Cervical Cancer

Once assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions for cervical cancer include the public health evidence-base for each intervention, details on designing interventions for cervical cancer screening, and links to examples and resources.

Multi-component interventions that include communications/media, education, reduction of barriers, and enhanced access to care will increase employees’ awareness of and participation in screening, prevention, and treatment.

Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measures for these programs are listed under evaluation of cervical cancer screening programs.

Cervical cancer is the easiest female cancer to prevent, because there is a vaccine and a screening test available. It also is highly curable when found and treated early.

  • In 2007, 12,280 women in the United States were diagnosed with cervical cancer, and 4,021 died from the disease1
  • The direct medical care costs associated with cervical cancer were estimated to equal $1.7 billion in 1996 dollars2
  • The 5-year survival rate for patients diagnosed with localized cervical cancer is 92%
  • Cervical cancer is diagnosed at an early stage more often in whites (53%) than in African Americans (44%) and in women younger than 50 (62%) than in women 50 and older (37%)
  • The most common cause of cervical cancer is the human papillomavirus (HPV). Tobacco use and obesity also increase the risk of cervical cancer

The United States Preventive Services Task Forceexternal icon recommends:

  • Cervical cancer screening (cervical Papanicolaou or PAP test) for all women who have been sexually active and have a cervix, beginning within 3 years of the onset of sexual activity or the age of 21, whichever occurs first, repeated at least every 3 years, and continuing until the age of 65 for adult women of normal risk or unless the woman receives a hysterectomy for benign disease

The Pap test is conducted by scraping cells from the cervix of the uterus and sending them to a laboratory for cytologic assessment. Newer screening methods for cervical cancer include thin-layer preparations, computer-assisted screening and testing for human papillomavirus (HPV). At present, the U.S. Preventive Services Task Force finds insufficient evidence to compare these with the Pap test. However, all these methods are FDA-approved and appropriate to consider for a health benefits package.

In Rankings of Preventive Services for the U.S. Populationexternal icon, the Partnership for Prevention provides an approach to ranking preventive services according to their clinically preventable burden (CPB) and cost effectiveness (CE). CPB is the disease, injury and premature death that would be prevented if the service were delivered to all people in the target population. With this approach, cervical cancer screening received a ranking of 7 on a scale of 1-10, with 10 the highest ranking.

One study estimated that the cost-effectiveness ratio of a conventional Pap test repeated every three years up to the age of 75 was $11,830 per quality adjusted life year (QALY) saved (in year 2000 dollars).3 In comparison with other preventive interventions and with cost-effectiveness benchmarks, cervical cancer screening is highly cost-effective.4 The harms of screening for cervical cancer are small compared to the benefits. False-positive screening results may lead to unnecessary treatment of low-grade lesions, unnecessary evaluations and biopsies, and psychological stress.

References

1.  U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2007 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2010. Available at: https://www.cdc.gov/uscs.

2.  Brown ML, Riley GF, Schussler N, Etzioni RD. Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care. 2002; 40(8 Suppl): IV-104-17.

3.  Mandelblatt JS, Lawrence WF, Womack SM, Jacobson D, Bin YI, Yi-Ting H. et al. Benefits and costs of using HPV testing to screen for cervical cancer. JAMA. 2002; 287(18): 2372-2381.

4.  Eichler H, Kong SX, Gerth WC, Mavros P, Jonsson B. Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value Health. 2004; 7(5): 518-528.