Cervical cancer once was a leading cause of death for women in the United States, but thanks to the widespread use of Pap tests beginning in the 1950s, it's a disease that has become relatively rare here. That's not the case in poorer and developing countries where Pap tests are simply unavailable, and even if they were accessible, there is a shortage of pathologists available to interpret test results.
In 2005, the latest figures available, the National Cancer Institute (NCI) estimates about 11,150 U.S. women were diagnosed with cervical cancer, and 3,924 women died from the disease, about 2.5 percent of all cancer deaths among women.
In certain populations and geographic areas of the United States, however, cervical cancer death rates are still high, in large part due to limited access to health care and cervical cancer screening. Worldwide, especially in middle and low income countries, cervical cancer is the second most common cancer in women, and the third most frequent cause of cancer death, accounting for nearly 300,000 deaths annually, the NCI says.
For example, in 2008, a study conducted by the Sabin Vaccine Institute, the Pan American Health Organization, the Centers for Disease Control and Prevention and others, compiled 15 years of research in what was the first major assessment of the effects of the human papillomavirus in the Caribbean and Latin America where as many as 33,000 deaths annually from cervical cancer are reported. According to its author, better screening and an affordable vaccine for girls could reduce those deaths, which could increase to 70,000 a year by 2030 without intervention.
Virtually all cervical cancer cases (99 percent) are linked to genital infection with human papillomavirus (HPV), which is the most common viral infection of the reproductive tract, infecting 20 percent to 30 percent of young women in the region, as well as 20 percent of young men.
Compared to the U.S. where cervical cancer death is less than 3 percent, in Haiti, as one example, 49 percent of all cancer deaths among women is from cervical cancer. The countries with the highest rates were Haiti, Bolivia, Paraguay, Belize, Peru, Guyana, Nicaragua, El Salvador, Colombia and Venezuela.
Cervical cancer screening services are very low outside of developed countries, and women at the highest risk of developing cervical cancer are typically among the least likely to be screened, particularly women who are poor, and those who are perimenopausal.
Not only are screening tests unavailable to most women in the region, a vaccine that prevents infection by the most dangerous strains of the virus costs $360 in the United States, far more than the health systems of most Latin American countries can afford. Perhaps just as challenging, vaccinating women against a sexually transmitted infection is by no means universally culturally accepted.
Emmanuela Gakidou of the Institute for Health Metrics and Evaluation Strategies at the University of Washington examined cervical cancer screening practices in 57 countries for a study published in 2008. She believes if cervical cancer prevention is to be improved globally it must be adapted to meet the specific needs of individual countries. “Expanded screening may be a viable option where sufficient infrastructure and health system access exists, but novel strategies need to be considered in other settings,” she writes.
If you are a U.S. resident with a low income, or do not have health insurance, you may be able to get a free or low-cost Pap test through the National Breast and Cervical Cancer Early Detection Program. To find out if you qualify, visit http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp to learn about local programs or call the Centers for Disease Control and Prevention at 1-800-CDC-INFO.
Sources: Vaccine Volume 26, Supplement 11, 19 August 2008, Pages L37-L48
Prevention of Cervical Cancer in Latin America and the Caribbean Region: Progress and Challenges on HPV Vaccination and Screening. Edited by FX Bosch, N Munoz, R Herrero, L Bruni, SM Garland, J Cuzick, KS Louie, TC Wright, M Stanley, E Ferrer and EL Franco.
Gakidou E, Nordhagen S, Obermeyer Z (2008) Coverage of Cervical Cancer Screening in 57 Countries: Low Average Levels and Large Inequalities. PLoS Med 5(6): e132. doi:10.1371/journal.pmed.0050132
Lynette Summerill, is an award-winning journalist who lives in Scottsdale, Arizona. In addition to writing about cancer-related issues, she writes a blog, Nonsmoking Nation, which follows global tobacco news and events.