TUESDAY, Jan. 16, 2007 (HealthDay News) -- States are making gains in the war against cervical cancer, although significant racial and economic disparities remain, a nationwide survey found.
And this year, for the first time, one state -- Minnesota -- received a score of "excellent," as calculated by the authors of Partnering for Progress 2007: the 'State' of Cervical Cancer Prevention in America.
The report, released Tuesday, is the third annual state-by-state comparison commissioned by Women in Government, a nonprofit organization representing women state legislators.
"I'm pleased that the majority of states, including the District of Columbia, saw a decrease in cervical cancer incidence and mortality and we also have a number of states that put cervical cancer prevention legislation into place last year," said Susan Crosby, president of Women in Government.
"Unfortunately, we still have a long way to go," Crosby added. "There is a disproportionately high rate of cervical cancer incidence and mortality for black and Hispanic women."
Cervical cancer is the second leading cancer killer of women in the world. In the United States, about 9,700 women were diagnosed with the disease in 2006 and 3,700 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 cervical cancer. In most cases, the virus clears up on its own. There are some forms of the virus, however, that persist and eventually turn into cancer, according to the U.S. Centers for Disease Control and Prevention.
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's 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.
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.
The approval of an HPV vaccine, called Gardasil, in June 2006 marked a milestone in prevention efforts. The vaccine, approved for girls and women aged 9 to 26, is 100 percent effective against the types of HPV that account for more than two-thirds of all cervical cancers. A second vaccine will likely be vetted for U.S. Food and Drug Administration approval in 2007.
"It's a sign of great progress," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "Now hopefully as we understand the biology of cervical cancer and its relationship to HPV, we can prevent cervical cancer not only by screening but we can inoculate a whole generation of women."
It's too early to tell what effect the vaccine is having on women's health. But it's not too early to see how states are doing when it comes to screening and placing legislative priority on the issue of cervical health.
Here are the report's key findings:
- After Minnesota, the top-performing states were Illinois (score of 78 percent) Alabama, Connecticut, Maine, North Carolina and Rhode Island, (72 percent each).
- Among these high-performing states, at least 87 percent of age-appropriate women were screened for cervical cancer in the past three years; at least 82 percent of women had health insurance; and state Medicaid programs covered HPV testing for women aged 30 and older.
- Idaho received the lowest score (33 percent), followed by South Dakota and Utah (39 percent each), and the District of Columbia, Iowa, Mississippi and Tennessee (44 percent each).
- Sixty-seven percent of states (33 states plus the District of Columbia) experienced a decrease in cervical cancer incidence, while 51 percent (25 states plus D.C.) experienced a drop in mortality.
- In 2006, state legislatures around the country introduced more than 25 policy measures addressing cervical-cancer prevention.
- Forty-nine percent of states experienced an increase in their rate of uninsured women and disparities remain between the states. Less than 10 percent of Minnesota women were uninsured, compared with 30 percent of Texas women. Nineteen percent of low-income women in Maine were uninsured, vs. more than 50 percent in Texas.
- In the majority of states, incidence and mortality rates of cervical cancer for black and Hispanic women were higher than for white women, although screening rates were as high, if not higher, for black women than for white women. Screening for Hispanic women in some states and for Asian-Pacific Islander women and American Indian/Alaska Native women around the country continued to lag. The incidence of cervical cancer for black women in Kansas was nearly triple that of white women, while the incidence rate for Hispanic women in Massachusetts was almost two-and-a-half times that of white women. The mortality rate for black women was nearly twice the rate or higher than for white women in half of all states.
"We continue to lag behind in making sure that Hispanic, Asian-Pacific Islander and Native-American women throughout the country, as well as African-American women, get the prevention and education and access to all the new technologies that white women seem to have available to them," Crosby said. "In today's age, it is totally inexcusable that we still have disproportionate rates of cervical cancer when we've got new technology as far as testing. We can no longer accept substandard prevention and treatment of underserved women in our country."
More information
Read more about the report at Women in Government.
