Screening patterns for cervical cancer: how best to reach the unscreened population

Although the mortality rate for cervical cancer in the United States has declined steadily since the introduction of the Pap smear for screening in 1945, recent statistics show a rising incidence, with the number of new cases expected in 1996 representing a record high since the mid-1980s. Part of the rising incidence may be because of increasing numbers of women in the United States who did not receive screening or having inadequate screening with the Pap smear. This paper will examine the recent patterns of cervical cancer screening in the United States, with particular attention to defining which populations are not being screened. Barriers to screening in these populations will be defined and grouped into four categories: lack of knowledge, economic, cultural, and belief system; and logistical. Successful approaches that have been used to overcome these barriers in screening programs targeted at the "hard to reach" population will be described.