Cervical Cancer Screening in Nebraska

Nebraska

Cervical cancer is preventable with screening tests and vaccines, and highly treatable when caught early. Increased screening in the form of routine Pap tests has contributed to significant declines in cervical cancer mortality over the past 40 years. Still, the American Cancer Society estimates that there will be approximately 13,500 new cases of invasive cervical cancer and 4,300 cervical cancer deaths in 2025. 

The leading cause of cervical cancer is the human papillomavirus (HPV), a group of common viruses transmitted during sexual contact. It is estimated that nearly all sexually active people will get HPV at some point during their lifetimes, but recommended HPV vaccinations effectively protect against and reduce rates of cancer-causing strains. 

Early-stage cervical cancer is not only easier but also much less expensive to treat. The Centers for Disease Control and Prevention (CDC) estimated that in 2020, cervical cancer care cost the United States $2.3 billion. Increasing cervical cancer screening rates can reduce health care costs and save lives.

According to America’s Health Rankings analysis, the prevalence of cervical cancer screening is higher among:

• Non-Hispanic white and multiracial women compared with Asian women. 
• Women ages 35-44 compared with those ages 25-34.
• Women with a college degree compared with those who have less than a high school education.
• Women with an annual household income of $75,000 or more compared with those who have incomes less than $25,000. The prevalence is higher with each higher income level.
• Women without a disability compared with those who have difficulty with mobility.

Additional studies have found that rates of cervical cancer screening are higher among:

• Women with a usual source of care compared with those who have none, or who use emergency departments for care.
• Women with insurance compared with those without insurance. Women with Medicaid coverage also have low screening rates.

The CDC recommends regular screening via Pap and/or HPV tests, as well as HPV vaccination in early adolescence, to prevent cervical cancer. The U.S. Preventive Services Task Force (USPSTF) strongly recommends that women ages 21-29 undergo a Pap test every three years. For women ages 30-65, the USPSTF recommends either: a) a Pap test every three years, b) HPV testing every five years, or c) a combined HPV and Pap test every five years. Women with HIV are at higher risk of cervical cancer. They should follow the screening recommendations in the federally-approved clinical Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV.

The Community Guide lists several evidence-based interventions for increasing cervical cancer screening, including:

• Interventions involving community health workers, which have reduced barriers to access and increased demand for screening services.
• Multicomponent interventions, which combine two or more evidence-based approaches to reduce structural barriers (such as reducing administrative barriers, assisting with appointment scheduling, addressing transportation barriers or offering child care). 

Health care providers should recommend and/or educate patients on screening during routine visits. Direct communication between patients and providers has been shown to increase screening rates and can be effective among populations of women whose cultural beliefs and practices may conflict with screening recommendations.

Healthy People 2030 aims to increase the proportion of women ages 21-65 who receive cervical cancer screening.

Dorsainvil, Merlyn A. “Increasing Cervical Cancer Screening in Underserved Populations.” Journal of Christian Nursing 34, no. 3 (July 2017): 152–58. https://doi.org/10.1097/CNJ.0000000000000405.

Sabatino, Susan A., Trevor D. Thompson, Mary C. White, Jean A. Shapiro, Tainya C. Clarke, Jennifer M. Croswell, and Lisa C. Richardson. “Cancer Screening Test Use?U.S., 2019.” American Journal of Preventive Medicine 63, no. 3 (September 2022): 431–39.https://doi.org/10.1016/j.amepre.2022.02.018.