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Economic and other barriers keep millions from getting cervical cancer screening, CDC finds

Minnesota has one of the lowest cervical-cancer incidence rates and death rates among all the states.

Histopathologic image (H&E stain) of carcinoma in situ, stage 0.
Wikimedia Commons

Cervical cancer screening is one of the great medical success stories of the 20th century. Since the Pap test  (which can detect changes in cells in the cervix that may indicate early signs of cancer) was developed in the 1940s, the U.S. death rate from cervical cancer has plummeted by more than 70 percent.

Yet, as a new study published last week by the Centers for Disease Control and Prevention (CDC) makes clear, a substantial number of women continue to develop — and die from — cervical cancer in the United States. Each year, according to the latest CDC statistics, about 12,000 women are diagnosed with the disease and 4,100 die from it.

Those numbers are truly tragic, for about 93 percent of cervical cases are preventable, experts say.

One in 10 women is inadequately screened

In their new study, CDC researchers took a look at which women were and were not being adequately screened for cervical cancer — and, most important, why. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) survey, they found that 11.4 percent of U.S. women aged 21 to 65 (8.2 million women in total) in 2012 had not been screened for cervical cancer within the previous five years.

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Of those women, 25 percent had no health insurance and 25 percent had no regular health-care provider.

(As I’ve noted here before, the annual Pap test is a thing of the past. Current guidelines recommend that cervical cancer screening begin at age 21 and continue every three years until age 65. The interval can be extended to every five years for women aged 30 and older who are also being tested for human papillomavirus infection (HPV), a risk factor for cervical cancer. Pap tests are not recommended for women over 65, except for those women whose past test results put them at high risk for developing cervical cancer. They are also not recommended for women under the age of 21, or for women who have had hysterectomies. Unnecessary screening should be avoided, experts stress, for the test produces many false positives, which can lead to unnecessary treatments, including treatments that may affect future pregnancies.)

Other disparities

The new CDC study also found the following disparities in cervical cancer screening by age, race/ethnicity and geography:

  • The highest percentages of unscreened women are among women aged 23 to 29 years (13.4 percent) and 60 to 65 years (12.6 percent).
  • Among racial and ethnic groups, those with the highest percentages of unscreened women are Asians/Pacific Islanders (19.7 percent) and American Indians/Alaska Natives (16.5 percent). By comparison, 10.8 percent of white women and 9.2 percent of black women have not been screened.
  • The South has the highest percentage of unscreened women (12.3 percent), while the Midwest has the lowest (10.6 percent). The South also has the highest death rate from cervical cancer (2.7 deaths per 100,000 women per year). That compares with rates of 2.1 in the Northeast and West and 2.2 in the Midwest.

Minnesota, by the way, has one of the lowest cervical cancer incidence rates (6 cases per 100,000 women per year) and death rates (1.4 deaths per 100,000 women per year) among all the states. It also has one of the lowest rates of women who have not been screened for the cancer: 8.4 percent. By comparison, Mississippi has an unscreened rate of 14.9 percent and Texas a rate of 13.7 percent.

Both the incidence and death rates for cervical cancer are particularly high in southeastern Atlantic states, Appalachia, the lower Mississippi Valley and along the United States-Mexico border, the CDC study notes.

Free screening is key

The Affordable Care Act (ACA) should help reduce the number of women who are not being screened for cervical cancer. Under the law, cervical cancer screening is provided at no cost-sharing to women who are covered by Medicare and who are receiving health insurance under the Medicaid expansion, as well as for most women who have private insurance.

But, as the CDC researchers point out, “nonfinancial barriers, such as lack of awareness and lack of transportation also need to be addressed.” 

Of course, if the ACA gets rolled back or repealed, as Republican leaders say is one of their current priorities, then we may see the U.S. incidence and death rates from cervical cancer begin to rise rather than fall in coming years.

The CDC report was published in the agency’s Morbidity and Mortality Weekly Report, where you can read it in full.