PAP TESTS STILL A MYSTERY TO MANY WOMEN

Improved Information, Particularly for Vulnerable Populations, Could Improve Care, Reduce Cancer

Undergoing regular Pap testing is critical to preventing cervical cancer, yet a lack of adequate knowledge about the test may discourage women from undergoing initial screening or returning for follow-up when they receive an abnormal result, according to “Poor Knowledge Regarding the Pap Test Among Low-Income Women Undergoing Routine Screening,” by Carmen Radecki Breitkopf et al. Overall knowledge about Pap testing is low, particularly among low-income and minority women, two at-risk groups who already face difficulties in accessing care and are relatively unlikely to receive follow-up care after an abnormal test result.

The authors found that many women undergoing cervical screening at two clinics in Texas lacked basic knowledge about what a Pap test is for, what an abnormal result means and why follow-up is important. Knowledge about human papillomavirus (HPV), abnormal Pap test results and cervical cancer was particularly poor. Women who had previously experienced an abnormal result were no more likely to understand the test results or implications than women who had previously had only normal results or who had never been screened—indicating that women may not be receiving adequate counseling when they learn of abnormal results.

According to the American Social Health Association, almost all new cases of cervical cancer could be prevented with regular Pap screening. The American Cancer Society estimates that 12,200 cases will occur among American women this year, and 4,100 women will die from the disease (representing just 1% of all cancer deaths among women). Cervical cancer rates in this country are low, due primarily to the widespread availability of Pap tests. Since the introduction of the Pap test in the 1950s, cases of cervical cancer in the United States have decreased dramatically—by 74% between 1955 and 1992.

The study’s authors highlight the importance of regular screening and follow-up, but acknowledge that Pap testing is effective as a preventive measure only if women understand the test and its results, and know what to do in the event of abnormal results. They suggest that intensive patient education and increased communication between providers and patients could help familiarize socioeconomically disadvantaged women with the test and encourage them to pursue testing and follow-up.

This article appears in the June 2005 issue of Perspectives on Sexual and Reproductive Health.

Also in this issue:

Worksite-Based Parenting Programs to Promote Healthy Adolescent Sexual Development: A Qualitative Study of Feasibility and Potential Content, by Karen L. Eastman et al.;

Availability of Services for Emergency Contraceptive Pills at High School–Based Health Centers, by Susan K. McCarthy et al.;

Evaluation of a Peer Provider Reproductive Health Service Model for Adolescents, by Claire D. Brindis et al.; and

Advanced Practice Clinicians’ Interest in Providing Medical Abortion: Results of a California Survey, by Ann C. Hwang et al.

What is a Pap Test?

The Pap test (also called a Pap smear) is a procedure that checks for changes in the cells of the cervix. The Pap test can identify infections, abnormal (unhealthy) cells or cancer. A Pap test can find precancerous changes in cervical cells, allowing for the removal of affected tissue long before invasive cancer sets in.

What is HPV?

Human papillomavirus (HPV) is considered to be the most common STD in the United States. Approximately 5.5 million new sexually transmitted HPV infections occur in this country every year, representing about one-third of all new STDs, and an estimated 20 million men and women are thought to have genital HPV at any given time. Some studies estimate that the majority of sexually active individuals are exposed to at least one type of HPV at some point in their lives, although most do not develop symptoms. Although the majority of HPV strains are harmless, a few "high risk" strains can develop into cervical cancer if left untreated.