Increased cancer screening is goal

BOISE – Idaho has the second-lowest rate in the nation of screening for cervical cancer, though simple screening easily can prevent the deadly disease.

But an interim legislative committee that’s looking into the issue learned last week that Idaho also has significantly lower rates of cervical cancer than most states – 22 percent lower than the rate among a group of states that are tracked nationally. The disease killed 72 Idaho women from 1999 to 2003.

“Why we don’t have worse statistics … we don’t know,” state epidemiologist Dr. Christine Hahn told the legislative committee.

She and other experts say the more deadly strains of human papillomavirus, or HPV, the sexually transmitted virus that’s tied to cervical cancer, simply may not have been prevalent in Idaho historically. However, with a time lag of 10 years to 20 years between infection with the virus and onset of the cancer, the state could see many more cases in the future.

“We need greater public awareness that, hey, we are sitting on a time bomb, and we need to start addressing it before we have a huge epidemic of cervical cancer,” said Rep. Bob Ring, R-Caldwell, a retired physician who is co-chair of the legislative committee with Sen. Joyce Broadsword, R-Sagle.

Broadsword said, “We’re at the bottom of the hill, and it’s going to get steeper as we go.”

Hahn said, “It’s so darn preventable.”

Cervical cancer was the main cause of cancer deaths in women before screening with the simple Pap test became widespread in the early 1940s. Since then, the death rate has dropped by more than 70 percent. The test detects early signs of cell changes that can be treated before cancer occurs.

Worldwide, the disease still kills 190,000 women each year, and it remains the leading cause of cancer deaths in women in parts of the world where Pap tests are not available, according to the Cancer Data Registry of Idaho.

Hahn said half the women who get cervical cancer haven’t had screening. “It’s the women who aren’t coming in at all,” she said. “They are the ones who are coming in with late-stage (cancer) and dying.”

The legislative committee heard a full day of presentations by medical experts and others on the disease in Idaho, but it reached no conclusions on how to proceed. It will meet again in the fall before deciding what to recommend to the full Legislature in January.

“We don’t know what legislation could help with the problem,” Hahn said. She noted that in 2003, Idaho saw 801 cases of breast cancer but only 42 cases of cervical cancer. “You look at that and you think, ‘Boy, where do we need to put our emphasis?’ “

Other health officials warned that uninsured women may have no access to Pap screening other than through their local health districts, and those districts often have long waiting lists for their women’s health services.

“In some districts, there’s up to a three-week waiting list to get into a family-planning clinic to find out if you’re pregnant or not,” said Richard Schultz, administrator of the state Division of Health. “It goes back to the money to pay for it.”

A federally funded Women’s Health Check program screens low-income women for cervical and breast cancer, but because of limited funds, it focuses on an older population, including many women who have had hysterectomies and thus no longer need cervical cancer screening. In 2001, the Legislature unanimously approved adding Medicaid coverage for women whose cancer is identified through the program. But cervical cancer occurs at much younger ages than most other cancers, often affecting women in their late 20s, 30s and 40s.

Experts say an early onset of sexual activity leads to a higher likelihood of cervical cancer. Various strains of the human papillomavirus tied to cervical cancer are common throughout the population, though infection with the virus will not always lead to cancer.

Schultz said the state Division of Health, in the hope of preventing risky behavior, is launching ads trying to alert 18- to 24-year-olds about the dangers of sexually transmitted diseases that can have long-term effects. Those include HPV along with HIV/AIDS, herpes, syphilis and chlamydia.

A new form of the Pap test promises much more accurate results, though it is more expensive. The newer test is being used by private physicians, but it has not yet been approved for public programs, though offi-cials told the legislative committee that approval likely is nearing. Drug companies also are working on a vaccine for the human papillomavirus.

“Regular, effective Pap smears are 99 percent of where we get around this disease,” Ring said. “We need to keep working on that.”

Federal health guidelines recommend a Pap test at least every three years until age 65, starting at age 21 or three years after the onset of sexual activity.

Broadsword said she’s not sure what lawmakers can do. “We can’t pass a law that says you can’t have sex till you’re 25,” she said. “It’s not a realistic outlook, and we have to be realistic.”

This year, the Senate passed legislation to have Idaho tap into a federally funded program to provide family planning services, including contraception but not abortion, to more low-income adult Idaho women. That program also would have provided cancer screenings, including those for breast and cervical cancer, to those women. But the bipartisan measure, co-sponsored by Sandpoint Sen. Shawn Keough, was killed in committee in the House.

“It was definitely a step in the right direction, and I hope Sen. Keough will pursue it again,” Broadsword said.