Cervical cancer can be stopped, and Isabel Scarinci intends to deliver the knockout blow 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
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.
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.
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 disease of poverty
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?”
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rotary.org/en/elimination-round
