Interventions to Increase Cervical Cancer Screening Rates

Practice Pointers Cervical cancer is diagnosed in more than 500,000 women worldwide each year, and is the fourth leading cause of cancer-related death in women.4 It is the second most commonly diagnosed cancer in developing countries and the 10th most commonly diagnosed cancer in developed countries.4 After cervical dysplasia becomes cancer, the five-year survival rate is between 60 and 72 percent.1 Based on long-term epidemiologic data from the United Kingdom, screening 80 women for cervical cancer throughout their lifetimes (every three to five years) will prevent one death.5 On average, about 6 percent of Papanicolaou (Pap) smears are abnormal and require follow-up.6 Easy-to-use algorithms for follow-up are available through the American Society for Colposcopy and Cervical Pathology at http://www.asccp.org/ConsensusGuidelines/tabid/7436/Default.aspx. According to a 2009 update of American College of Obstetricians and Gynecologists guidelines, cervical cancer screening should not be initiated until a woman is 21 years of age, regardless of age at first sexual activity.7 Screening should be performed every other year until a woman is 30 years of age. Human papillomavirus (HPV) vaccination status does not affect these recommendations.7 Although newer liquid cytology methods reduce the incidence of unsatisfactory samples, improve laboratory efficiency, and allow for optional HPV testing (thus foregoing a second collection), they have not been shown to improve detection of cervical precancerous lesions compared with traditional Pap smears.8 Traditional Pap smears or liquid cytology remain acceptable screening options.