America’s health professionals generally do a good job of screening for cervical cancer (search), but they could do even better, says Women In Government (search), a nonprofit lobbying group.
All states have a significant opportunity to improve their performance in cervical cancer prevention by making screening a legislative and public health priority, says a report by the group.
In the U.S., cervical cancer is the third most common reproductive tract cancer; in some parts of the world it is still considered the most common cancer in women. The most common cause of this cancer is infection from certain types of the human papillomavirus (search) (HPV) that prompt abnormal changes in cervical cells.
Medical experts know the cause, and technology exists for screening. With widespread access to and utilization of screening services, this disease is almost preventable, they write.
The American Cancer Society predicts that 10,370 American women will be diagnosed with cervical cancer this year and that about 3,700 will die of the disease.
The Pap test (search) is routinely used to screen for cervical cancer. It involves taking a sample of cervical cells and looking for early signs of abnormalities. It has had major success in screening for and prevention of the disease. Since initiating Pap screening programs, cervical cancer death rates have decreased by 75 percent in the U.S.
The Pap screening method works. In women screened periodically, Pap smears identity between 50 and 85 percent of cervical cancer or early signs of the disease, according to the report.
A test can also detect HPV infection and determine what type of HPV is present. The testing might further help reduce the rates of cervical cancer.
Since the HPV virus is sexually transmitted, women are advised to start Pap screening within three years after becoming sexually active or by age 21, whichever comes first. Most cervical cancer patients are in their 40s and 50s.
Recently, Women in Government released “A Call to Action: The ‘State’ of Cervical Cancer Prevention in America.” The report’s publication was facilitated by Digene, which makes an HPV test.
Grading the States
All states do a fair, good, or very good job of testing for cervical cancer, but none earned an “excellent” rating, says the report.
The state rankings were based on rates of cervical cancer and deaths from the disease, access to and utilization of tests, and policies. Four states — Massachusetts, Illinois, Maryland, and North Carolina — earned a “very good” rating. A “good” grade went to 26 states, while 21 states were rated as “fair.”
Massachusetts had the highest score. Tennessee and Texas scored lowest, following Wyoming and Nevada, although these states all received “fair” grades.
Geographic Differences
Screening rates varied from state to state. For instance, the percentage of women aged 18-64 who reported being screened within the last three years varied from 77 to 89 percent. Women aged 18-64 have the highest cervical cancer risk.
Insurance was an important factor in whether women were screened for the disease. In 2001, 31 percent of uninsured women didn’t get a Pap test, compared with only 15 percent of women with health insurance.
Cervical cancer and its death rates also varied greatly from state to state. Nationwide, cervical cancer strikes about 9 out of every 100,000 women. The average U.S. mortality rate is 2.7 per 100,000 women.
Some states beat those numbers.
Cervical cancer rates were lowest in North Dakota, where the incidence rate was 5.5 cases per 100,000 women. It was highest in Washington, D.C. (14.3 per 100,000 women).
Death rates also vary. Some states have both the high incidence and the high death rates: Texas, New Mexico, West Virginia and Arkansas. Mortality rates ranged from 1.3 to 6.1 per 100,000 women. The rate was highest in Washington, D.C. States with the lowest death rates include Minnesota, Wisconsin, Massachusetts, Connecticut, and Washington.
Policy Notes
The Pap test, in use for 60 years, is almost universally available. It’s covered by every state Medicaid program.
However, only 23 states and Washington, D.C., have some type of Pap screening coverage requirement for public and private insurers, says the report. HPV testing is covered without restrictions when medically necessary in 46 states and Washington, D.C., but it’s often not part of routine screening.
“Only North Carolina mandates coverage for all FDA-approved cervical cancer screening technologies, including HPV testing,” says the report. Rankings will be updated in 2006.
By Miranda Hitti, reviewed by Brunilda Nazario, MD
SOURCES: Women In Government, “A Call to Action: The ‘State’ of Cervical Cancer Prevention in America.” American Cancer Society, “Overview: Cervical Cancer — How Many Women Get Cancer of the Cervix?” WebMD Medical Reference from Healthwise: “Cervical Cancer: Topic Overview.” WebMD Medical Reference from Healthwise: “Cervical Cancer: Exams and Tests.” Digene, “About Digene.” News release, Women In Government.
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