By F.J. Montz, M.D., K.M.
           1955-2002

The prevention of cervical cancer by the screening for and treatment of pre-cancerous changes is one of the great success stories of Modern Medicine. Unfortunately, not all of the segments of the American populace have equally benefited from cervical cancer screening and this potentially lethal disease remains endemic in select subsets of Americans.Cervical cancer precursors are screened for by a simple and relatively inexpensive test call the Papanicolou ("Pap") Smear. The Pap Smear was named after the Greco-American pathologist who developed this valuable tool in the 1940's. The test is performed by gently scraping cells from the surface of the cervix and upper vagina with a small brush and/or spatula. The collected cells are placed on a glass slide, stained using special dyes, and then looked at under a microscope. If cells are present that are suspicious for pre-cancerous or cancer changes, further evaluation of the cervix is performed by direct inspection using a microscope ("colposcopy") and collecting little pieces of tissue ("biopsies"). Treatment is recommended based upon the findings of the colposcopy and biopsies. Undergoing a Pap smear is almost completely painless, takes less than 10 minutes, and costs around $100 for collection, processing, and interpretation. In part as a result of the wide spread use of the Pap smear, cervical cancer has gone from being the most common cause of cancer death for U.S. women in the 1940's, to not even being one of the Top Ten causes of cancer mortality in the late 1990's.Unfortunately, cervical cancer still kills many thousand American women each year. Of those women who end up dying from this disease, about 50% have never even had a Pap smear and another sizable proportion have not had adequate screening (every one to three years, depending upon individual risks). Why not? The answer is that for many segments of our Society (the Elderly, the Poor, those living in Rural America, the New Immigrant, the Native American, and women with less than a high school education) the barriers to screening are difficult if not impossible to surmount. These barriers are numerous and include such varied realities as socio-cultural attitudes and lack of affordable and convenient screening. It is this latter barrier that can be, at least in theory, eliminated.There have been two major groups of initiatives undertaken to improve access to Pap smear screening: changes in Federal and State coverage of the cost of Pap smear screening and innovative, community based programs for Pap smear screening and treatment of pre-cancerous changes. Investigations completed within the last year have demonstrated that recent changes in the Medicare laws so that Pap smear screening is a covered benefit have led to decreasing rates of cervical cancer in those women covered by these programs. Other trials using novel community of church based single visit education-Pap screening-evaluation and treatment programs have confirmed the belief that if Pap screening is offered to women who don't have easy admittance into the American Health System in a culturally acceptable and easily accessible manner, that these women will participate.Hopefully, with further changes in funding and delivery of Pap smear screening services, we can realize the dream of Dr. Papanicollou: the elimination of cervical cancer as sources of pain, suffering, and death for women.