College of American Pathologists
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  Underserved Populations and the
  Effect on Cervical Cancer
  Screening, Treatment and Survival




Posted August 23, 2007


The College of American Pathologists supports efforts to expand cervical cancer screening programs to include currently underserved populations of women in the United States.

Information Highlights

The Pap test – Background

  • The Pap test is the most effective cancer screening procedure known to medicine. Since its introduction after World War II, the death rate from cervical cancer plummeted more than 70 percent.
  • Pap tests can detect abnormalities in the uterine cervix before they develop into cancer.
  • Pathologists recommend that every woman begin having regular Pap tests to screen for cervical cancer three years after they become sexually active or by the age of 21.
  • Eighty percent of women who die of cervical cancer have not had a Pap test in the previous five years.

Risk Factors for Cervical Cancer

  • Lack of accessible health care to women in disadvantaged socio-economic groups is clearly associated with much higher rates of cervical cancer.
  • Smoking is associated with both cervical dysplasia, or the abnormal development of tissues and cells, and invasive cancer. It is also reported to increase the risk of contracting the Human Papillomavirus (HPV), which can cause cervical cancer.

The Importance of Early Detection

  • Patients with stage I disease at diagnosis have a greater than 90 percent five-year survival rate, whereas corresponding survival rates for stage II and III (more advanced cancer) are much lower. Therefore, early detection is the key to survival for women with cervical cancer.
  • Early detection occurs when regular Pap testing is performed. Combined with appropriate follow-up care, women with cervical dysplasia/carcinoma have significantly improved survival rates.
  • Regular screening for cervical cancer saves lives.

Barriers to Screening

  • Despite abundant healthcare resources available in the US, women in minority, socioeconomically disadvantaged, and rural populations have not benefited equally from Pap test screening.
  • Non-English speaking immigrant women face language and cultural barriers to Pap test screening, including modesty, religious concerns, and prohibitions against pelvic examinations by male clinicians. Lack of culturally sensitive screening and treatment environments are barriers to early cancer detections among some immigrant populations.
  • Cultural barriers that may impede a woman’s access to regular cervical cancer screening may be successfully overcome by the development of focused community programs that include community leaders.
  • Access to health care services is compromised among certain underserved populations. The barriers to well-organized Pap test screening and follow-up clinical services may be complex. Lack of access to regular Pap test screening and appropriate clinical follow-up care places underserved populations at significant risk for increased occurrence of and death from cervical cancer, a largely preventable and, if diagnosed early, highly treatable disease.

Potential Solutions

  • A key to reducing disparities in cervical cancer screening is to identify women with high disease risk and low screening rates. These include women with low income, underinsured or uninsured women, women in ethnic minority populations, non-English speakers, recent immigrants, and groups with cultural barriers to pelvic examination.
  • Focus groups reveal that women in underserved target areas respond well to individuals they trust. Cultural barriers can be addressed in individual or small group settings between outreach workers and women in the target community.
  • To decrease the risk associated with lack of follow-up, one therapeutic approach is the see-test-treat approach, under which Pap test interpretation, colposcopy and treatment are performed in a single visit.