Published on February 05, 2020

Local Doctors Respond to Declining Rates of Cervical Cancer Screening

Photo of the Factulty and Residents of the Family Practice Center - Alma.

Resident physicians at the Family Practice Center in Alma recently conducted a research project to improve cervical cancer screening rates at their clinic. They are also reaching out to the community to spread awareness of the new screening guidelines and the benefits of screening and HPV vaccination.

Cervical cancer is one of the most preventable types of cancer impacting women, thanks to two highly effective screening tests. One is the Pap test, which can identify pre-cancerous cells and early-stage cancers that are highly treatable. The other, an HPV test, detects the presence of human papillomavirus, the leading cause of cervical cancer.

According to the National Institutes of Health, regular screening has reduced both the number cases and the number of deaths from cervical cancer over the past 40 years.[i] Yet, recent analysis shows that screening rates are now “unacceptably low.”

A 2016 study by the Mayo Clinic found that less than two-thirds (60.8 percent) of women ages 30-65 were up to date with cervical cancer screening and only about half (53.8 percent) of women aged 21 to 29 years were up to date.[ii] A 2019 analysis led by University of Michigan’s Rogel Cancer Center found that screening rates in women ages 45-65 are ‘insufficient to reduce cervical cancer incidence.’[iii] These findings contradict self-reported data from the 2015 National Health Interview Study, in which 81 percent of women reported compliance.

The analysis also found racial disparities, with African American women 50 percent less likely and Asian American women 30 percent less likely than white women to get screened. Women with less education or insurance and women in rural areas also were less likely to get screened. This is despite the fact that most insurance companies are now required to cover this screening at no out-of-pocket cost to patients.

Photof the Family Practic Center in Alma, Michigan.

The Family Practice Center in Alma is currently welcoming new patients and provides care for the whole family, including women's health, pregnancy and delivery. To make an appointment, call (989) 629-8140.

In response to this trend, health care providers at the Family Practice Center – Alma on the campus of MidMichigan Medical Center – Gratiot surveyed their own electronic medical records and confirmed that local screening rates are likewise not where they should be. Hence they’ve adopted a project to boost public awareness of new guidelines and the benefits of cervical cancer screening in the region.

“We are hoping to increase awareness in our community through a variety of public outreach methods,” said Anisha Kapoor, M.D., a family medicine resident physician at Family Practice Center – Alma. “We started by putting up informational posters in our own practice and by reaching out to our patients whose records show they are currently overdue for screening. However, we are also looking to extend awareness beyond our own practice to alert the broader community of women in our service area.”

There are several possible explanations for the recent drop in screening participation:

  • Recent efforts to prevent HPV by vaccinating teens and young adults may have drawn attention away from older women.
  • Women may be confused about current guidelines, which have recently changed from annual screening to screening every three to five years. It may also be more difficult for patients to keep track of screenings that are not performed every year.
  • Patients may not fully understand the benefits of screening. Older women in particular may not realize that they are still at risk of developing cervical cancer as they age. Half of all cervical cancers are diagnosed in women over age 49 and more than 20 percent in women over 65[iv]. Yet those who continue regular screenings are less likely to develop cancer.
  • Patients may not be aware that regular preventive screening is a covered benefit under their insurance.
  • Minorities and women in rural areas may have fewer local healthcare providers in their communities.

Current cervical cancer screening guidelines recommend that:

  • Women ages 21-29 get screened with a Pap test every 3 years.
  • Women ages 30-65 can receive a Pap test every three years or primary HPV test every five years or pap with HPV testing (co-testing) every 5 years.
  • Women 66 and older should ask their doctors whether they need continued screening.

In addition to the above screening methods, The Advisory Committee on Immunization Practices recommends the HPV vaccination in the younger population starting at ages 11 to 12. There is also a catch-up version of the vaccine for females, ages 13 to 26 and males, ages 13 to 21.

Women who are vaccinated will still need regular cervical cancer screening, because the vaccine protects against most but not all HPV types that cause cervical cancer. Also, women who got the vaccine after becoming sexually active may not get the full benefit of the vaccine if they had already been exposed to HPV.

If women are unsure whether they are up to date on their screenings, Dr. Kapoor recommends that they contact their family doctor or gynecologist to check their records and then make an appointment if needed. Dr. Kapoor and her colleagues at Family Practice Center – Alma are also welcoming new patients and provide gynecology and obstetrics services in addition to family medicine. Those who would like more information about the practice or to make an appointment may call (989) 629-8140.

[i] National Institutes of Health. Cervical Cancer. NIH Consensus Statement. 1996;14(1):1–38.

[ii] MacLaughlin K, Jacobson R, Breitkopf C, et al. Trends over time in Pap and Pap–HPV cotesting for cervical cancer screening [published online January 7, 2019]. J Womens Health. doi: 10.1089/jwh.2018.7380.

[iii] Harper et al, “Three large scale surveys highlight the complexity of cervical cancer under-screening among women 45–65 years of age in the United States”