Women
In Government: Challenge to Eliminate Cervical Cancer Campaign |
Women In Government, a bipartisan, non-profit, educational association
for women in state government, launched its Challenge to Eliminate
Cervical Cancer Campaign in 2003. The campaign engages its members,
state-level women elected officials, in helping to improve public
education about cervical cancer and HPV and to broaden access to
the most advanced screening tests available, regardless of women’s
socioeconomic status.
Most members’ legislation or resolutions have called for
the creation of task forces on the elimination of cervical cancer
and other initiatives to achieve these goals in their states.
“No woman should die of cervical cancer, because it is almost
completely preventable,” says Susan Crosby, Women In Government’s
deputy executive director. “Two key issues have traditionally
held us back from eliminating this preventable disease: First, we
need more education and wider access to screening, and second, women
need to be screened with greater accuracy, so that early intervention
is possible. With the recent approval of a test for HPV, we have
a tremendous opportunity to reduce the number of deaths even further,
or eliminate them altogether. It is particularly important that
we reach underserved women with awareness programs and access to
advanced screening techniques and new technologies.”
For more information, visit: www.womeningovernment.org. |
The most sensitive tests used to screen for cell abnormalities and the
presence of high-risk HPV will not do much good if the women who need
to be tested do not make it in to see a health care provider for screening
or are tested inadequately—not often enough or with the wrong follow-up.
To reduce the impact of cervical cancer, finding and screening these women
is even more important than improved screening technology.
“There is no direct evidence that liquid-based cytology has reduced
the morbidity or mortality associated with the diagnosis of cervical cancer
or its precursors,” says CDC’s Lawson. “Moreover, they
are only of potential value if women present themselves for cervical cancer
screening.”
According to NCI’s Solomon, at least half the women who develop
cervical cancer in the United States were not adequately screened. “It’s
increasing the universality of screening by whatever method—even
the 50-year-old Pap test—that will have the biggest impact on reducing
mortality further,” Solomon said. “The new technologies may
add a layer of increased sensitivity, even productivity, but they are
not going to have a significant impact on mortality unless we can increase
the number of women who are screened appropriately.”
Adequate screening is defined by the following, according to NCI:
- Start screening approximately three years after onset of vaginal
intercourse, or no later than 21 years of age.
- Screen at least every three years. The screening interval depends
on age and methodology used. Stop screening around age 65–70 if
there is adequate history of negative screening results.
- Women who have had a total hysterectomy for benign reasons (fibroids,
for example) and who no longer have a cervix do not need to be screened
if (1) there is adequate history of negative screening results and (2)
adequate documentation about the reason and findings for the hysterectomy
that did not include cervical precancer or cancer. If the hysterectomy
continued screening is indicated until three consecutive negative screening
results are obtained.
According to Lawson, health surveys indicate that women least likely
to have recommended cervical cancer screening have no health insurance
and/or usual source of health care or are recent immigrants. Studies suggest
that underserved women include those who are of low income, have low education,
live in rural or inner-city areas, are foreign born, are of racial/ethnic
minority, and are older, disabled, uninsured or underinsured.
“Reasons for not being screened vary considerably across these
populations,” Lawson said. “But efforts to identify and encourage
these women to be screened requires culturally and community-sensitive
education and methods to facilitate informed decision making about preventive
health in general and cervical cancer screening specifically.”
Access problems significantly inhibit adequate cervical cancer screening—lack
of insurance, lack of resources, or simply lack of time. “The major
reason is lack of health insurance and poverty,” Saslow said. “But
remember that women without health insurance and who are poor also tend
to have other priorities. A woman who has no home and/or can’t feed
her kids may have little interest in getting a Pap test even for free.”
For women who have insurance, a key reason for not being screened is
that the doctor doesn’t specifically recommend screening, according
to Saslow.
“In addition, cervical cancer is more likely to occur in middle-aged
and older women who have not been screened, or not screened in the previous
five years,” Saslow said. “After their child bearing is finished,
women often stop seeing a doctor or gynecologist and stop getting Pap
tests. Doctors are less likely to screen older versus younger women for
cervical cancer.”
“Efforts to increase awareness of the need for adequate screening
have been going on for 50 years...almost as long as we’ve had the
Pap test,” Saslow said. “The newer efforts regarding HPV reflect
the fact that we have only known for the past 10-15 years that HPV is
necessary—but not sufficient—to cause cervical cancer and
because in the last year or two, HPV testing became available and FDA
approved, and now vaccines are being developed.” |
