Elimination round
Cervical cancer can be stopped, and Isabel Scarinci intends to deliver the knockout blow in Alabama
by Sam Worley
01 Nov 2024Loading component...
Lily Mayner is about to take the stage, and she’s nervous: “I am so stressed out right now,” she says, practically humming with energy. A chatty 17-year-old wearing torn jeans and a nose ring, Mayner is slated to speak at the Back to School Bash, an annual event in LaFayette, a small town near Alabama’s border with Georgia. It’s late July, hot and overcast; kids and their parents wander between a bouncy house and a hot dog stand. Mayner’s phone is nearly dead — a problem, since that’s where her speech is stored. But she transfers the text to somebody else’s device, and the show goes on.
“Good afternoon, everyone,” Mayner says to a distracted crowd. “Today we’re spreading awareness about a virus that is very prevalent in our community. This virus is called human papillomavirus. We know that this can be a very difficult topic to broach, but today it’s very important for us to talk about it to prevent illness.”
HPV is a highly common sexually transmitted infection that can cause six kinds of cancer, including cervical cancer. The reason Mayner is talking about it is that Chambers County, where LaFayette is located, has the highest rate of cervical cancer in Alabama, which itself is near the top nationally in both incidence of and mortality from the disease. A high school senior who hopes to become a psychiatrist, Mayner has been part of a health sciences class that’s worked to reverse these numbers, one cog in a larger machine devoted to stopping cervical cancer in Alabama.
The face of Operation Wipe Out is Isabel Scarinci, a behavioral psychologist and the vice chair of the Global and Rural Health Program in UAB’s Department of Obstetrics and Gynecology.
Image credit: Charity Rachelle
HPV is a highly common sexually transmitted infection that can cause six kinds of cancer, including cervical cancer. The reason Mayner is talking about it is that Chambers County, where LaFayette is located, has the highest rate of cervical cancer in Alabama, which itself is near the top nationally in both incidence of and mortality from the disease. A high school senior who hopes to become a psychiatrist, Mayner has been part of a health sciences class that’s worked to reverse these numbers, one cog in a larger machine devoted to stopping cervical cancer in Alabama.
Caught early, cervical cancer is treatable. But more than that, it’s preventable. In 2006, the U.S. Food and Drug Administration approved the first HPV vaccine, which could be administered starting at age 9. Since HPV causes virtually all cervical cancer cases, this means people can basically immunize themselves against it. “We really can eliminate a cancer,” says Nancy Wright, director of the Cancer Prevention and Control Division of the Alabama Department of Public Health, which has set up a booth at the Back to School Bash. “It’s a miracle.”
This hopeful prospect means Alabama can stake its claim to another superlative, far sunnier than high mortality rates: It’s the first state in the nation to devise a comprehensive plan for the elimination of cervical cancer. Launched statewide in 2023, Operation Wipe Out is a collaborative effort between the Alabama Public Health Department, the University of Alabama at Birmingham, and various partners, including the Rotary clubs of Birmingham and LaFayette.
The face of the initiative is Isabel Scarinci, a behavioral psychologist and the vice chair of the Global and Rural Health Program in UAB’s Department of Obstetrics and Gynecology. Sixty-two years old and a member of the Rotary Club of Birmingham, Scarinci has deep expertise in cancer prevention; she was recently tapped by the American Cancer Society to lead a task force developing a nationwide cervical cancer strategy. And she has deep personal experience that dramatizes the stakes of vaccination: As an infant in the early 1960s, Scarinci contracted polio when an epidemic struck the small Brazilian town where she grew up. When she was older, her mother took Scarinci — who, due to the infection, walks with a limp — door to door, exhorting her neighbors to immunize their children against the disease.
Now it’s Scarinci who’s spreading the word, with Operation Wipe Out aimed at multiple audiences. Young people and their parents, she insists, need to learn about vaccination. Before Operation Wipe Out went statewide, Scarinci coordinated an early version in Chambers County that boosted the full HPV vaccination rate among county school district students to 60 percent in 2024, including 82 percent at one of two high schools. The broader county vaccination rate in 2023 for all eligible young people was much lower: Only about 30 percent of those ages 9 to 18 completed their HPV shots.
At an Operation Wipe Out event in Alabama’s Chambers County, Scarinci worked alongside high school student
Image credit: Sam Worley
At an Operation Wipe Out event in Alabama’s Chambers County, Scarinci worked alongside Butch Busby of the Rotary Club of LaFayette. Image credit: Sam Worley
Adult women, meanwhile, need regular testing to identify cell changes before they become lethal. At the Back to School Bash, Scarinci, wearing a blue Operation Wipe Out T-shirt, is stationed at the LaFayette Rotary club’s tent, trying to sign up women for screening appointments at an upcoming mobile clinic event. “When was your last cervical cancer screening?” she asks one woman who stops by. She gives the woman the rundown. “Oh, girl, let me tell you,” she says. “It’s the only cancer we can truly prevent.” Another woman, towing a couple of kids, has what appear to be needle marks on her arms. She has survived cervical cancer, she tells Scarinci, who offers to connect her to a cancer survivors support group.
Scarinci has been doing this kind of work in underserved Alabama communities for decades. Another program she spearheaded has connected thousands of Latina women with cancer screenings. Sitting beneath the tent, Scarinci remembers one of the first Spanish-language events she organized. Half the people with screening appointments never came. Her husband said to her: “Why are you killing yourself? They’re not interested.”
But the next morning she got a call: One of the few who made the appointment had been diagnosed with cancer — early-stage, totally treatable. A wry look spreads across Scarinci’s face, “And I said, OK, God, I got the message.”
A few days later, in her office in Birmingham, Scarinci is still thinking about the woman with needle marks on her arm. Most cervical cancer is a “disease of poverty,” she says. It’s preventable if people have access to vaccination and to reliable medical care. That’s part of the reason Alabama, a poor, rural state with a tattered social safety net, has been hit so hard. For Scarinci, though, Operation Wipe Out began not in Chambers County but across the globe in Sri Lanka, where she became involved in a similar project sponsored by the Rotary Club of Birmingham.
In the past 75 years, the medical understanding of cervical cancer and its prognosis have changed seismically. “Pre-World War II, more women in this country died from cervical [and uterine] cancer than from breast cancer,” says Warner Huh, a gynecological oncologist who leads UAB’s OB-GYN department. The 1940s saw the widespread adoption of the Pap smear, a test that collects cells from the cervix to detect potentially cancerous ones. But it wasn’t until around the turn of the 21st century that physicians came to a deeper understanding of the relationship between HPV and cervical cancer — and then, with the HPV vaccine, the means to sever that link. “People in the 2000s started making the connection,” Huh says. “If we screened well, with a better test, and vaccinated, there’s very little reason why any woman should develop cervical cancer.”
In 2018, the World Health Organization launched a global initiative to eradicate cervical cancer. That same year, before Scarinci had joined Rotary, she and a colleague, oncologist Edward E. Partridge, who belonged to the Rotary Club of Birmingham, began talking with his fellow club members about teaming up with counterparts in Sri Lanka on their own project. Sri Lanka is a small island and its people are relatively well-educated, the two reasoned. “We said, This is an opportunity,” Scarinci recalls. “This is a country that can eliminate cervical cancer.” She and Partridge suggested that the country’s Ministry of Health boost childhood vaccination and revise its screening guidelines, using not just Pap smears but also tests for HPV infection.
But they didn’t communicate this directly. “I think a lot of governments will resent the United States’ influence,” Scarinci says. Instead, she emphasizes a holistic approach to public health. Doctors and governments alone can’t heal society; they need buy-in from the people who make up that society, and from the institutions that can foment social bonds, like the local Rotary club. Scarinci could offer “evidence-based strategies”; it would be up to the Sri Lankans to take that information to their government.
Vaccination campaigns are nothing new to Rotary. The WHO introduced a global immunization program in 1974 that targeted six childhood vaccine-preventable diseases, including polio. But a decade after that, polio was still paralyzing a thousand children a day worldwide. The technology was there to combat the disease, but governments needed civil society to strengthen access to, and build trust in, the vaccine. Launched in 1988, the Global Polio Eradication Initiative included governmental and nongovernmental bodies, chief among them Rotary International. According to the GPEI, global polio rates have declined 99.9 percent since the project’s beginnings.
The world today is in a similar position with cervical cancer: The technology is there; the disease can be eliminated. But Scarinci poses the question that must first be answered before all that can happen: “How do we get these tools in the hands of those that need them the most?”
As a Rotaractor in Brazil, Scarinci, a polio survivor, administers the polio vaccine in 1985.
Courtesy of Isabel Scarinci
It was because of Sri Lanka that Scarinci — who, as a young person in Brazil, had been a member of Rotaract — ended up joining the Rotary Club of Birmingham. Still, despite her success in the South Asian country, something was bothering her. In 2019 she approached Philippe Lathrop, her club’s president at the time. “I said, I feel like an imposter,” she recalls. “Here we are working in Sri Lanka, patting ourselves on the back, when we have a problem right here.”
OK, he said, what do you want to do? Remembering the exchange, Scarinci laughs. She didn’t actually have a plan. “But give me time,” she told him. “I’ll come up with something.” That something would become the whole state of Alabama, starting in Chambers County.
Rural poverty isn’t merely a subject of academic interest for Scarinci. She was born in 1962 in Cambará, a small Brazilian town about 200 miles west of São Paulo. Her parents grew up “dirt poor,” she says. Her family has told Scarinci that she takes after her mother, who was strong-willed and service-oriented. “That woman,” Scarinci says. “She knew how to do things.”
When she was 8 months old, Scarinci contracted polio. She had received the first vaccine dose of a two-part series but was under the weather when the time came to get a second dose. Don’t worry about it, the doctor told her mother; it can wait another month. But in the interim, a polio epidemic struck, and Scarinci was among its victims. When she was older, her mother took her door to door with a cooler filled with vaccines. Scarinci would deliver a speech about her condition, and then her mother would say, “You don’t want this to happen to your child.”
Scarinci knew from a young age that she wanted to be a psychologist. She saw it as a way to help others, and she has an easy gift for conversation. After finishing college and working in a charity hospital in Brazil, Scarinci received a scholarship to study for a year in the United States. She ended up pursuing a PhD at Louisiana State University in Baton Rouge, where she met her husband. She planned on going back to Brazil but first wanted one more notch in her belt: “I know it’s very shallow,” she said. “I want a Harvard diploma on the wall.”
At age 6, Isabel Scarinci participates in a fashion show in her native Brazil.
Courtesy of Isabel Scarinci
She landed a one-year clinical residency at the Ivy League school. At a party for new residents, she chatted with an older psychiatrist wearing a bow tie. Southerners, he told her, don’t do very well at Harvard. Oh? she asked. How many Southerners have you had? “He said, We had two that didn’t finish,” she recalls, a little gleam in her eye. “I took my beer and I toasted and I said, When you increase your sample size, we’ll talk.”
She was getting a taste of the chauvinism sometimes directed at the South, where Scarinci returned, settling in Birmingham and ultimately staying in the United States for good. Alabama’s status as a kind of national punch line came up more than once in interviews with Scarinci and others, who said that even the compliments they received for their plans were often tinged with condescension: If Alabama can do it ...
Still, there’s a legitimate question here: Why Alabama, and not one of the other 49 states? The answer seems to be simply that Alabama happened to have the right combination of experts and enthusiasts, in the right places: UAB’s world-class medical center. A supportive state public health apparatus. The Rotary Club of Birmingham and other community partners that have stepped up to forge connections between these institutions and the diffuse constellation of rural health care providers and vulnerable communities that need their help.
Plus one particularly energetic public health advocate. “Like most things, if you don’t ask, then nothing happens,” as Warner Huh puts it. “What Isabel did was, she made the ask.”
Turning her attention from Sri Lanka to Alabama, Scarinci decided to start in Chambers County, where the need was greatest — and where she knew not a soul. Rotary provided the necessary introductions. In 2021, giving a talk to the club in LaFayette, she met Butch Busby, who had recently retired as the town’s only dentist. A past club president, Busby agreed to coordinate the campaign locally. While those efforts got underway, the Alabama Department of Public Health’s Nancy Wright had already been working to increase her own division’s focus on cervical cancer. She approached Huh and Scarinci; together the group decided to convene a summit, with the Birmingham Rotary club and other community partners joining the campaign.
Friends in the fight against cervical cancer: (from left) Warner Huh, a gynecological oncologist who chairs the OB-GYN department at the University of Alabama at Birmingham; Nancy Wright, director of the Cancer Prevention and Control Division of the Alabama Department of Public Health; Scarinci; and Bruce Rogers, president of the Rotary Club of Birmingham.
Image credit: Charity Rachelle
Held in fall 2022 in Birmingham, the summit marked the statewide beginnings of Operation Wipe Out. Scarinci and Huh knew the conversation needed to be led by those on the front lines. “One of the life lessons I learned from that summit is, you cannot assume what people and providers and patients are going through,” Huh says. “You have to understand what those challenges are and then create strategy, not create strategy and then force it on people.” They heard that rural providers felt overlooked, that they lacked access to resources, that their patients had no local hospitals to go to in the event of abnormal screening results.
“There are no OB-GYNs here in LaFayette,” Busby says. “Most OB-GYNs are in Auburn-Opelika,” two towns about 25 miles away from LaFayette. “Now for me, that’s just a ride down the road. But I know two people right now: They go to church with me; they’re elderly. They’re on a very small fixed income. They don’t have vehicles.”
The Wipe Out strategy that emerged from the summit has three prongs: vaccination, screening, and follow-up care. The strategy involves both increasing access to medical care — through schools, county health departments, mobile clinics, and the like — and engaging trusted institutions in rural communities to help spread the word. “There’s no money on the table — real money,” Scarinci says. “The beauty of this is that it’s a mobilization of people who believe in the mission.” In this sense, Scarinci hopes to prove a model that can be replicated by states, public health advocates, and Rotary clubs elsewhere.
The plan sets 2033 as a target date, but it will take longer to see results: Kids who get vaccinated now won’t be at risk for cervical cancer for another couple of decades. And in the very short term, increased screenings may mean a rise in reported cases.
Still, victory is fully achievable. Scarinci has seen one human disease, smallpox, eradicated in her lifetime and others, like polio, achieve near-eradication. She wants to continue that progress, a way of honoring her mother’s legacy. “I asked her before she died: Did you ever think we would eliminate polio?” Scarinci recalls. “She said, ‘Not at the time. But I was doing my part.’ She saw the end of it, almost, before she died. That’s pretty cool. To say, ‘I made a contribution to that.’ Not many people can do it.” But there are those who definitely do.
This story originally appeared in the November 2024 issue of Rotary magazine.