One of the great success stories of the last half of the 20th century has been the conquest of cervical cancer. In the 1950s, cervical cancer killed more women each year than breast cancer. Most of the women who died were young, under the age of 50.

In the mid-40's, a pathologist, Dr. George N. Papanicolaou, introduced the use of a simple test, a vaginal smear to detect cervical cancer. It was rapidly accepted worldwide. Women who were sexually active were advised to have regular Pap smears so that early cervical cancer could be detected and eradicated by surgery and/or radiation.

In the intervening decades, we have learned that "pre-invasive" cervical cancer could be found and treated with less than a complete hysterectomy, allowing many women to remain capable of having children after minimal treatment for early non-invasive cervical cancer. We have also learned that this disease is caused by a virus, human papilloma virus, and that this viral infection can be detected even before the earliest signs of cervical cancer. This infection is sexually transmitted and the use of condoms will, for the most part, prevent transmission of this disease and the incipient cancer.

Screening for cervical cancers is one of the great successes of cancer screening. The recommendation for all women who are sexually active is to have an annual Pap smear. If the smear is negative on two consecutive years and she is in a monogamous relationship with little or no other risk factors, the Pap test can be deferred to every second year. This is particularly true for women over the age of 60. Women who have had a total hysterectomy need only to have two or three consecutive negative Pap smears before deciding not to continue with annual tests.

In Rhode Island over 80% of women have regular Pap smears. Unfortunately, this is not the case for Hispanic and African-American women and, particularly, for women who do not have health insurance. Thus, although we could completely eradicate this cancer by early detection of the papilloma virus infection, social and cultural problems for a small minority of the population exposes them to the risk of still developing this avoidable deadly disease. All insurance programs in RI provide Pap smears as a covered benefit. We have in Rhode Island a program for women between the ages of 40 to 64 who are uninsured or underinsured to be able to have regular Pap smears through community health centers paid for by the State Health Department. RIteCare provides Pap smears as a regular benefit for all women that fall under their insurance plan. However, the major barrier to universal Pap smears is cultural. We must educate women about the importance of this test. We need to overcome all barriers so that universal screening will occur in Rhode Island and the likelihood of seeing cervical cancer should disappear from medical practice in the 21st century. It can be done.

For more information and answers to specific questions contact the Rhode Island Cancer Council at Tel@ricancercouncil.org or call us at (401) 728-4800 or toll free 866-879-4100.

IT IS EASIER TO PREVENT CANCER THAN TO TREAT IT.

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