Cervical Cancers Preventable; More Screening and Vaccination Needed

Cervical cancer is a top cancer cause for women, currently ranking number 13 for new cancer cases and number 14 for cancer deaths. Every year, 12,000 women get cervical cancer and 4,000 women still die from it. While deaths from cervical cancer have fallen since the Pap test was introduced in 1950, between 2007 and 2011, the death rate remained stable, not yet reaching the healthy people 20/20 objective.


HPV vaccination and cervical cancer screening combined can prevent as many as 93 percent of new cervical cancer cases. Despite evidence that cervical cancer screening saves lives, about eight million women ages 21 to 65 years have not been screened for cervical cancer in the past five years, according to a new report from the CDC. More than half of new cervical cancer cases occur among women who have never or rarely been screened.


“Every visit to a provider can be an opportunity to prevent cervical cancer by making sure women are referred for screening appropriately,” said CDC Principal Deputy Director Ileana Arias, Ph.D. “We must increase our efforts to make sure that all women understand the importance of getting screened for cervical cancer. No woman should die from cervical cancer.”


Cervical cancer is the easiest gynecologic cancer to prevent, with regular screening tests and follow-up. Two screening tests can help prevent cervical cancer or find it early. First, the Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. Second, the HPV test looks for the virus (human papillomavirus) that can cause these cell changes.


The Pap test is one of the most reliable and effective cancer screening tests available. Women 30 years old or older, may choose to have an HPV test along with the Pap test. Both tests can be performed at the same time. If a woman’s test results are normal, her chance of getting cervical cancer in the next few years is very low.


The Pap test is recommended every three years for all women between the ages of 21 and 65 years old, and can be done in a doctor's office or clinic. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to widen the vagina. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are then placed on a slide or in a bottle of liquid and sent to a laboratory. The laboratory will check to be sure that the cells are normal. The cells collected during the Pap test will be tested for HPV at the laboratory.


Using the human papillomavirus (HPV) vaccine as a primary prevention measure could also help reduce cervical cancer and deaths from cervical cancer. Another recent CDC study showed that the vaccine is underused; only one in three girls and one in seven boys had received the 3-dose series in 2013. The HPV vaccine is recommended as a routine vaccine for children 11 to 12 years old. Modeling studies have shown that HPV vaccination and cervical cancer screening combined can prevent as many as 93 percent of new cervical cancer cases.


As part of the CDC study, researchers reviewed data from the 2012 Behavioral Risk Factor Surveillance System to determine women who had not been screened for cervical cancer in the past five years. They analyzed the number of cervical cancer cases that occurred during 2007 to 2011 from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. Cervical cancer deaths were based on death certificates submitted to the National Vital Statistics System.


The key findings of the study included that in 2012, 11.4 percent of women reported they had not been screened for cervical cancer in the past five years; the percentage was larger for women without health insurance (23.1 percent) and for those without a regular health care provider (25.5 percent). Additionally, the percentage of women not screened as recommended was higher among older women (12.6 percent), Asians/Pacific Islanders (19.7 percent), and American Indians/Alaska Natives (16.5 percent). From 2007 to 2011, the cervical cancer incidence rate decreased by 1.9 percent per year while the death rate remained stable. The Southern region had the highest rate of cervical cancer (8.5 per 100,000), the highest death rate (2.7 per 100,000), and the largest percentage of women who had not been screened in the past five years (12.3 percent). Cervical cancer incidence rates are higher for black and Hispanic women than for white women, and death rates are higher for black women.


Even with improvements in prevention and early detection methods, most cervical cancers occur in women who are not up-to-date with screening. Addressing financial and non-financial barriers can help increase screening rates and, in turn, reduce new cases of and deaths from this disease. Women with a low income or no health insurance may be able to get a free or low-cost Pap test through the National Breast and Cervical Cancer Early Detection Program.


Barriers to regular screening include structural barriers, such as access and transportation in rural areas, and subjective interpersonal barriers, such as feared results, mistrust of the health care system, and lack of knowledge about the test. Researchers expect that the Affordable Care Act will help with financial barriers and will help women get connected with a regular doctor. However, it will not address additional individual and systemic barriers to women.


The CDC’s National Breast and Cervical Cancer Early Detection Program provides low-income, uninsured, and underinsured women access to breast and cervical cancer screening and diagnostic services in all 50 states, the District of Columbia, five U.S. territories, and 11 American Indian/Alaska Native tribes or tribal organizations.


See the CDC Announcement on Screening for Cervical Cancer


See the CDC Announcement on Stopping Deaths from Cervical Cancer


See the CDC Report on Cervical Cancer Statistics


See the CDC Vital Signs Report on Preventing Cancer


See also Medical Law Perspectives, October 2012 Report: Mistakes in Diagnosing Cancer: Liability Concerns for Misdiagnosis, Failure to Diagnose, and Delayed Diagnosis