From: Chartbook on Trends in the Health of Americans Health,
United States, 2005
Pap Smear
A Pap smear is a microscopic examination of cells scraped from the cervix that is used to detect cancerous or precancerous conditions of the cervix and other medical conditions. If detected, precancerous conditions can be treated before they become malignant. Between 1975 and 2001 use of the Pap smear is credited with cutting the age adjusted cervical cancer incidence in half, from 14.8 to 7.9 cases per 100,000 women; and with reducing the age adjusted cervical cancer death rate from 5.6 to 2.7 deaths per 100,000 women (1).
In 2002 cervical cancer was the reported cause of death for 4,000 women in the United States (2).
The U.S. Preventive Services Task Force, the American
Cancer Society, and the American College of Obstetricians and Gynecologists all recommend regular Pap smear screening for cervical cancer, although recommendations vary as to the frequency, timing, risk factors, and age of women to be screened (3–5).
Between 1987 and 2003 the percent of women 18 years of age and over with a Pap smear within the past 3 years increased from 74 percent to 79 percent, with increases occurring among women of all race and ethnic groups (figure 22). However, Pap smear screening rates vary considerably by race and ethnicity. In 2003 non-Hispanic black women had the highest rate of screening, 84 percent.
Both non-Hispanic black and non-Hispanic white women were considerably more likely to report having a recent Pap smear than Asian and Hispanic women in 2003. Screening rates for both Asian and Hispanic women increased between 1987 and 1993, but have remained fairly stable through 2003. Pap smear screening rates remained lower for Asian and Hispanic women than for non-Hispanic black and non-Hispanic white women. Several studies have examined barriers to cervical cancer screening for Hispanic and Asian women. Demographic and socioeconomic variables were found to be important predictors of Pap smear screening for Hispanic and Asian women, as they are for the general U.S. population (6). In addition, language and acculturation has been shown to predict Pap smear utilization among Hispanic and Asian women, with more recent immigrants and those with English language barriers, fatalistic views on cancer, and culturally-based embarrassment reporting less frequent receipt of Pap smear (7–9).
Incidence rates of cervical cancer were highest for Hispanic women and rates for black women were also higher than the average for all women (10). Despite their high Pap smear screening rates, black women had the highest death rates from cervical cancer in 1997–2001, 5.6 deaths per 100,000 women. Hispanic women also had cervical cancer death rates higher than that of non-Hispanic white and Asian women. In contrast, both the incidence rate of cervical cancer and the death rate for Asian women—who had the lowest screening level—were in line with the average rates for women of all races and ethnicities combined. The reasons for the higher death rates among black women despite their high screening rates are not fully understood. This higher mortality among black women may be in part due to diagnosis at more advanced cancer stages and lower socioeconomic status (11).
For women in whom precancerous lesions have been detected through Pap smears, the likelihood of survival is nearly 100 percent with appropriate evaluation, treatment, and followup (12).
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and other initiatives help low income, uninsured, and underserved women to obtain access to both screening and follow-up care for cervical cancer.
1. Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer
Statistics Review, 1975–2001. Table V-3. National Cancer
Institute. Bethesda, MD. 2004. Available at seer.cancer.gov/csr/
1975_2001/ accessed on January 5, 2005.
2. Kochanek KD, Murphy SL, Anderson RN, Scott C. Deaths: Final data for 2002. National vital statistics reports; vol 53 no
5. Hyattsville, MD: National Center for Health Statistics. 2004.
Available at www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_05.pdf accessed on February 18, 2005.
3. U.S. Preventive Services Task Force. Screening for cervical cancer: Recommendations and rationale. AHRQ pub no
03–515A. January 2003. Agency for Healthcare Research and
Quality. Rockville, MD. Available at www.ahrq.gov/clinic/
3rduspstf/cervicalcan/cervcanrr.htm accessed on January 3,
2005.
4. Saslow D, Runowicz CD, Solomon D, et al. American Cancer
Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 52(6):342–62. 2002.
5. The American College of Obstetricians and Gynecologists.
ACOG News Release: Revised cervical cancer screening guidelines require reeducation of women and physicians.
Available at:
www.acog.org/from_home/publications/press_releases/nr05–04-04–1.cfm accessed on January 5,
2005.
6. Swan J, Breen N, Coates RJ, et al. Progress in cancer screening practices in the United States: Results from the 2000 National Health Interview Survey. Cancer 97(6):1528–40.
2003.
7. Chaudhry S, Fink A, Gelberg L, Brook R. Utilization of
Papanicolaou smears by South Asian women living in the
United States. J Gen Intern Med 18:377–84. 2003.
8. Alba D, Sweningson JM, Chandy C, Hubbell FA. Impact of
English language proficiency on receipt of Pap smears among
Hispanics. J Gen Intern Med 19(9):967–70. 2004.
9. Austin LT, Ahmad F, McNally MJ, Stewart DE. Breast and cervical cancer screening in Hispanic women: A literature review using the health belief model. Women’s Health Issues
12(3):122–8. 2002.
10. Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer
Statistics Review, 1975–2001. Table V-7. National Cancer
Institute. Bethesda, MD. 2004. Available at:
seer.cancer.gov/csr/1975_2001/results_merged/topic_race_ethnicity.pdf accessed on January 6, 2005.
11. Schwartz KL, Crossley-May H, Vigneau, FD, et al. Race, socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes Control 14:761–6. 2003.
12. Lawson HW, Henson R, recommendations for the early detection of breast and cervical cancer among low-income women. MMWR Recomm Rep. 49(RR-2):37–55. 2000.
Available at www.cdc.gov/mmwr/PDF/RR/RR4902.pdf accessed on January 26, 2005.
When quoting from this source, use the following citation:
National Center for Health Statistics
Health, United States, 2005
With Chartbook on Trends in the Health of Americans
Hyattsville, Maryland: 2005
Library of Congress Catalog Number 76–641496
For sale by Superintendent of Documents
U.S. Government Printing Office
Washington, DC 20402
