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Regular use of the Pap test followed by appropriate and timely treatment reduces deaths from cervical cancer. Women who have never been screened or who have not been screened in the past five years face a greater risk of developing invasive cervical cancer.
Percentage of women aged 18 years and older who reported they had a Pap test within the past three years.
Trends – Rising slightly from 1987 until 2000, then falling slightly until 2010 for whites and blacks. Stable for Hispanics from 1987 to 2010 and from 2001 to 2007 for California Asians (not graphed, 2007 is most recent year for which data are collected).
In 2010, 74 percent of women aged 18 and older had a Pap test within the past 3 years. This includes 72 percent of Hispanics, 77 percent of blacks, and 75 percent of whites. These rates were down for all women (from 81 percent in 2000), for blacks (from 84 percent in 2000), and for whites (82 percent in 2000). Among Asian women interviewed in California, 71 percent had a Pap test in 2005 (compared with 73 percent in 2005 and 74 percent in 2003).
The Healthy People 2020 target was to increase to 90 percent the proportion of women aged 18 and older who have received a Pap test within the past 3 years. The 2010 target was not met. The overall rate was 77 percent in 2008 and 75 percent in 2010. The Healthy People 2020 target modified the age groups for Pap testing to include women aged 21 to 65 years. The 2020 baseline for women 21 to 65 is 84.5 percent. The target is a 10 percent improvement to 93 percent in 2020.
In terms of social determinants of health, between 1998 and 2010, Pap test rates were consistently lower for women living in households with incomes at less than 200 percent of the federal poverty level. There was a consistent education gradient, with women less who had earned than a high school diploma least likely to report a Pap test, women with a high school diploma in the middle, and women with more than a high school education most likely to report being screened.
Older, poor, and less educated women are less likely to be screened for cervical cancer. Women 35 to 84 are at greater risk than younger women of developing and dying from cervical cancer, and black women are at greater risk than white women. Women who have received the human papillomavirus vaccination (HPV) should still continue to obtain Pap tests.
Sexually active women are more likely to be exposed to the human papillomavirus (HPV) and the human immunodeficiency virus (HIV), both of which can increase the risk of developing cervical cancer. HPV testing is a promising new technique that may improve screening efforts because detection of these viruses identifies women at higher risk of cervical cancer, who then may be followed more closely.
A new HPV vaccine for cervical cancer, shown to be effective in girls not exposed to the sexually transmitted virus, was approved in 2006. By 2010, CDC estimated that 48 percent of girls ages 13 to 17 had gotten at least one dose of the HPV vaccine (Adolescent vaccination-coverage levels in the United States: 2006-2009. Stokley S, Cohn A, Dorell C, Hariri S, Yankey D, Messonnier N, Wortley PM. Pediatrics. 2011 Dec;128(6):1078-86. Epub 2011 Nov 14.)
In November 2011, the United States Preventive Services Task Force (USPSTF) released new guidelines for cervical cancer screening, which indicate women ages 21 to 65 should be routinely screened every three years. The advice is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. Different organizations have generated different guidelines. To see guidelines issued by various organizations, go to http://www.ahrq.gov/clinic/USpstfix.htm. The Guide to Community Preventive Services, http://www.thecommunityguide.org/index.html , is a source of information about evidence-based approaches for enhancing cancer screening.