individuals aged 21-29 years, screening is recommended every three years with cytology (Pap testing). For individuals aged 30-65 years, screening options include primary hrHPV testing every five years, cytology every three years, or co-testing every five years. All recommended screening approaches rely on detection of hrHPV or HPV-associated cellular changes and are effective at identifying precancerous lesions.
Despite these advances, gaps in vaccination and screening persist. Rural residence, limited access to primary care, transportation challenges, lack of insurance, and socioeconomic factors all contribute to lower uptake of preventative services, particularly in states with large rural populations like Iowa.
Lessons From Palliative Care Practice
In palliative care, specialized medical care for people living with a serious illness, the consequences of delayed diagnosis are tangible. Advanced or recurrent cervical cancer can be associated with significant symptom burden, including chronic pain, fatigue, bleeding, bowel or bladder dysfunction, sexual health concerns, and psychological distress. These symptoms frequently interfere with patients’ ability to work, care for loved ones, and maintain independence.
Conversations about goals of care often include reflection on whether earlier screening or vaccination might have altered the disease course. While palliative care plays a vital role in alleviating suffering, these experiences underscore the importance of prevention and early detection efforts that reduce the likelihood of presentation with advanced disease.
Community Pharmacies as Access Points for Prevention
Community pharmacies represent one of the most accessible health care settings in Iowa. National data suggest that approximately 90% of Americans live within five miles of a community pharmacy. In a predominantly rural state like Iowa, pharmacies often serve as one of the most consistently available points of health care access. Extended hours, walk-in availability, and established patient relationships position pharmacies as critical partners in preventive care delivery.
Pharmacists already contribute to cervical cancer prevention through HPV vaccination. In Iowa, pharmacists are authorized to administer HPV vaccines, increasing convenience for adolescents and adults who may otherwise face barriers such as limited clinic availability or transportation challenges. Despite this accessibility, HPV vaccination rates in Iowa remain below national goals. In 2024, only about 45% of Iowa adolescents had completed the HPV vaccine series, compared with the Healthy People 2030 target of 80%. Each HPV vaccine administered represents an intervention to reduce further cancer diagnoses and the associated physical, emotional, and financial burden.
Expanding the Model: Cervical Cancer Self-Screening
Recent changes to the Iowa Pharmacy Practice Act in 2025 have expanded opportunities for pharmacists to engage in innovative preventive health services. One emerging area of interest is cervical cancer self-screening.
Self-screening involves patient-collected vaginal samples that are tested for hrHPV. Evidence indicates that hrHPV self-collection has comparable sensitivity to clinician-collected samples for detecting hrHPV and is an acceptable collection method for patients. This approach may be particularly beneficial for individuals who face barriers to traditional pelvic examinations, including limited access to clinicians, past trauma, cultural considerations, or competing work and caregiving responsibilities.
Community pharmacies could serve as trusted, convenient locations for education, distribution, and support of self-screening programs. With appropriate training, protocols, and referral pathways, pharmacists could help facilitate timely follow-up for abnormal results while maintaining patient privacy and autonomy.
As a Clinical Assistant Professor at the University of Iowa College of Pharmacy, I am committed to further examining this model through research and implementation efforts. Studying feasibility, patient acceptability, and clinical outcomes will be essential to determining how pharmacy-based self-screening services can expand access to cervical cancer screening.
Conclusion and Call to Action
My work in palliative care consistently reinforces the importance of preventing advanced disease whenever possible. While symptom management and serious illness conversations remain essential components of comprehensive cancer care, evidence-based prevention strategies offer the greatest opportunity to reduce morbidity and mortality.
During Cervical Cancer Awareness Month, I encourage Iowans to speak with their pharmacist about HPV vaccination and to stay current with recommended cervical cancer screening. I also remain committed, through my academic role, to advancing research on pharmacy-based hrHPV self-screening models that may improve access to screening services across Iowa.
Continued investment in pharmacist-led prevention initiatives has the potential to strengthen cervical cancer prevention efforts and improve outcomes for Iowans.