This article is cross-posted from and in partnership with the National Latina Institute for Reproductive Health, and is published as part of a series on cervical cancer.
See all our coverage of Cervical Cancer Awareness Month 2012 here.
One of the first pieces of information you come across when you start to read about cervical cancer is that it is 100 percent preventable if caught and treated in the precancerous stage – yes, you read that right, 100%. So then why in the United States are more than 12,000 women a year still diagnosed with cervical cancer and why do more than 4,000 women a year die of cervical cancer? While many factors contribute to these unnecessarily high numbers, problems with cervical cancer screening practices are a major contributor.
I’ll take a few steps back – the reason cervical cancer is described as 100 percent preventable is two-fold. First, cervical cancer progresses extremely slowly and second, there are treatments that are highly effective when the disease is in an early stage. The key then is to catch it early, which brings us back to screening. Given this information, a natural inclination might be to recommend that healthcare providers screen every woman they see, every time they see them – but that leads to over-screening women with access to health care services and under-screening women who face barriers to getting healthcare.
Evidence shows that screening once every three years is sufficient to catch problems early and prevent cervical cancer in the vast majority of women. The most common screening method, the Pap smear, detects precancerous changes of the cervix. However, like many screening tests, the Pap smear also detects conditions that aren’t cancerous and some that aren’t even dangerous and will go away on their own. Consequently, after a “bad” Pap smear, further tests are needed to confirm what the changes, or abnormal cells, mean. For more information on cervical cancer and screening, click here for the National Women’s Health Network fact sheet.
Both over-screening and under-screening have negative health consequences. The danger of under-screening is obvious – women who don’t get screened, or don’t get screened regularly, are more likely to end up with a diagnosis of cervical cancer at a later stage when treatments are less effective. Most women diagnosed with cervical cancer in this country today did not receive regular Pap smears or did not follow up on “bad” Pap smear results. Sadly, though unsurprisingly, low-income women and women of color are disproportionately likely to get cervical cancer and have disproportionately higher rates of mortality from the disease. These disparities are largely due to lack of access to healthcare services and consequent lack of regular screening.
But over-screening causes health problems as well. Women who are screened more often than necessary are more likely to get false positive results. This in turn results in women undergoing unnecessary additional testing and even treatment, which expose women to the harm associated with these medical procedures without reducing their chance of developing cervical cancer. The additional tests include different cervical biopsies that come with their own risks ranging from bleeding and cramping to infections to scarring of the cervix, which can make it harder to become pregnant and increase the chance for premature delivery.
Effective screening and treatment for cervical cancer have greatly reduced the threat and harm of this disease in the United States. This is progress that health advocates can celebrate, but we can still do better. Guaranteed access to appropriate screening could go a long way towards ending cervical cancer. The Network agrees with the evidence-based recommendation that sexually active women between the ages of 21 and 65 should be routinely screened for cervical cancer every three years. Eliminating over-screening would prevent women from the harms associated with unnecessary testing and treatment and eliminate the waste of healthcare dollars which could potentially be used instead to expand screening programs to reach women who are currently under-screened. The fact is that our healthcare system is overburdened and we need to better allocate our healthcare dollars. If we can avoid outright waste and use our scare resources more effectively, we could provide care to everyone living in this country rather than just those with the best insurance.