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4,600 Deaths That a Simple Yearly Test Might Prevent : Minorities are less likely to get Pap smears. White women often don't get follow-up care.

October 04, 1994|SHARI ROAN | TIMES HEALTH WRITER

During her 20s and 30s, Maria Vasconez faithfully had an annual medical checkup, including a Pap smear to screen for cervical cancer.

And then she stopped.

"I used to get a physical every year and I never had any problems," says the Los Angeles hair salon owner, 43. "I had always been very healthy. Nothing was ever wrong with me. We don't have cancer in our family. So I didn't see the urgency in going to the doctor. Plus, I opened my own business, and I got so busy working."

Then one day--several years after her last Pap smear--Vasconez began bleeding and made a frantic dash to her doctor's office. Within a week, she knew the problem.

She had cervical cancer.

"I wish someone had told me to get Pap smears every year," Vasconez says. "If you are healthy or not, go for checkups."

Vasconez was treated for her cancer three years ago and is healthy. But thousands of other women who eschew regular Pap tests on a regular basis are not as lucky.

About 4,600 U.S. women die of cervical cancer each year. This fact is disheartening because cervical cancer deaths would be extremely rare if women had regular Pap smears--which involves collecting a small sample of cells from the cervix and examining it for abnormalities.

"With regular screening, we would see very few cervical cancer deaths," says Dr. Cary Presant, immediate past president of the American Cancer Society California Division. "When screened regularly, cervical cancer is picked up at an early stage when cells are just beginning to change. You can treat localized cervical cancer very easily."

Cervical cancer deaths have dropped dramatically since the 1950s, when Pap tests came into widespread use. But officials point to several unrelated factors that have stymied attempts to further curtail the death rates, including failure among women with abnormal results to seek follow-up care.

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As many as 70% of the women who die from cervical cancer have never, or rarely, had a Pap smear, studies show.

Pap smears are crucial to detecting cervical cancer. The Pap test can detect abnormal cells long before other symptoms of a problem--such as bleeding--become apparent.

It usually takes five or more years for invasive cervical cancer--cancer that has spread beyond the cervix--to develop. If the cancer is detected when it is confined to the cervix, survival rates five years after treatment are 90% compared to a 67% five-year survival rate for women whose cancer has spread.

Various studies, however, suggest that only about 60% of women get Pap smears at the recommended intervals.

And, in Southern California, poor and uninsured women as well as nonwhite women are far less likely to obtain an annual Pap smear.

This statistic is of particular concern because one long-term study showed that Latinas in Los Angeles County had more than double the rates of cervical cancer compared to whites. Black women also had higher rates than whites.

"We are very, very concerned about this because of the fairly large Latino population in Southern California," Presant says. "It's also our impression that Latinos are less likely to get Pap smears. One reason may be that there is a higher percentage of poor people in the Latino communities. There is also a higher portion of Latino women who are (illegal immigrants), and they have poor access to health care. There is a cultural barrier as well. Many times, Latino women don't feel as comfortable seeking Pap tests."

Clearly cost is a problem, experts say. A pelvic examination including a Pap smear can cost $100 or more--a fee that may not be paid by insurance plans that provide little preventive care coverage. One 1993 study of women ages 30 to 48 found that 43% of the poor women surveyed had received a Pap smear in the past year compared to 62% of the well-to-do women.

"I think we've probably failed to stress the continuing importance of Pap testing," Presant says. "We've been good about mammography testing, and rates are improving there. But I think we've fallen down a bit on Pap testing. With this low-cost screening program, women can address two of the things--mammography and Pap testing--that are most important to their bodies."

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It is equally important, however, that all women seek Pap tests regularly, health experts say. Studies show cervical cancer rates are increasing a disturbing 3% per year in white women under age 50.

Overall, about 70,000 new cases of cervical cancer are diagnosed yearly in the United States, according to the American Cancer Society.

"For young white women, the rate is going up slightly, although we don't know absolutely why," says Dr. Barry Kramer of the National Cancer Institute. "It could be for a variety of reasons. It could be because human papilloma virus may be more common than in the past."

Human papilloma virus is a sexually transmitted disease that is epidemic among college-age people, especially whites. Some strains of the disease are strongly linked to the later development of cervical cancer.

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