In 1975, 15 women out of every 100,000 were diagnosed with cervical cancer—roughly 6 of these women died from the disease. By 2013, this number was down to 7 out of every 100,000 getting diagnosed, with 2 of those fatal. This 50% decline in 40 years is an impressive feat. However, in the past few years, this steady decline has started to stagnate. Cervical cancer is one of the more treatable cancers. However, more than 4,000 women in the U.S., out of the over 13,000 who will be diagnosed with the disease, will die from it.

One of the reasons for the reduction in cervical cancer deaths is that early screening and prevention techniques work. Early screening can detect lesions that are precancerous. This allows for early treatment when survival rates are at their peak. This screening can be done during an annual Pap test. But, screening is most effective if an HPV DNA test is paired with the Pap test screening. Unfortunately, the number of cervical cancer screenings that are attended has dropped. 1 out of every 5 women who are of screening age are not abiding by these testing recommendations.

The Causes Of Low Attendance

Many medical professionals and public health experts have a goal of further lowering the prevalence and mortality rate of cervical cancer. In order to do this, though, they need to increase attendance rates for cervical cancer screenings. The most effective way to accomplish this is to understand why roughly 20% of women are failing to adhere to screening recommendations.

1. A Screening Disparity

The fact is that screening costs money. In order to get it at an affordable rate, women need to have insurance. And even then, there is a significant percentage of women who simply can not afford the co-payment that comes part and parcel with an annual gynecological checkup.

Hispanic, Asian, or American Indian/Alaska Native descent, women with fewer than 12 years of education, and uninsured women represent the lowest rates of screening. Many of these women qualify for the National Breast and Cervical Cancer Early Detection Program, which pays for breast and cervical cancer screenings and similar services for underinsured, uninsured, and low-income women. Unfortunately, this program has not kept up with inflation and has lost federal and state funding. Due to this, only 10% of women who qualify for NBCCEDP are able to obtain the services.

2. The HPV Vaccine

In 2006, the doctors released the HPV vaccine. This vaccine has been highly effective in preventing HPV infection in the strains of the virus linked to cervical cancer. However, this does not mean that getting the vaccine will prevent women from HPV infection 100% of the time. Nor will it prevent women from getting cervical cancer 100% of the time. Cervical cancer screening on a regular basis is still essential. In fact, lack of regular screening is linked to over two-thirds of cervical cancer cases.

Recently, study results were released about research that had been completed in the years following the introduction of the HPV vaccine. The research followed nearly 1,000 women for several years. All of the women were between the ages of 18 and 26. At the time, doctors recommended that women between the ages of 21 and 30 get an annual Pap smear or 3 years after their first sexual intercourse. However, these guidelines are outdated.

Roughly half of the women in the study only received their HPV vaccination mid-study. Of these women, nearly 83% were abiding by the suggested guidelines for Pap smear attendance before they received their vaccination. After vaccination, though, this number plummeted to about 49%. The study shows that many women incorrectly assume that the HPV vaccination sufficiently prevents them from both contracting HPV and getting cervical cancer. A fourth-year OBGYN resident from the University of Rochester in New York completed the study. Doctors have carried out similar studies across the nation with comparable results.

closeup of legs of female patient at the obgyn doctor office

3. Screening Guideline Alterations

As professionals continue to make discoveries and find new evidence, medical guidelines change. Recently, however, cervical cancer screening guidelines have changed on a much more regular basis than other guidelines. In 2009, 2012, and 2017, the U.S. Preventative Services Task Force, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology all released updated guidelines. For the most part, these organizations have collaborated and all released similar cervical cancer screening guidelines. Unfortunately, changing the guidelines so regularly can create confusion for patients.

The latest guidelines suggest women only get a Pap test every three years before the age of 30 and up to every five years after the age of 30. This is quite a time gap. It becomes easy for women to forget when their last appointment was or to allow too much time to lapse between appointments. Additionally, insurance presents problems even for the women who do remember to schedule the appointment according to the guidelines. Many will choose between a Pap test or the HPV DNA test, as insurance covers only one. The noticeable price difference means women will choose based on budget rather than their health.

Alongside these contributors, there are other reasons that women fail to regularly attend their screenings. These include difficulty in finding time outside of work and family for an appointment, lack of information about what these tests involve, and embarrassment or distress involved in receiving the results. In order to continue the improvement that has taken decades to achieve, public health and medical professionals will need to find ways to address the issues that lead to low attendance of cervical cancer screenings. For more information, please contact us.