Cervical cancer risk remains despite test

ASSOCIATED PRESS

Virtually all deaths from cervical cancer are preventable, yet the disease will kill almost 4,000 women in this country this year. Frustrated scientists know who most of them will be: black women in the South, Hispanics along the Texas-Mexico border, white women in Appalachia and the rural Northeast, and Vietnamese immigrants.

Efforts are under way to reach those women, including a $25 million federal program poised to let communities recruit volunteers -- average women who speak their patients' languages and can engender trust -- to push Pap testing and shepherd the newly diagnosed through an often-baffling medical system.

It's work made more urgent by the discovery that excess cervical cancer is a red flag for other health disparities: The same localities also have too-high rates of breast and colorectal cancer, strokes and infant mortality.

The new report, from the National Cancer Institute, will "hopefully ring a bell for policy-makers" in those communities, said Dr. Harold P. Freeman, a cancer specialist who works in the Harlem section of New York City and directs the NCI's Center to Reduce Cancer Health Disparities.

"People are dying who should not die, based on what we already know. Delivering what we already know to all American people is the issue," Dr. Freeman said.

Pap smears are credited with slashing cervical cancer deaths by 75 percent in recent decades. This simple $50 test can detect precancerous cells in time to prevent cervical cancer from forming -- or, if it's already there, in time to cure this usually slow-growing malignancy.

But most invasive cervical cancer is found in women who haven't had a Pap test in five years, or ever.

Poverty is one culprit. Also, women with no regular doctor slip through the cracks. Older women are less likely to get a Pap test, as are recent immigrants, perhaps because of language or cultural issues.

"Cervical cancer shouldn't be a cause of death anymore. In fact, it shouldn't be a problem anymore," said Dr. Stephen J. McPhee of the University of California at San Francisco. "Yet here we are in 2005 dealing with a problem that should have been fixed 25 years ago. It's a bad reflection on the U.S. health-delivery system."

With funding from the Centers for Disease Control and Prevention, Dr. McPhee started a program in Santa Clara County, Calif., to fight cervical cancer among Vietnamese immigrants, who have the nation's highest incidence of the disease -- a rate five times higher than that of white women.