More screening, better insurance coverage needed, survey finds
By Amanda Gardner
HealthDay Reporter
THURSDAY, Jan. 13 (HealthDayNews) -- States are not doing enough to prevent cervical cancer.
That's the conclusion of a report released Thursday, which found that no state in the country is doing what it should to screen for cervical cancer, to provide coverage of routine screening tests in public insurance programs, or to pass legislation making elimination of the disease a priority.
"We're doing a fair job, but we can do much better," said Beverly Hammerstrom, a Michigan state senator and chairwoman of Women in Government, the bipartisan educational association for women in state government that published the report, A Call to Action: The 'State' of Cervical Cancer in America.
Women in Government has made eliminating cervical cancer a priority.
According to the report, more than 10,000 women in the United States were diagnosed with this largely preventable disease in 2004, and almost 4,000 women died from it.
Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). While most women will have the virus at some point in their lives, the vast majority will not go on to develop cancer. In most cases, the virus clears on its own. There are some forms of the virus, however, that persist and eventually turn into cancer.
Up-to-date screening methods can detect which women may be progressing toward cancer. The Pap test is the traditional screening test to identify early signs of cancer and pre-cancer. Since the Pap smear was introduced half a century ago, cervical cancer mortality rates in the United States have plummeted by 75 percent.
There is a new test for HPV itself that's more effective than the Pap smear; it's approved for women 30 and older when used in conjunction with the traditional test. The two tests together boost accuracy to about 100 percent, the report stated.
When done together, a Pap test and an HPV test detect 93 percent to 100 percent of precancerous changes, compared with 51 percent to 85 percent for the Pap alone.
"They're both so accurate," said Dr. J. Thomas Cox, director of the Women's Clinic at the University of California, Santa Barbara. "The chances of missing a significant lesion that could go on to cancer before the next test or the next evaluation is so miniscule that it gives tremendous reassurance that the woman should not get cervical cancer. It's kind of a double punch."
About half of cervical cancer cases arise in women who have never been screened, while 10 percent of the cases show up in women who have not been screened in the previous five years.
In the report, states received an overall "grade" on cervical cancer prevention based on three areas: incidence and mortality; access and use of health services; and legislation.
No state received an "excellent" grade. Massachusetts received the highest overall score, followed by Illinois, Maryland and North Carolina. These four states ranked in the "very good" grade category.
The lowest overall performers were Tennessee and Texas, followed by Wyoming and Nevada.
Delaware had the highest screening rate, at 89.3 percent. Maryland and Washington, D.C. were close behind at 88.6 percent and 87.6 percent, respectively.
All but two states had 80 percent or higher screening rates.
In Utah, however, only 77.4 percent of women were screened, while in Idaho, only 78.4 percent were screened.
Incidence rates varied from a low of 5.5 cases per 100,000 women in North Dakota to a high of 14.3 cases in the District of Columbia. Mortality rates ranged from 1.3 deaths per 100,000 women in Minnesota to 6.1 deaths per 100,000 women in the District of Columbia.
Medicaid programs in all states covered Pap tests, while 46 states plus Washington, D.C. covered HPV tests, at the time of the report. Twenty-three states plus the District of Columbia had some type of Pap screening coverage requirement. Only North Carolina, however, required coverage for all FDA-approved cervical cancer screening technologies.
Improving the picture will require education, said Susan Crosby, acting executive director and president of Women in Government. "The surprise was that no state was really doing the job," she said. "But the good news is now we're showing what they need to do the job."
"There are so many opportunities for states to see where they are gapping in providing the education we need and make sure we eliminate cervical cancer," she continued. "This gives them a benchmark to go ahead and proceed."
SOURCES: Beverly Hammerstrom, Michigan state senator (R-17th district), and chairwoman, Women in Government; Susan R. Crosby, acting executive director and president, Women in Government, Washington, D.C.; J. Thomas Cox, M.D., director, Women's Clinic, University of California, Santa Barbara; Jan. 13, 2005, A Call to Action: The 'State' of Cervical Cancer in America
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