4,600 Deaths That a Simple Yearly Test Might Prevent : Minorities are less likely to get Pap smears. White women often don’t get follow-up care.

During her 20s and 30s, Maria Vasconez faithfully had an annual medical checkup, including a Pap smear to screen for cervical cancer.

And then she stopped.

“I used to get a physical every year and I never had any problems,” says the Los Angeles hair salon owner, 43. “I had always been very healthy. Nothing was ever wrong with me. We don’t have cancer in our family. So I didn’t see the urgency in going to the doctor. Plus, I opened my own business, and I got so busy working.”

Then one day--several years after her last Pap smear--Vasconez began bleeding and made a frantic dash to her doctor’s office. Within a week, she knew the problem.

She had cervical cancer.

“I wish someone had told me to get Pap smears every year,” Vasconez says. “If you are healthy or not, go for checkups.”

Vasconez was treated for her cancer three years ago and is healthy. But thousands of other women who eschew regular Pap tests on a regular basis are not as lucky.

About 4,600 U.S. women die of cervical cancer each year. This fact is disheartening because cervical cancer deaths would be extremely rare if women had regular Pap smears--which involves collecting a small sample of cells from the cervix and examining it for abnormalities.

“With regular screening, we would see very few cervical cancer deaths,” says Dr. Cary Presant, immediate past president of the American Cancer Society California Division. “When screened regularly, cervical cancer is picked up at an early stage when cells are just beginning to change. You can treat localized cervical cancer very easily.”

Cervical cancer deaths have dropped dramatically since the 1950s, when Pap tests came into widespread use. But officials point to several unrelated factors that have stymied attempts to further curtail the death rates, including failure among women with abnormal results to seek follow-up care.

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As many as 70% of the women who die from cervical cancer have never, or rarely, had a Pap smear, studies show.

Pap smears are crucial to detecting cervical cancer. The Pap test can detect abnormal cells long before other symptoms of a problem--such as bleeding--become apparent.

It usually takes five or more years for invasive cervical cancer--cancer that has spread beyond the cervix--to develop. If the cancer is detected when it is confined to the cervix, survival rates five years after treatment are 90% compared to a 67% five-year survival rate for women whose cancer has spread.

Various studies, however, suggest that only about 60% of women get Pap smears at the recommended intervals.

And, in Southern California, poor and uninsured women as well as nonwhite women are far less likely to obtain an annual Pap smear.

This statistic is of particular concern because one long-term study showed that Latinas in Los Angeles County had more than double the rates of cervical cancer compared to whites. Black women also had higher rates than whites.

“We are very, very concerned about this because of the fairly large Latino population in Southern California,” Presant says. “It’s also our impression that Latinos are less likely to get Pap smears. One reason may be that there is a higher percentage of poor people in the Latino communities. There is also a higher portion of Latino women who are (illegal immigrants), and they have poor access to health care. There is a cultural barrier as well. Many times, Latino women don’t feel as comfortable seeking Pap tests.”

Clearly cost is a problem, experts say. A pelvic examination including a Pap smear can cost $100 or more--a fee that may not be paid by insurance plans that provide little preventive care coverage. One 1993 study of women ages 30 to 48 found that 43% of the poor women surveyed had received a Pap smear in the past year compared to 62% of the well-to-do women.

“I think we’ve probably failed to stress the continuing importance of Pap testing,” Presant says. “We’ve been good about mammography testing, and rates are improving there. But I think we’ve fallen down a bit on Pap testing. With this low-cost screening program, women can address two of the things--mammography and Pap testing--that are most important to their bodies.”

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It is equally important, however, that all women seek Pap tests regularly, health experts say. Studies show cervical cancer rates are increasing a disturbing 3% per year in white women under age 50.

Overall, about 70,000 new cases of cervical cancer are diagnosed yearly in the United States, according to the American Cancer Society.

“For young white women, the rate is going up slightly, although we don’t know absolutely why,” says Dr. Barry Kramer of the National Cancer Institute. “It could be for a variety of reasons. It could be because human papilloma virus may be more common than in the past.”

Human papilloma virus is a sexually transmitted disease that is epidemic among college-age people, especially whites. Some strains of the disease are strongly linked to the later development of cervical cancer.

Doctors are eager for more research on the link between HPV and cervical cancer, Kramer says. One problem with Pap smears now is that about 10% of all test results fall into a vague category that are not quite normal or abnormal. But a better understanding of HPV might give doctors a new way to predict which women with these hard-to-classify test results are at high risk of developing cervical cancer.

Researchers plan to study women with these vague test results who also test positive for human papilloma virus to see if having the virus confers a greater chance of developing cervical cancer.

Despite the difficulty in classifying some Pap test results, the accuracy of the test has improved dramatically in recent years, experts note. In previous years, Pap screening was plagued by a high rate of “false negative” results--abnormalities that were missed by lab technicians. But state regulations to improve laboratory testing have lowered the error rate, Presant says.

“We know in the past there have been quality control problems in Pap testing. But we’re much more confident of testing now,” he says.

Moreover, the National Cancer Institute now has a nationwide system to better classify abnormal and normal results, Kramer says. The new terminology--called the Bethesda System--was adopted by the NCI a few years ago to help standardize Pap results.

“The Bethesda System has helped us develop a lexicon of terminology that is easily understandable,” Kramer says. “It puts lesions into more crisp categories that are easier for the doctor to act upon. In spite of that, there is still uncertainty about how to manage certain lesions.”

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But deaths from cervical cancer will only decline if consumers, too, take Pap tests seriously.

A new study by the Jonsson Comprehensive Cancer Center showed that as many as 30% of women who get Pap smears and have abnormal results do not return for either their results or follow-up care, says Dr. Celia Kaplan of the Los Angeles-based center.

Poor, uninsured, single and very young women are least likely to follow recommendations for follow-up care.

“People (with abnormal results) are usually referred to another facility for treatment, which is a main reason there is a lower return rate,” she says. “It’s usually farther away. It demands another appointment. And you may have to take time off from work.”

The study showed that some women, especially those in the country illegally, may not give correct addresses or phone numbers to clinics performing the Pap tests.

“You wouldn’t believe how much this interferes with good medical care,” Kaplan says. “The problem with the Pap test system is that it only informs you. And sometimes it’s difficult to locate women for follow-up care. Women should at least provide an accurate address. Because if an abnormality is found, you can be contacted.”

Low-Cost Screenings

To ease the financial burden, the Los Angeles Regional Family Planning Council and the American Cancer Society are offering a low-cost Pap Package through November that includes a Pap smear and pelvic exam. These examinations--mammography is also available--will be offered at 350 family planning clinics. For information on the program, call (800) ACS-2345.

Cervical Cancer Rates

Latinas have more than doubled the rate of invasive cervical cancer compared to white women, according to a 1987 survey in Los Angeles County. The higher than average rates in Latinas and African American women may be related to how often the women receive Pap smears to screen for early signs of cancer. The lack of screening may also account for an unusually high death rate for African American women who develop cervical cancer.

Who Gets Cervical Cancer * Whites: 9.5 Latinas: 21.7 Blacks: 17.0 Chinese: 12.4 Japanese: 6.6

Who Dies From Cervical Cancer * Whites: 3.0 Latinas: 5.5 Blacks: 6.5 Chines: 4.5 Japanese: 3.0

* Average annual rate per 100,000 in L.A. County, 1972-87

Facts on Cervical Cancer

* Risks

Women who had sexual intercourse at an early age, have had multiple sexual partners or have been infected with human papilloma virus are at higher risk for the disease. Smokers are at higher risk.

* Warning signs

Early signs are abnormal uterine bleeding or spotting and abnormal vaginal discharge. Pain and systemic symptoms are much later signs of the disease.

* Screening

An annual Pap smear and pelvic examination are needed for all women older than 18 and those under 18 who are or have been sexually active. After a woman has had three of more annual exams with normal readings, the Pap test may be performed less frequently at the discretion of the physician.

Sources: Universtiy of Southern California Cancer Center Surveillance Program; American Cancer Society