Cervical Cancer Screening in Tennessee

Tennessee

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. However, an estimated 18.3 million women were not up-to-date on their cervical cancer screening in 2019. Screening rates declined sharply during the COVID-19 pandemic, but have gradually returned to near baseline since clinics resumed routine screening. 

The American Cancer Society estimates that there will be approximately 14,000 new cases of invasive cervical cancer diagnosed, and 4,300 cervical cancer deaths  in 2024. The main 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. 

The Centers for Disease Control and Prevention (CDC) estimates that cervical cancer care cost the United States $2.3 billion in 2020. Early-stage cervical cancer is much less expensive to treat. 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 Black, non-Hispanic white and multiracial women compared with Asian women. 
• Women ages 25-44 compared with those ages 21-24.
• Women with some post-high school education or a college degree compared with those with less than a high school education.
• Women with an annual household income of $50,000 or more compared with those who have incomes less than $50,000.

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

• Women living in metropolitan areas compared with those in non-metropolitan areas.
• Women with a usual source of care compared with those who had none or used emergency departments for care.
• Women with insurance compared with those without insurance. Women with Medicaid coverage also have low screening rates.
• Heterosexual women compared with lesbian women.

The CDC recommends regular screening via Pap and/or HPV tests, as well as HPV vaccination in early adolescence to prevent cervical cancer. The CDC also promotes awareness of cervical cancer and the benefits of screening. The U.S. Preventive Services Task Force (USPSTF) strongly recommends women ages 21-29 get 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, and 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 that involve community health workers, which have been found to reduce barriers to access and increase 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 at routine visits. Direct communication between patient and provider has been shown to increase screening and can be effective among populations of women whose cultural beliefs and practices may disagree with screening.

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.

Hernández-Ramírez, Raúl U, Meredith S Shiels, Robert Dubrow, and Eric A Engels. “Cancer Risk in HIV-Infected People in the USA from 1996 to 2012: A Population-Based, Registry-Linkage Study.” The Lancet HIV 4, no. 11 (November 2017): e495–504. https://doi.org/10.1016/S2352-3018(17)30125-X.

Miller, Maureen J., Lanfang Xu, Jin Qin, Erin E. Hahn, Quyen Ngo-Metzger, Brian Mittman, Devansu Tewari, et al. “Impact of COVID-19 on Cervical Cancer Screening Rates Among Women Aged 21–65 Years in a Large Integrated Health Care System — Southern California, January 1–September 30, 2019, and January 1–September 30, 2020.” MMWR. Morbidity and Mortality Weekly Report 70, no. 4 (January 29, 2021): 109–13. https://doi.org/10.15585/mmwr.mm7004a1.

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.

Suk, Ryan, Young-Rock Hong, Suja S. Rajan, Zhigang Xie, Yenan Zhu, and Jennifer C. Spencer. “Assessment of US Preventive Services Task Force Guideline–Concordant Cervical Cancer Screening Rates and Reasons for Underscreening by Age, Race and Ethnicity, Sexual Orientation, Rurality, and Insurance, 2005 to 2019.” JAMA Network Open 5, no. 1 (January 18, 2022): e2143582. https://doi.org/10.1001/jamanetworkopen.2021.43582.

Tracy, J. Kathleen, Alison D. Lydecker, and Lynda Ireland. “Barriers to Cervical Cancer Screening Among Lesbians.” Journal of Women’s Health 19, no. 2 (February 2010): 229–37. https://doi.org/10.1089/jwh.2009.1393.