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Cervical cancer is preventable, yet many fail to get screened regularly

By Laura Ungar,May 02, 2011

Tamika Felder stopped getting Pap smears because she lacked insurance. (Sarah L. Voisin/The Washington…)

In her early 20s, Tamika Felder skipped seeing her gynecologist and getting Pap smears for a few years because she couldn’t afford health insurance.

She was working part time in a job that paid only about $6 an hour, and “it was either go to the doctor’s or pay the rent,” she recalled. But her health was good, and Felder figured she’d be fine.

Except she wasn’t.

In 2001, at age 25, Felder learned that she had cervical cancer. She needed a hysterectomy, chemotherapy and radiation. And she was left unable to bear children.

“I didn’t want to lose my womb. I didn’t want to lose my fertility. But I was tossed into this world of cancer,” said Felder, now 35 and a television producer living in Upper Marlboro. “It changes you in such a profound way. You have to rebuild your whole life.”

Each year, about 12,000 U.S. women receive diagnoses of cervical cancer and 4,000 women die of the disease. Yet doctors view cervical cancer as a disease that can easily be prevented and treated. Precancerous lesions and early cancer are easily detected through Pap smears; lesions can be removed in a minimally invasive procedure before they turn into cancer. And since 2006 there has been a vaccine against human papillomavirus, or HPV, the sexually transmitted virus that causes most cases of cervical cancer.

But Felder’s case is a good example of why this disease remains a threat. Too often, doctors and public-health experts say, women who don’t get regular screenings — because they don’t have health insurance or for other reasons — discover the problem when the disease has already progressed.

“In most cases, women who get cervical cancer in this country are those who did not get a Pap smear,” said Robert Hilgers, a gynecologic oncologist in Kentucky, one of the states with the highest incidence of cervical cancer. (The District also has a relatively high rate.) “I have been here — in all aspects of this disease — having cared for over 1,000 women with cancer of the cervix, and don’t want to see another woman die of this disease.”

Hilgers and other doctors say cervical cancer is highly correlated with poverty and a lack of health insurance. The Centers for Disease Control and Prevention cites disproportionate levels of cervical cancer among the uninsured and underinsured.

For instance, in the Appalachian region of Kentucky, where the poverty rate was 24.5 percent in 2005-2009 — compared with the national rate of 13.5 percent — women get cervical cancer at a rate that is one-third higher than the national rate, and they die at a rate that is 37 percent higher, according to statistics from the Kentucky cancer registry and the National Cancer Institute.

Hilgers and others say they believe income disparity, and the resulting disparity in access to health insurance and health care, contribute to an elevated death rate from cervical cancer in African American women. According to statistics from the National Cancer Institute, African American women died of cervical cancer at a rate of 4.4 per 100,000 vs. 2.2 per 100,000 for white women.

“Socioeconomic factors that people live under affect their health,” said Hilgers, founder of the Kentucky Cervical Cancer Coalition.

Shobha Krishnan, a gynecologist in New York who is the president of the Global Initiative Against HPV and Cervical Cancer, says one way to reduce cervical cancer rates would be to bring help, screening and education to vulnerable women instead of waiting for them to seek it out. “There are uninsured and underinsured who lack access to care. There are people living in rural areas without access to care. . . . If we can adapt what we do in the developing world [where health-care workers visit homes to provide information and treatment] we might make more progress. Four thousand deaths is 4,000 too many.”

Pap smears

Cervical cancer used to be a much bigger scourge in America. Before Pap screening began in the 1940s, about 26,000 women died each year of the disease. But the American Cancer Society promoted the screening, and rates fell steadily as physicians began to routinely perform it. The test involves a quick, painless scraping off of cells from the cervix, which are then examined in a lab for abnormalities.

Not only did fewer women die when the test became widely used, but fewer got the disease because doctors found and then could deal with the changing cells before they turned into cancer. In 1973, the incidence rate was 14.2 per 100,000; by 2003-2007 it had fallen to 8.1 per 100,000.