Improvements in Cervical Cancer Testing Needed
Cervical Cancer Nearly Preventable by Widespread Use of Pap Test, Says Nonprofit Group
Grading the States
All states do a fair, good, or very good job of testing for cervical cancer, but none earned an "excellent" rating, says the report.
The state rankings were based on rates of cervical cancer and deaths from the disease, access to and utilization of tests, and policies. Four states -- Massachusetts, Illinois, Maryland, and North Carolina -- earned a "very good" rating. A "good" grade went to 26 states, while 21 states were rated as "fair."
Massachusetts had the highest score. Tennessee and Texas scored lowest, following Wyoming and Nevada, although these states all received "fair" grades.
Screening rates varied from state to state. For instance, the percentage of women aged 18-64 who reported being screened within the last three years varied from 77% to 89%. Women aged 18-64 have the highest cervical cancer risk.
Insurance was an important factor in whether women were screened for the disease. In 2001, 31% of uninsured women didn't get a Pap test, compared with only 15% of women with health insurance.
Cervical cancer and its death rates also varied greatly from state to state. Nationwide, cervical cancer strikes about 9 out of every 100,000 women. The average U.S. mortality rate is 2.7 per 100,000 women.
Some states beat those numbers.
Cervical cancer rates were lowest in North Dakota, where the incidence rate was 5.5 cases per 100,000 women. It was highest in Washington, D.C. (14.3 per 100,000 women).
Death rates also vary. Some states have both the high incidence and the high death rates: Texas, New Mexico, West Virginia and Arkansas. Mortality rates ranged from 1.3 to 6.1 per 100,000 women. The rate was highest in Washington, D.C. States with the lowest death rates include Minnesota, Wisconsin, Massachusetts, Connecticut, and Washington.
The Pap test, in use for 60 years, is almost universally available. It's covered by every state Medicaid program.
However, only 23 states and Washington, D.C., have some type of Pap screening coverage requirement for public and private insurers, says the report. HPV testing is covered without restrictions when medically necessary in 46 states and Washington, D.C., but it's often not part of routine screening.
"Only North Carolina mandates coverage for all FDA-approved cervical cancer screening technologies, including HPV testing," says the report. Rankings will be updated in 2006.