The Importance of Pap Smears in Underserved Populations

“Cervical cancer used to be one of the most common forms of cancer and a major cause of death affecting women. In the 1950s, the Papanicolaou (Pap) smear was introduced, and the incidence of cervical cancer declined dramatically” (Dorsainvil 2017). Pap smears are a type of gynecological test considered a key factor in diagnosing several types of cervical cancers. Most women are encouraged to begin getting them around the age of 21 until 65 every 3 years with repeated annual exams if abnormal. Pap smears are performed by different types of medical professionals, including nurse practitioners, family medicine doctors and OBGYNs. To receive this exam, patients lay down on the exam table with a drape covering the lower half of their body. The provider then puts on gloves, places lubricant on a lighted speculum, and guides it into the vaginal canal. The speculum is opened, a small swab is then brushed over the cervix to collect a sample and then sent to a lab for analysis of the cells. It takes approximately 5-7 minutes with rare complications during and after the exam.

Although a pap smear is something that every woman should have done, there is a vast disparity between populations regarding knowledge about the specific exam. Underserved communities more commonly have much higher incidences of cervical cancer even though the cancer itself has decreased in prevalence. This can partially be explained by the fact that racial and ethnic minority groups are disproportionately affected due to a lack of screening/access to preventative care. One of the most important factors in pap smear screening is a physician's guidance to do so. Therefore, by educating more women specifically in these communities, they are more likely to have routine pap smears performed rather than at later stages when symptoms such as abnormal vaginal discharge, vaginal bleeding, pelvic pain, and pain during intercourse have already occurred. An example to support this claim is that even though 82.2% of African American women receive a Pap test in a given year, they are considered more likely to die of cervical cancer than any other group, followed by Hispanic, Asian, and American Indian women (Dorsainvil 2017). By the time the testing is performed, the cancer has oftentimes already progressed leading to increasing mortality rates. Early testing saves lives as it may detect cancers before they become untreatable and thus, is something that should be accentuated in these populations.

One way to improve these outcomes is placing a higher emphasis on instructing medical professionals about racial and ethnic disparities, as well as putting forth public health measures focusing on affordable gynecologic health. By creating free, accessible, and accurate resources and then distributing them with equity being the main goal, more women can make knowledgeable decisions about their health and begin to increase cervical cancer prevention. This does not just stop at preventive measures but also includes the quality of care received after an abnormal pap smear/cancer diagnosis. These ideas can be adapted to other areas of medicine affected by bias that negatively impact underserved communities.

The Breast and Cervical Cancer Early Detection Program provides no-cost breast and cervical cancer screening exams such as mammograms, pap smears, pelvic exams, and clinical breast exams to women between 50-64 years of age, those who are uninsured, or are low income.

References:

Dorsainvil, Merlyn A. “Increasing Cervical Cancer Screening in Underserved... : Journal of Christian Nursing.” LWW, Sept. 2017, https://journals.lww.com/journalofchristiannursing/Abstract/2017/07000/Increasing_Cervical_Cancer_Screening_in.9.aspx.