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.
The American College of Obstetricians and Gynecologists recommends that women get their first screening at age 21 and that most women younger than 30 get screened every two years. After age 30, if a woman has had three negative tests in a row she should be screened only every three years. And many doctors believe that by age 65 to 70, most women can stop getting Pap smears altogether if they have a history of normal ones. (Some doctors disagree with this and say checkups are still needed in this age group.)
Almost all cervical cancer is caused by HPV, according to the CDC. Roughly half of all sexually active people get HPV at some point in their lives, but the body’s immune system clears the virus in most people. For those who do develop cancer, it’s typically slow-growing and easily detectable by Pap smears before it becomes extremely dangerous.
According to the CDC, in 2008 about 83 percent of American women 18 and older with insurance had gotten a Pap smear within the previous three years; for uninsured women, the figure was 67 percent. The Agency for Healthcare Research and Quality says that about half of women with newly diagnosed cervical cancer had not received a Pap test in the previous five years.
A. Bennett Jenson, a University of Louisville physician who has researched cervical cancer for decades and helped invent the HPV vaccine, said even though the disease spreads slowly, he believes it’s important to get yearly Pap smears. The tests have a 30 percent false-negative rate, he said, so frequent tests increase the likelihood that any abnormality will be detected. He said young women should also protect themselves by getting vaccinated against HPV before becoming sexually active.