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Nearly One in Five Women Go Without Pap Test

In some cases, doctors fail to mention screen to patients, survey finds

WEDNESDAY, May 11, 2005 (HealthDay News) -- While screening for cervical cancer using the Pap smear has become commonplace in the United States, nearly one woman in five still doesn't get this potentially lifesaving test, a new survey finds.

When asked why, about half of women who hadn't gotten the test said they simply hadn't thought of it. And of those women who had been to the doctor within the last year but had not gotten a Pap smear, 88 percent said their physician had failed to recommend the test, according to a study in the May issue of Cancer Epidemiology, Biomarkers and Prevention.

"Cervical cancer screening rates have increased, but not all women share equally in this progress," said study co-author Stephen Coughlin, a senior cancer epidemiologist in the division of cancer prevention and control at the U.S. Centers for Disease Control and Prevention.

"This study highlights the important role of physicians. They need to make sure that women who have never screened or rarely screen receive routine Pap testing," he added.

Each year, more than 10,000 American women are diagnosed with cervical cancer, and more than 3,700 still die from the disease, according to the American Cancer Society (ACS). Cervical cancer deaths have dropped dramatically -- 74 percent -- since the 1950s, largely because of the Pap test, which can detect changes in the cervix before they have a chance to develop into cancer. The Pap test can also detect early cervical cancer, which is when treatments are most effective.

The ACS recommends that women start getting Pap tests within three years of first sexual intercourse or beginning at age 21, whichever comes first. After that, they should receive an annual Pap test, or get the newer, liquid-based Pap test every two years until age 30. After age 30, women who have had three normal Pap tests in a row need only go for screening once every two to three years.

The good news from Coughlin's study: many women are, in fact, heeding this message. Analyzing data on nearly 14,000 women interviewed in the 2000 National Health Interview Survey, his team found that over 83 percent had had at least one Pap test over the previous three years.

That means nearly 17 percent of women did not avail themselves of the potentially lifesaving test, however. Reasons cited by the 2,310 women who hadn't had a Pap smear included:

  • No reason/never thought about it -- 48 percent
  • Doctor didn't order it -- 10 percent
  • Haven't had any problems -- 9 percent
  • Too expensive/no insurance -- 8.8 percent
  • Didn't need it/Didn't know I needed it -- 8 percent
  • Put it off -- 7.4 percent
  • Too painful/embarrassing -- 3.5 percent
  • Doesn't have doctor -- 1.7 percent

The researchers found some slight variations between races in the reasons for not getting the test. Hispanic and Asian women were more likely than white or black women to say they had never thought about the test. Hispanic women were much less likely than the other three groups to say they had put the test off. Black and Asian women were almost twice as likely as white or Hispanic women to report that they felt they didn't need the test.

The researchers also examined a smaller group of women who hadn't had a recent Pap test, but who had been to the doctor in the past year. Of those 1,502 women, about 88 percent said their doctor didn't recommend the test to them.

"Our findings show that it's important to talk with your physician about routine cervical cancer screening," Coughlin said.

Dr. Julia Smith, associate director of the New York University Cancer Institute's Cancer Screening and Prevention Program, said this study has some limitations, but that the "conclusions are undoubtedly true."

One limitation is that all of the information gathered was self-reported by the women, not from their physicians or medical records. So, it's possible some women had gotten the test as part of their care but didn't realize it.

"The key here is that women should be aware that the Pap smear is an effective screening for cervical cancer and if your doctor doesn't bring it up, you should, and also ask about other cancer screenings that can help save lives," Smith said.

More information

To learn more about the importance of Pap testing, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Stephen Coughlin, Ph.D., senior cancer epidemiologist, division of cancer prevention and control, U.S. Centers for Disease Control and Prevention, Atlanta; Julia Smith, M.D., Ph.D., associate director, New York University Cancer Institute's Cancer Screening and Prevention Program, director, Lynne Cohen Breast Cancer Preventive Care Program, NYU Medical Center/Bellevue, and clinical assistant professor, New York University School of Medicine, New York City; May 2005 Cancer Epidemiology, Biomarkers and Prevention
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