CDC Leads Effort to Improve Access to Cervical Cancer Screening

In March, a joint CDC and American Cancer Society collaboration began work on a consensus guide for cervical cancer screening. Several studies looking at over-screening and how to reach under-screened women will be published soon. One such study demonstrates how STD clinics have been able to identify and test women who have never or rarely had a Pap smear. Another looks at barriers to older African-American women who are eligible for free screening but failed to enroll. Over-screening has become a critical issue, particularly in government programs where cost-effectiveness is scrutinized, since every dollar spent on over-screening could have been used to reach high-risk women who have never been screened.

A CDC meeting in November 2001 was convened specifically to focus upon ways of reducing the health disparities in high cervical cancer mortality regions. Data presented at this meeting showed that about 29 percent of women who develop invasive cervical cancer never had Pap smears, and another 24 percent had not had one in the past four years. In some areas of the country, more than half of women over 65 have not had a Pap in the previous three years, even though half of cervical cancer deaths are in women of this age.

The CDC's early detection program has increased coverage of women rarely or never screened from 18 percent to 23 percent in the past three years. However, coverage varies dramatically by program area. "The hidden and bad news is that we have counties that year after year have the highest cervical cancer mortality rates in the nation," said Jon Kearner, PhD, a cancer researcher at the National Cancer Institute.

The CDC has pilot tested a new approach to providers that explains its screening policy, emphasizing the need to reach those never tested and the need to reduce over-screening. The pilot indicated that providers changed their attitudes toward screening after hearing the talk. The program has been offered to medical advisory committee chairs, and research data are included in the presentation. In addition, the CDC is completing a low- literacy handout on cervical cancer screening that should be available in the next few months.

"We are trying to help move this policy forward on a lot of levels," says Judith Hannan, RN, MPH, chief of education and training at the CDC's National Center for Chronic Disease Prevention.

Back to other CDC news for April 12, 2002

Previous Updates