Medicare OKs Pap Smear Benefit for High-Risk Women 65 and Older

In an effort to reduce the incidence of cervical cancer in women 65 years and older, Medicare has started a policy that, for the first time, will help pay for Pap smears to screen high-risk women for early detection of the disease.

Before July 1, Medicare paid for diagnostic Pap smears only if a patient was being treated for an existing gynecological cancer or other disorders or showed signs of some abnormality.

A Pap smear is a small smear of vaginal cells that is sent to a laboratory for study. Staining makes cell abnormalities easily visible.

Medicare coverage of Pap smear screenings is intended to increase access to this effective method of picking up the malignancy when it is more treatable, according to Secretary of Health Dr. Louis W. Sullivan.

Dr. Gail R. Wilensky, the new director of the Health Care Financing Administration, which administers the Medicare program, said, “Elderly women are less likely to be screened than younger women, a situation that must be corrected if we are to reduce the incidence of invasive cervical cancer in those 65 and older.”

Invasive cancer means the malignancy is pursuing a fatal course.

Under the policy, Pap smear screenings will be covered once every three years or more often if the patient is at high risk for cervical cancer.

Although “high risk” was not defined, the announcement said that an upcoming regulation would make it more clear, using such factors as personal medical history and the date of the last Pap smear.

The American Cancer Society estimates that there will be 13,500 new cases of invasive cervical cancer this year and 6,000 deaths. The incidence of cancer of the cervix among elderly women has been dropping about 4% a year, but, the society said, there is still a significant number of women--about 2,500 this year--who are dying unnecessarily because they failed to get a Pap smear.

One-quarter of new cases of invasive cervical cancer occur in women 65 and over and only about half of these women have had a Pap smear within the past three years, according to a study earlier this year by the Congressional Office of Technology Assessment.

The study also found that at least one of every four elderly women have never been screened and that “the number could be even higher.”

Screening elderly women every three years would save about 21,400 life-years for every million women screened, the study estimated. It said that for high-risk women, annual screening would yield substantial benefits at modest cost for every life-year gained.

Wilensky said that Medicare expects about 2.9 million claims to be filed under the new benefit this year and another 4.1 million next year. She said that Pap smear screenings will cost Medicare about $15 million in fiscal 1990 and another $30 million in fiscal 1991.

In 1988, Medicare paid about $7.4 million for nearly a million diagnostic Pap smears to determine the extent of malignancies or abnormalities.