PerspectiveIn the Journals

More than 8 million American women unscreened for cervical cancer

Show Citation

November 6, 2014

An estimated 8.2 million US women have not undergone cervical cancer screening within the past 5 years, and that statistic highlights the need to eliminate barriers to screening access, according to a CDC Vital Signs report published in Morbidity and Mortality Weekly Report.

“We know that cervical cancer screening works,” Ileana Arias, PhD, principal deputy director of the CDC, said during a press conference. “Today, we have additional screening and prevention tools, including testing for HPV — which could lead to cervical cancer — and the HPV vaccine. Together, cervical cancer screening and the HPV vaccine could prevent as many as 93% of all cervical cancers. Despite these important advances and opportunities, however, Vital Signs reports some sobering statistics and gaps in cervical cancer prevention.”

Ileana Arias, PhD

Ileana Arias

Vicki B. Bernard, PhD, of the division of cancer prevention and control at the CDC, and colleagues used the 2012 Behavioral Risk Factor Surveillance System survey to evaluate cervical cancer screening data from more than 70 million women.

Overall, 8.2 million (11.4%) women had not undergone cervical cancer screening within the previous 5 years. The age groups with the highest proportion of unscreened women were those aged 23 to 29 years (13.4%) and 60 to 65 years (12.6%).

The percentage of unscreened women was higher among those who were Asian/Pacific Islander (19.7%) and American Indian/Alaska Native (16.5%) compared with those who were Hispanic (11.7%), non-Hispanic white (10.8%) and black (9.2%).

About one-quarter of women without health insurance (23.1%) and without a regular health care provider (25.5%) had not undergone screening in the previous 5 years.

“These numbers show us that we continue to miss opportunities to prevent cervical cancer,” Arias said. “We need to close these gaps and make sure that all women get the recommended screening, especially among vulnerable populations.”

Cervical cancer incidence, mortality

Bernard and colleagues also evaluated cervical cancer screening and mortality data from the United States Cancer Statistics and the National Vital Statistics System. They identified 62,150 cases of cervical cancer in the United States from 2007 to 2011.

The overall incidence rate of cervical cancer during the study period was 7.8 cases per 100,000 women, and the mortality rate was 2.3 deaths per 100,000 women.

Cervical cancer incidence declined 1.9% annually, with even greater annual declines in Arizona, California, Georgia, New York and Rhode Island (9.9%). However, age-adjusted mortality rates did not decline at a significant rate (annual percentage change, –1.2%).

The South Census region was associated with a higher cervical cancer incidence (8.5 per 100,000 women) and cervical cancer mortality (2.7 per 100,000 women) compared with other Census regions.

Screening barriers

Data suggesting increased incidence and mortality among women who live in the South, as well as the lack of screening among women without a primary care doctor or insurance, suggest major barriers to cervical cancer prevention exist in the United States, researchers said.

“The southern states have a higher concentration of lower resource areas that have been shown to have higher rates of disease,” Arias said. “Barriers include structural barriers, such as transportation in rural areas and access, and subjective interpersonal barriers, such as fear of results, mistrust of the health care system and [a lack of] knowledge about the test.”

Primary care providers can improve cervical cancer screening rates, as well as adherence to adolescent HPV vaccination, Bernard said.

“We’re really encouraging primary care providers to do the screening now that all national organizations have a consensus of when to screen and how often,” Bernard said. “It is a very easy opportunity for primary care providers, especially in community health centers, to reach that never-screened population and for these individuals to be able to access cervical cancer screening easily.”

Although the Affordable Care Act will help remove financial barriers and increase access to primary care doctors, these data represent a call to action, researchers said.

“The bottom line is no women should ever die from cervical cancer,” Arias said. “Screening is proven to work, but not enough women are getting these recommended preventive services. We need to take action now to increase cervical cancer screening by educating women, eliminating barriers to care and seizing on existing opportunities to provide this preventive care.”

itj+ Infographic

itj+ Perspective

PERSPECTIVE
Maurie Markman

Maurie Markman

This can only be described as a most distressing report. The benefits of cervical cancer screening are absolutely clear, not only in preventing deaths from cervical cancer but also in rather substantially reducing the morbidity associated with treatment for more advanced disease (surgery, radiation and chemotherapy). It is particularly problematic that approximately one-quarter of women who are likely at greatest risk for developing cervical cancer — individuals without health insurance or a regular health care provider — have not undergone screening. Hopefully, this report will serve as a wake-up call to medical professionals and governmental officials that much more needs to be done to ensure that all women are able to benefit from this well-recognized, highly effective and low-cost cancer screening strategy.

Maurie Markman, MD
HemOnc Today Editorial Board member
Cancer Treatment Centers of America

Disclosure: Markman reports no relevant financial disclosures.