Shement茅 Jones knew something wasn鈥檛 right. Her back hurt. She felt pain during sex.
She said she kept telling her doctor something was wrong.
Her doctor told her, 鈥淛ust wash your underwear in Dreft,鈥� Jones said, referring to a brand of detergent.
Within months of that 2016 appointment, Jones, who lives in a suburb of Jackson, Mississippi, was diagnosed with stage 3 cervical cancer. She underwent a hysterectomy then weeks of radiation therapy.
鈥淚 ended up fine,鈥� said Jones, now 43. 鈥淏ut what about all the other women?鈥�
The question is especially pertinent in Jones鈥� home state, which had the nation鈥檚 second-highest age-adjusted cervical cancer mortality rate, women and girls annually from 2016 through 2020, behind only Oklahoma, according to National Cancer Institute data. And, for non-Hispanic Black women such as Jones, the rates in the state are even higher 鈥� 3.7 deaths per 100,000 people. This all translates to about 50 avoidable deaths of Mississippi women from cervical cancer each year in this largely rural state.
Health care experts said such a high death rate from a cancer that is preventable, detectable, and successfully treatable when found early is a warning sign about the general state of health care in Mississippi.
鈥淭hey desperately need help there,鈥� said , a professor of oncology at Johns Hopkins School of Medicine and an expert on health disparities. 鈥淧olitical leadership is incredibly important in turning this around, and in Mississippi, the political leadership don鈥檛 give a damn.鈥�
Despite the beauty of Mississippi, from the rolling hills of the to white-sand beaches on the Gulf of Mexico, and the cultural renown of its famous musicians and storytellers, the state鈥檚 reputation is marred by its high rates of poverty. People who live there are accustomed to being the butt of jokes, but it hurts.
鈥淥ften Mississippi gets represented poorly,鈥� said , an OB-GYN at the University of Mississippi Medical Center in Jackson.
Recently the state has reeled from crisis after crisis. As recently as March, tornadoes and other severe weather and caused extensive damage. Last year, the , the state capital, was undrinkable for months because of treatment plant failures.
On just about any measure of health, Mississippi ranks near or at the bottom. Nationally, an of people under 65 lack health insurance, but in Mississippi it is . Deaths from , , , and many other illnesses are among the highest per capita in the country.
The high rates of poverty contribute to the high cervical cancer mortality, health experts said. About of Mississippians 鈥� nearly 1 in 5 鈥� live in poverty, while nationally it is .
鈥淚f I had to pinpoint what that鈥檚 from, it鈥檚 from lack of education,鈥� said Ridgway, referring to a lack of knowledge about regular cervical cancer screening, which the U.S. Preventive Services Task Force for women 21 to 65.
But it likely goes far beyond that, many health experts said. Doctors may be less likely to stress preventive care to less educated women and women of color, .
鈥淭here鈥檚 a big difference in the quality of care,鈥� said , a professor of public health at the University of Virginia who has extensively studied oncology care in Appalachia and other underserved areas.
In her case, Jones said, she could not get her doctor鈥檚 office to return her calls in a timely manner. She was concerned about her symptoms.
鈥淚 felt I wasn鈥檛 listened to. I called her more than she called me,鈥� Jones said of her doctor. 鈥淚 was going to my appointments, and I was ignored.鈥�
And getting access to any care 鈥� let alone quality, culturally competent care from providers who acknowledge a patient鈥檚 heritage, beliefs, and values during treatment 鈥� may be difficult.
Most of the state鈥檚 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, a vice president in Mississippi for the .
Low-income rural residents often lack reliable transportation, she said, and even if they own a vehicle, they lack gas money. They often can鈥檛 find 鈥� or pay for 鈥� someone to take care of their children so they can go to the doctor. Women with low-paying jobs often lack the time to drive to a clinic in a distant town, or the ability to take off from work without losing pay.
鈥淲omen who work and take care of children often have a huge burden of responsibility,鈥� Ridgway said. 鈥淭hey don鈥檛 have time or the money.鈥�
Many also don鈥檛 have insurance. While the Affordable Care Act has in Mississippi, an estimated additional could have coverage through Medicaid if the state expanded eligibility for the federal-state insurance program for low-income Americans. But the state is that have not agreed to expand coverage to more adults.
Mississippi Gov. Tate Reeves, a Republican up for reelection this year, is opposed to expansion. His Democratic challenger, Brandon Presley, a second cousin of the music legend Elvis, favors it. Polls show Presley
Without expansion of Medicaid, people who have low incomes are often left to decide between forgoing insurance and purchasing a policy through the Affordable Care Act marketplace if they cannot get insurance through employment. Even if they qualify for subsidized marketplace plans, they may face high deductibles or copayments for visits, health experts said. That often means going to the doctor only when sick. Preventive care becomes a luxury.
鈥淵ou save your health care dollars for when you are sick or your kids are sick,鈥� said Thompson, of the American Cancer Society.
But regular medical care can make all the difference with cervical cancer. Pap tests have long helped detect abnormal cervical cells that could turn malignant. Brawley said the test is 鈥渙ne of the best鈥� cancer screening tests because of its accuracy.
In 2006, were first approved by the FDA. The vaccines guard against the common sexually transmitted infection called the human papillomavirus, which causes nearly all cervical cancers. The HPV vaccine is most effective when administered before a person has become sexually active; the federal recommendation is to get the shots by age 12.
Only a handful of places in the U.S. 鈥� including Hawaii, Rhode Island, Virginia, Puerto Rico, and the District of Columbia 鈥� require the vaccines to attend school. California has that initially would have required that middle schoolers get the shots, but the bill has since been watered down to recommend them instead.
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 there were up to date on HPV vaccination as of 2022, , compared with an estimated 63% nationally.
Thompson said she thinks many parents are hesitant to have their children vaccinated because they believe it would encourage sexual activity.
鈥淭his is an anti-cancer vaccine,鈥� Thompson said.
Krista Guynes, director of the at the Mississippi State Department of Health, said the state has several efforts underway to better inform women about the need for screening. It also has clinics for uninsured women. In partnership with the National Cancer Institute and University of Mississippi Medical Center, she said, the health department is to evaluate 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.
鈥淚 would just like to say to every woman, 鈥楪et the vaccine.鈥� The vaccine will make the difference, so they won鈥檛 have to be told, 鈥業鈥檓 sorry, you have cancer.鈥欌��