Women In Government Presents

Partnering For Progress 2007

The “State” of
Cervical Cancer
Prevention in
America
To request free copies of this report or to send inquiries,
contact:
Women In Government
HPV & Cervical Cancer Policy Resource Center
Toll free: 1.888.333.0164
E-mail: resourcecenter@womeningovernment.org
Web: www.womeningovernment.org/prevention

Women In Government is a national 501(c)(3), non-profit,

bi-partisan organization of women state legislators providing
leadership opportunities, networking, expert forums, and
educational resources to address and resolve complex
public policy issues.
Women In Government leads the nation with a bold,
courageous, and passionate vision that empowers and
mobilizes all women legislators to effect sound policy.

Suggested Citation:
Women In Government. Partnering For Progress 2007:
The “State” of Cervical Cancer Prevention in America.
Washington, DC, 2007.
 Table of Contents

Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Report Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Recommended Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Cervical Cancer Prevention Facts. . . . . . . . . . . . . . . . . . . . . . . 23

State Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Appendixes

Appendix A: State Score Comparison Chart . . . . . . . . 84

Appendix B: Methodology . . . . . . . . . . . . . . . . . . . . . . . 86

End Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Acknowledgements

CONTRIBUTORS:

Patricia A. Miller, MA
Consultant, Wordsmith Editorial Consulting
Sarah F. Wells, MA
Senior Director of Public Policy, Women In Government
Kathryn A. Guccione, MA
Senior Public Policy Associate, Women In Government
Whitney Little
Graduate Research Assistant, Women In Government
Ellen Schleicher
Graduate Policy Fellow, Women In Government

REVIEW PANEL:

Heidi M. Bauer, MD, MPH

Chief, Office of Medical and Scientific Affairs, STD Control Branch,
California Department of Health Services
Senator Beverly S. Hammerstrom (R)
Michigan State Legislature
Kathryn Kushner, MA
Senior Research and Policy Analyst,
National Institute for Health Care Management Foundation
Tracy Morris
Communications Consultant,
Women In Government
Alina Salganicoff, PhD
Vice President and Director, Women’s Health Policy,
Kaiser Family Foundation
Marie Savard, MD
Internist, author and patients’ rights advocate
Senator Diane J. Savino (D)
New York State Legislature
Charles A. Scott, MD, FAAP
Children’s Health Associates, LLC

The opinions expressed in this report do not necessarily reflect the views
of the individuals or organizations who reviewed the document.

Design: Alana Vachris, The Creative Ad Company

Women In Government would like to acknowledge the support of

Digene Corporation, which facilitated the publication of this report.

Disclaimer: Women In Government has provided the statistics and

analysis in this report as an educational resource only, and does not
endorse or lobby for any specific legislation, organization or individual.
 Foreword

Progress and Partnership on the Road to Cervical Cancer Elimination

Since the launch of our first report, Women In Government has realized the
importance of collaboration among all interested parties—from state legislators, to
public health officials, to the medical community—in the effort to prevent cervical
cancer. Collaboration and partnership serve as the foundation of our “Challenge to
Eliminate Cervical Cancer Campaign.” Women In Government actively brings
stakeholders together on this issue through the Campaign and the Annual Cervical
Cancer & HPV Task Force and Summit. We believe that by working together with
common goals and vision, we can eliminate this deadly disease.

Women In Government’s Campaign is designed to educate state legislators about

Susan R. Crosby
President cervical cancer and the human papillomavirus (HPV)—the cause of cervical cancer—
and to advocate for education and access to the most advanced and appropriate
screening and preventive technologies available. The Campaign has achieved tremendous success in its
three-year history, with 45 states having introduced legislative initiatives around cervical cancer prevention
and 40 states having enacted these measures as of November 1, 2006. Legislative action across the
country has included the establishment of statewide accountable entities, such as task forces, public
awareness educational campaigns, and insurance reimbursement for advanced screening technologies,
such as the HPV test. In 2005, we released the first cervical cancer and HPV state report in an effort to build
upon momentum and establish a baseline from which stakeholders can measure their progress in preventing
this disease. In 2006, we issued a second report, which demonstrated great success in just one short year,
as well as identified further work that needed to be done on this issue. To evaluate states’ achievements
nationwide, identify gaps in cervical cancer prevention policy and demonstrate examples of collaboration, we
now present Partnering for Progress 2007: The “State” of Cervical Cancer Prevention in America.

This year’s report shows how states are working with stakeholders in their efforts to prevent cervical
cancer and tracks each state’s performance since we released our inaugural report two years ago.
Overall, we found that the states have made great strides toward cervical cancer prevention. We
applaud Minnesota on becoming the first state to receive a grade of “Excellent.” Women In Government
challenges other states to follow Minnesota’s lead in making cervical cancer prevention a top priority.

Looking to the future, we anticipate greater commitment and even greater success in 2007 with our
mission to eliminate cervical cancer. Collaboration with all stakeholders will ensure success for this
historic women’s health effort—to make cervical cancer the first victory in the war on cancer. We hope
that you will accept the challenge to eliminate cervical cancer and partner with stakeholders in your
community against this preventable disease.

Sincerely,

Susan R. Crosby
President
Women In Government

The “State” of Cervical Cancer Prevention in America 1

 Executive Summary
Partnering for Progress 2007:
The “State” of Cervical Cancer
Prevention in America
Partnering for Progress 2007: The “State” of
Cervical Cancer Prevention in America is the
third annual review of state efforts to eliminate
cervical cancer compiled by Women In
Government in conjunction with the “Challenge
to Eliminate Cervical Cancer Campaign.” The
Campaign is based on the premise that while
great progress has been made in fighting
cervical cancer over the last 60 years, thanks to
the development and widespread use of Pap
tests, there must be a renewed effort to
eliminate this preventable disease through
advocacy, advanced technology and public
policy. Furthermore, Women In Government
strongly supports a collaborative approach to
cervical cancer prevention, enlisting the
participation and support of stakeholders from
across the globe at annual conferences and
through the Campaign.
Worldwide, cervical cancer is the second most
common cancer among women. In the United
States, the American Cancer Society estimates
that 9,710 women will be diagnosed with
cervical cancer in 2006 and more than 3,700
women will die of the disease. Recent advances
in the medical understanding of cervical cancer,
particularly that cervical cancer is caused by the
human papillomavirus (HPV), and the availability
of new technologies for preventing HPV and
cervical cancer put the elimination of cervical
cancer within reach. An HPV test now is
available to detect high-risk types of the virus
that can lead to cervical cancer. When used in
conjunction with a Pap test in women 30 and
older, it is nearly 100% effective in identifying
women who require early intervention.
The “State” of Cervical Cancer Prevention in America
In addition, in June of 2006, the Food and Drug
Administration (FDA) approved an HPV vaccine,
called Gardasil,® for girls and women between the
ages of 9 and 26. This vaccine is 100% effective
in preventing infection with high-risk types of
HPV (types 16 and 18) that account for
approximately 70% of cervical cancers. A second
HPV vaccine, called Cervarix,TM that has been
shown to be equally effective against types 16
and 18, is expected to be submitted for FDA
approval in 2007. In addition to the development
of these new technologies, cervical cancer
incidence and mortality rates continue to decline
across the country.
This year’s report shows continued progress in the
fight against cervical cancer. The report charts a
continued decline in cervical cancer incidence and
mortality rates; robust rates for Pap screening;
coverage of advanced technologies, including the
HPV test; and significant legislative activity aimed
at eliminating cervical cancer by increasing access
to screening and treatment services, raising
awareness, and promoting better coordination of
state resources and efforts through statewide
accountable entities, such as task forces.
However, women still die needlessly from cervical
cancer, which is a preventable disease. The report
notes significant shortfalls in key areas, including
dramatic racial disparities in incidence, mortality,
and screening rates and a continued lack of
access to care for low-income women, which will
require additional collaborative efforts to address.
State scores show continued improvement across
the board, and, for the first time, one state,
Minnesota, has achieved the score of Excellent.
Scores ranged from a low of six out of 18 possible
points for Idaho to a high of 15 out of 18 possible
points for Minnesota. A total of 13 states received
a grade of Very Good, up from 11 states in 2006.
A total of 30 states received a grade of Good and
6 states plus the District of Columbia received a
grade of Fair.
3
 Executive Summary

Key Findings

• For the first time, one state—Minnesota—received a grade of Excellent (15 out of 18
possible points), marking a milestone in state efforts to eliminate cervical cancer.

• A majority of states and the District of Columbia saw a decrease in both cervical cancer
incidence and mortality.

• Just under half of the states (49%) experienced an increase in their rate of
uninsured women.

• State legislators continue to advance policies to address cervical cancer prevention,

including measures designed to increase screening and treatment options, bring together
stakeholders in collaborative initiatives, and raise awareness of cervical cancer and HPV.

• Despite overall progress in the elimination of cervical cancer, disparities continue in

terms of incidence, mortality, and screening at the national level. These systemic
weaknesses may undermine the ability of all women to have access to and utilize new,
preventive technologies.

The availability of new technologies such as the
HPV test and HPV vaccines creates a new set of
challenges for states in terms of ensuring that all
women can and do take advantage of these
tools. States must work to create the necessary
infrastructure to support the integration of
cervical cancer screening and vaccination in
comprehensive cervical cancer prevention
programs that address issues of access and
insurance coverage, while increasing awareness
and education.
Finally, Women In Government believes that no
single person or entity can achieve success on
this issue alone. Therefore, the focus of this
year’s report is “collaboration” and we strongly
recommend that stakeholders work together in
their efforts to eliminate cervical cancer. Women
In Government is committed to collaboration as
well and invites all interested parties to join us at
our Annual HPV and Cervical Cancer Summit,
which provides an opportunity for education and
dialogue on this important issue.

4 Partnering For Progress 2007

 Introduction

Partnering for Progress 2007: The “State” of address cervical cancer prevention by increasing
Cervical Cancer Prevention in America is the access to the most advanced and appropriate
third annual review of state efforts to eliminate screening and preventive technologies, including
cervical cancer compiled by Women In HPV testing and HPV vaccines, particularly for
Government in conjunction with the “Challenge underserved women, and improving awareness
to Eliminate Cervical Cancer Campaign.” The about cervical cancer and HPV. The Campaign
Campaign is based on the premise that while also encourages partnership at the state and
great progress has been made in fighting cervical national levels to address existing and emerging
cancer over the last 60 years, thanks to the issues in cervical cancer prevention.
development and widespread use of Pap tests,
there must be a renewed effort to eliminate this
preventable disease through advocacy, advanced
technology and public policy. Furthermore,
Women In Government strongly supports a
collaborative approach to cervical cancer Partnering for Progress
prevention, enlisting the participation and support
of stakeholders from across the globe at annual
conferences and through the Campaign. Since the beginning of the Campaign, Women In
Government has believed that collaboration is the
Worldwide, cervical cancer is the second most key to furthering prevention efforts. Collaboration
common cancer among women. In the United is necessary to streamline communications, to
States, the American Cancer Society estimates advance comprehensive strategies and tactics,
that 9,710 women will be diagnosed with cervical and to produce the necessary infrastructure to
cancer in 2006 and more than 3,700 women will prevent, and eventually eliminate, cervical cancer.
die of the disease. Progress, however, continues By initiating a discussion, stakeholders can come
to be made toward the elimination of this together to share resources and information and
preventable disease. create a dialogue to address the barriers each
group faces and how to collectively overcome
The cervical cancer incidence rate for 2002, the these challenges.
most recent year available, was 8.7 cases per
100,000 women in the United States. This is
down from 9.5 cases per 100,000 women in
2000 and continues a long-term decline resulting
from the widespread adoption of routine Pap
tests1 and the recent introduction of HPV testing.
Cervical cancer mortality also continues on a
downward trend, with rates declining 3.4%
between 1999 and 2003.2

It was the conviction that no woman should die

of cervical cancer and the belief that a systemic,
comprehensive and collaborative approach could
eliminate this disease once and for all that led
Women In Government to launch the “Challenge
to Eliminate Cervical Cancer Campaign” in 2004.
The Campaign mobilizes state policymakers to

The “State” of Cervical Cancer Prevention in America 5

 Introduction
Key stakeholders in the collaborative process
include state policymakers, health care
providers, parents and school administrators,
public health advocates, state and public health
officials, and representatives of the private
sector. State legislators are especially key to the
collaborative process because they have the
ability to coordinate state efforts through the
introduction and implementation of legislation,
including access and coverage of important
technologies and the creation of statewide
accountable entities, such as task forces. Such
task forces can coordinate cervical cancer
prevention efforts, ensure that screening and
preventive measures correspond with the most
recent medical guidelines, and address
emerging medical, social, and governmental
issues around the elimination of cervical cancer.
As a result of the cervical cancer task force
model advocated by Women In Government
through the Campaign, numerous states have
created cervical cancer task forces. We
challenge additional states to enact task forces
and those states with such infrastructure to
evaluate membership and goals to ensure task
forces are keeping up with changes in cervical
cancer prevention research and technologies.
National-level collaboration also is necessary to
address cervical cancer prevention, particularly
infrastructure gaps. Women In Government has
developed a framework to eliminate cervical
cancer wherein stakeholders, regardless of their
primary interests, can join forces to effect
positive change. In November of 2005, Women
In Government organized the first annual HPV &
Cervical Cancer Summit, which brought together
key stakeholders to outline collaborative
strategies to eliminate cervical cancer. The
annual Summit is the largest gathering of state
legislators, public health advocates, members of
the medical community, and state and federal
health officials, including those from the Centers
for Disease Control and Prevention, assembled
to address this important disease in the
United States.
6 Partnering For Progress 2007
Recommendations from the first annual Summit
called for the creation of coalitions among
stakeholders to implement cervical cancer elimination
strategies, which include the implementation of FDA-
approved vaccines and the importance of advanced
and appropriate screening technologies, such as HPV
testing, to reach vulnerable populations. Collaboration
will be especially important to integrate HPV vaccines
into the existing cervical cancer screening environment,
to create a comprehensive prevention infrastructure.
The Current Landscape
In these past two years—since the inaugural
publication of this report—the landscape regarding
cervical cancer has changed dramatically. Recent
advances in the medical understanding of cervical
cancer, particularly that cervical cancer is caused by
HPV, and the availability of new preventive
technologies put the elimination of cervical cancer
within reach.
An HPV test is now available to detect high-risk types
of the virus that can lead to cervical cancer. Providing
the HPV test as a regular component of cervical
cancer screening is important for women 30 and
older, especially for those women who may not
receive regular screenings, as studies show it is more
sensitive than a Pap test alone at identifying women
with cervical cancer or its precursors.3 Studies show
that the Pap test alone is 51% to 85% accurate at
identifying women needing early intervention to
identify the disease. When used in conjunction with a
Pap test in women 30 and older, the HPV test is
nearly 100% effective in identifying women who
require early intervention.
The American College of Obstetricians and
Gynecologists, the American Cancer Society, and the
Association of Reproductive Health Professionals all
recommend the use of the HPV test along with a Pap
test for routine cervical cancer screening for women
30 and older.
 Introduction
In addition, in June 2006, the Food and Drug
Administration (FDA) approved an HPV vaccine,
called Gardasil,® for girls and women between the
ages of 9 and 26. This vaccine is 100% effective in
preventing infection with high-risk types of HPV
(types 16 and 18) that account for approximately
70% of cervical cancers. A second HPV vaccine,
called Cervarix,TM that has been shown to be equally
effective against HPV types 16 and 18, is expected
to be submitted for FDA approval in 2007. This
vaccine also has been shown to potentially provide
protection against infection with HPV types 45 and
31, the third and fourth most prevalent cancer-
causing types of HPV. Collectively, HPV types 16,
18, 45 and 31 are responsible for 80% of cervical
cancers worldwide.
For the HPV vaccine to achieve its full potential in
the fight against cervical cancer, it must be made
available to all age-appropriate groups, regardless
of income level or insurance status. To help meet
this goal, the federal Advisory Committee on
Immunization Practices (ACIP) has recommended
that the HPV vaccine be routinely given to girls aged
11 and 12, at a physician’s discretion for 9 and
10-year-olds, and to all other FDA-approved age
groups. The ACIP also recommended that the
vaccine be included in the federal government’s
Vaccines for Children (VFC) program, which covers
vaccines for uninsured and some underinsured
children. Private insurers typically cover vaccines as
a result of ACIP recommendations. Medicaid
coverage of vaccines for adults is optional under
individual state programs and, as such, decisions
about coverage will need to be made by each state.
While HPV vaccines mark a tremendous milestone in
the fight against cervical cancer, screening remains
critical for realizing the collective goal of cervical
cancer elimination. It is important that stakeholders
continue to educate the public about the importance
of cervical cancer screening to cover women who
may not receive the vaccine, for those already
exposed to the virus types contained in the vaccine,
and for cervical cancer caused by HPV types not
covered in the vaccine.
The “State” of Cervical Cancer Prevention in America
Reaching Underserved
Populations
Cervical cancer continues to disproportionately
affect minority and low-income women. The gap
in incidence between White women and Black
and Hispanic women has closed somewhat in
recent years, but remains significant. While the
incidence rate for White women in 2002 was
8.2/100,000, it was 12.4/100,000 for Black
women and 13.1/100,000 for Hispanic women.4
Mortality rates also exhibit significant disparities.
In 2002, the mortality rate for White women was
2.3/100,000. Black women had a rate more
than double that at 5.0/100,000, while Hispanic
women had a rate of 3.2/100,000 and American
Indian/Alaskan Native women had a rate of
3.0/100,000.5
A report by the National Cancer Institute (NCI)
notes that high rates of cervical cancer mortality
are indicators of larger problems with access to
health care for women, including a tendency for
women to lack a regular source of care and
access to preventive health services and to live
in medically underserved areas.6 Low-income
and minority women often lack access to
screening and prevention technologies, as well
as education about the importance of cervical
cancer screening and prevention. Lack of health
insurance is a particular problem for many.
Nationally, more than 17 million women are
uninsured and rates of insurance coverage for
women have continued to decline concomitant
with a general decline in health insurance
coverage. Women who are at high risk of being
uninsured include Black and Hispanic women,
as well as younger women and non-citizens.7
On average, almost 25% of women who are
uninsured have not had a Pap test in the past
three years.8
7
 Introduction
Increasing access to screening for these women is
vitally important, as approximately half of all
cervical cancers occur in women who have never
been screened and 10% occur in women who
have not been screened in the last five years.
Women of underserved groups currently receive
cervical cancer screening at a much lower rate
than average. While 88% and 87% of Black and
White women, respectively, report having had a
Pap test in the past three years, only 72% of
Asian/Pacific Islanders, 82% of Hispanics, and
83% of American Indian/Alaska Natives receive
regular Pap tests.9
There are two important sources of care for
underserved women to access cervical cancer
screening and preventive technologies. The
Medicaid program provides coverage for Pap
tests for women who meet individual state
qualifications for the Medicaid program; most
states also provide coverage of HPV tests as part
of regular cervical cancer screening and all states
provide coverage of HPV tests for the follow-up of
inconclusive Pap tests. Approximately one in ten
women were covered by Medicaid in 2004, for a
total of nearly 19 million low-income women.
Approximately two-thirds of adult women enrolled
in the Medicaid program are in their reproductive
years. As a result of Medicaid coverage, most
recipients receive care on par with that of women
who receive employer-based coverage. In 2004,
only 16% of Medicaid recipients reported that they
had not received a Pap test in the past two years,
versus 40% of uninsured women and 20% of
privately insured women.10
To improve cervical and breast cancer screening
among women not covered by Medicaid,
Congress created the National Breast and Cervical
Cancer Early Detection Program (NBCCEDP). This
program provides both screening and diagnostic
services, including Pap tests, in all 50 states, four
U.S. territories, the District of Columbia, and 13
American Indian/Alaska Native organizations. This
program offers more limited coverage of HPV
testing, providing it only as a follow-up to women
8 Partnering For Progress 2007
with inconclusive Pap tests. It is a particularly
important source of cervical cancer screening
for several high-risk populations such as
Hispanic and Black women. Between 2000 and
2005, almost 25% of women receiving cervical
cancer screening through the program were
Hispanic, slightly more than 14% were Black,
and slightly fewer than 6% were American
Indian/Alaskan Native.11
Summary
Lack of access to screening for underserved
populations may point to gaps in the health care
infrastructure that will similarly undermine efforts to
provide these women with access to new
screening and preventive technologies. The
availability of new technologies such as an HPV
test and an HPV vaccine creates a new set of
challenges for states in terms of ensuring access.
States must work to create the necessary
infrastructure (e.g., funding, outreach and
education programs—particularly to underserved
women—and provider partnerships) and
environment (e.g., higher levels of insured women)
to ensure that all eligible girls and women are able
to take advantage of these preventive
technologies and to support the integration of
screening and vaccination in comprehensive
cervical cancer prevention programs.
This report continues Women In Government’s
ongoing effort to track state progress in
developing comprehensive strategies and tactics
toward the elimination of cervical cancer. The
report tracks state-level cervical cancer incidence
and mortality data, insurance coverage, screening
rates and coverage of advanced screening
technologies, in addition to policy initiatives. New
indicators to track the state-level implementation
of the HPV vaccine and its integration within
existing cervical cancer screening programs will
be added to future editions of this report.
 Report Findings

Partnering for Progress 2007 shows continued Key Findings

progress in the fight against cervical cancer. The
report charts a continued decline in cervical
cancer incidence and mortality rates; robust • For the first time, one state—Minnesota—
rates for Pap screening; and significant legislative received a grade of Excellent (15 out of 18
activity aimed at eliminating cervical cancer by possible points).
increasing access to screening and treatment,
Minnesota, which received a grade of Very
raising awareness, and prompting improved
Good last year, is in the top tier for five of the
coordination of state resources and efforts
six health indicators scored and in the middle
through statewide accountable entities, such as
tier on one: the percentage of uninsured,
task forces.
unscreened women. Notably, it is the only
state with a rate of uninsured women below
However, the report notes significant shortfalls in
10%. The state also has a cervical cancer
key areas, including dramatic racial disparities in
task force and has introduced other
incidence, mortality, and screening rates and a
legislative measures to fight cervical cancer.
continued lack of access to care for low-income
women, which will require additional collaborative
efforts to address. Advanced technologies,
including the HPV test and an HPV vaccine, are • A majority of states and the District of
Columbia saw a decrease in both cervical
now available to further decrease incidence, but
cancer incidence and mortality.
each state must continue to develop an
appropriate infrastructure (e.g., funding, outreach A total of 33 states and the District of
and education programs—particularly to Columbia, or 67%, experienced a decrease in
underserved women—and provider partnerships) incidence, while 25 states and the District of
and environment (e.g., higher levels of insured Columbia, or 51%, experienced a decrease
women) to ensure that all women are able to in mortality.
take advantage of these preventive technologies.

• Just under half (49%) of the states

experienced an increase in their rate of
uninsured women.
Dramatic disparities remain in terms of
insurance coverage for women. While less
than 10% of women in Minnesota are
uninsured, almost 30% of women in Texas do
not have insurance. And while only 19% of
Maine’s low-income women are uninsured,
more than 50% of Texas’ low-income women
lack insurance. Lack of insurance coverage
threatens to undermine some progress unless
coverage is extended to make new screening
and preventive technologies available to
uninsured and underinsured women.

The “State” of Cervical Cancer Prevention in America 9

 Report Findings

• State legislators continue to advance • Screening rates for Black women are
policies to address cervical cancer usually as high, if not higher, than for
prevention, including measures designed to White women, but screening continues
increase screening and treatment options, to lag for Hispanic women in some
bring together stakeholders in collaborative states and for Asian/Pacific Islander
initiatives, and raise awareness of cervical women and American Indian/Alaskan
cancer and HPV. Native women throughout the country.
While 94% of Black women and 90%
This year, more than 25 measures dealing with
of White women in Massachusetts
cervical cancer prevention were introduced in
reported receiving a cervical cancer
legislatures around the country. Since Women
screening in the past three years, only
In Government began advocating and tracking
68% of Asian/Pacific Islander women
cervical cancer-related legislation, 45 states
had been screened. In the District of
have introduced legislation or resolutions and
Columbia, only 77% of Hispanic
40 states have enacted such measures.
women had been screened in the past
three years, compared to nearly 90% of
White and Black women. Lack of
• Despite overall progress in the elimination access to screening for underserved
of cervical cancer, disparities continue in
populations may point to gaps in the
terms of incidence, mortality, and screening
health care infrastructure that will
at the national level. These systemic
similarly undermine efforts to provide
weaknesses may undermine the ability of
these women with access to new
all women to have access to and utilize
screening and preventive technologies.
new, preventive technologies.
• Incidence and mortality rates for Black
and Hispanic women are higher than
those for White women in most states
where that data are available. For
example, the cervical cancer incidence
rate for Black women in Kansas is
nearly three times that for White
women. The incidence rate for Hispanic
women in Massachusetts is almost
two-and-one-half times that of White
women. The mortality rate for Black
women is nearly twice the rate
—or higher—than for White women in
half of all states.

10 Partnering For Progress 2007

 Report Findings

State Scores A total of 13 states received a grade of Very

States have cemented the gains made in the
fight against cervical cancer in recent years and
continue to improve upon their efforts, as
reflected in their scores in this year’s report.
The scores show a continued improvement
across the board, and, for the first time, a state
has achieved the grade of Excellent. Scores
ranged from a low of 6 out of 18 possible points
for Idaho to a high of 15 out of 18 possible
points for Minnesota. The majority of states
(57%) received a grade of Good.
2007 vs. 2006
State Grade Comparison
40 2006
35 34 2007
30
30
Good, up from 11 states in 2006. States that
moved from the Good to Very Good category
were Washington, Connecticut, Maine, Kansas,
and Michigan. This is a dramatic increase from
the first report, when only four states received a
grade of Very Good. Including Minnesota, nearly
one-third of all states are now rated Very Good
or Excellent in efforts to prevent cervical cancer.
A total of 30 states received a grade of Good.
States moving from the Fair to Good category
were Kentucky, California, and West Virginia.
There has been a dramatic decrease in the
number of states rated as Fair since the inaugural
report in 2005. While 21 states were rated as Fair
in the 2005 report, only 6 states and the District of
Columbia are now rated as Fair, which attests to
the progress the majority of states have made.
Three states—Mississippi, Utah, and Iowa—and
the District of Columbia slipped from the Good
category into the Fair category.

25

20

15 13
11
10 7
6
5
0 1
0
Fair Good Very Good Excellent

Minnesota, which received a grade of Very Good

last year and Good in the 2005 benchmark
report, increased its score to Excellent, scoring
15 out of 18 possible points. Minnesota is in the
top tier for five of the six health indicators scored
and in the middle tier on one: the percentage of
uninsured, unscreened women. It is the only state
with a rate of uninsured women below 10%.
The state also has a statewide cervical cancer
task force and has introduced other legislative
measures to address cervical cancer prevention.

The “State” of Cervical Cancer Prevention in America 11

 Report Findings
Cervical Cancer Incidence
A total of 33 states and the District of Columbia,
or 67%, experienced a decrease in cervical
cancer incidence. However, 16 states, or 31%,
experienced an increase in incidence rates, while
1 state (2%) stayed the same. The NCI and the
CDC caution against reading too much into year-
to-year changes in cancer incidence because of
natural fluctuations in this type of data.12
Incidence rates ranged from a high of 11.4 cases
per 100,000 women in Mississippi to a low of 4.9
per 100,000 in Utah.
• 15 states received the highest score of 2 for
cervical cancer incidence rates between
4.0/100,000–7.3/100,000.
• 33 states and the District of Columbia received
a score of 1 for incidence rates between
7.4/100,000–10.7/100,000.
Highest Cervical Cancer Incidence by Locale
AR
AL GA
MS
TX
12 Partnering For Progress 2007
• 2 states received a score of 0 for incidence
rates between 10.8/100,000 –14.0/100,000.
Nine of the ten lowest ranking states are located
in the southern and southwestern portion of the
United States, which points to a clear pattern of
cervical cancer incidence concentrated in
southern states, many with high poverty rates
and/or high rates of uninsured women.
Current incidence rate data were not available for
seven states due to the unavailability or quality of
data; three-year cumulative rates from previous
years were used for these states. As three of
these states—Arkansas, Maryland, and
Mississippi—had the highest incidence rate
rankings in the nation, the possibility exists that
variations in the data sets may be responsible for
the higher numbers.
MD
DC
WV
• Mississippi
• Maryland
• Alabama
SC
• Arkansas
• District of Columbia
• South Carolina
• Florida
FL
• Georgia
• Texas
• West Virginia
 Report Findings

Cervical Cancer Mortality • Only the District of Columbia received a score

A total of 25 states and the District of Columbia,
or 51%, experienced a decrease in cervical
cancer mortality, while 9 states (18%) showed no
change in their rate. However, 16 states, or 31%,
experienced an increase in mortality rates. The
average increase typically was small.
Cervical cancer mortality ranged from a high of
4.3 per 100,000 women in the District of
Columbia to a low of 1.3 per 100,000 women in
Massachusetts.
of 0 for its cervical cancer mortality rate of
4.3/100,000.
As with cervical cancer incidence, high rates of
mortality are clustered in states in the South and
Southwest.
As with the incidence data, a number of states
either did not collect mortality data or submitted
data of insufficient quality; 13 states did not
provide current data and data from previous
years were used for these states.

• 9 states received a score of 2 for mortality

rates of between 2/100,000–1.3/100,000.

• 41 states received a score of 1 for mortality

rates between 2.1/100,000–4/100,000.

Highest Cervical Cancer Mortality by Locale

DE
DC
WV

KY
• District of Columbia
• West Virginia
• Kentucky
OK SC
AR • Mississippi
MS AL
• Delaware
TX
• Arkansas
• Texas
• South Carolina
• Alabama
• Oklahoma

The “State” of Cervical Cancer Prevention in America 13

 Report Findings

Pap Screening Rates Medicaid Coverage of HPV Tests

Pap screening rates remained constant since the
last report, as there was no new data collection
for the data set used in previous reports.
Screening rates ranged from a low of 78.2% in
Utah to a high of 89.7% in New Hampshire.
• 26 states and the District of Columbia earned
a score of 2 for Pap screening rates between
85.8%–90%.
• 22 states earned a score of 1 for rates between
81.4%–85.7%.
• 2 states received a score of 0 for rates between
77%–81.3%.
Providing the HPV test as a regular component of
cervical cancer screening is especially important for
low-income women who may not receive regular
screenings, as studies show it is more sensitive than a
Pap test alone at identifying women with cervical
cancer or its precursors.13
The overwhelming majority of states cover HPV testing
as part of Medicaid services for female beneficiaries.
Only four states currently place restrictions on Medicaid
coverage of HPV testing: California, Pennsylvania,
South Dakota, and Tennessee. These state Medicaid
programs cover HPV testing for resolving inconclusive
Pap test results but not HPV testing for routine primary
screening along with the Pap test.

A new screening indicator was added to this

year’s report: the percentage of uninsured women
who do not receive regular Pap screening. The
rates of uninsured, unscreened women ranged
from a low of 16.1% in Connecticut to a high of
35.8% in Utah.
• 12 states received a score of 2 for rates of
uninsured, unscreened women between
16.1%–22.6%.

• 34 states and the District of Columbia received

a score of 1 for rates between 22.7%–29.2%.

• 4 states received a score of 0 for rates between

29.3%–35.8%.

14 Partnering For Progress 2007

 Report Findings
Health Insurance Coverage
The lack of health insurance is an important marker
for higher rates of incidence and mortality for many
cancers, including cervical cancer, because it limits
access to screening and preventive services. In
2004, 40% of women who had no health insurance
said they hadn’t had a Pap test in the past two
years, versus 20% of women with insurance.14
This year’s report demonstrates that health insurance
coverage remains a challenge for all 50 states and
the District of Columbia. A total of 25 states, or 49%
of the total, experienced an increase in the number of
women without health insurance. Nine states and the
District of Columbia (21%), however, saw a decrease
in the number of uninsured women and 16 states
(31%) saw no change. The percentage of uninsured
women in the states ranged from a low of 9% in
Minnesota to a high of 29% in Texas.
• Minnesota was the only state to score a 2 for
having a rate of uninsured women below 10%.
• 38 states and the District of Columbia received a
score of 1 for rates of uninsured women between
11% and 20%.
• 11 states received a score of 0 for rates between
21% and 30%.
Uninsured Scores
50
40 38 39
Number of states
30
20
12
10
1 1
0
2 1
Score
The “State” of Cervical Cancer Prevention in America
This year’s report includes, for the first time, statistics for
the number of low-income, uninsured women to further
inform the discussion about the impact of the lack of
insurance coverage on cervical cancer incidence and
mortality. This indicator is not scored. Rates of low-
income, uninsured women ranged from a low of 19.2%
in Maine to a high of 51.9% in Texas.
It is notable that ten of the 13 states that fall into the
lowest tier in terms of the lack of insurance coverage
for low-income women are in the bottom half of the
states in terms of cervical cancer incidence. Similarly,
eight of the same 13 states are in the bottom half of
the states in terms of cervical cancer mortality.
Policy Initiatives and Infrastructure
Since the launch of the “Challenge to Eliminate
Cervical Cancer Campaign,” legislators in states
across the country have continued to implement
policy initiatives to help meet the goal of eliminating
cervical cancer. Women In Government has worked
to bring state legislators together with key
stakeholders in a number of initiatives, including
state-based educational programs and national
seminars. These forums give state legislators,
representatives of state departments of health,
physicians and other heath care providers from the
private and public sectors, and manufacturers of
new technologies an opportunity to collaboratively
craft strategies designed to broaden access to
screening and preventive technologies.
2006
2007 Since Women In Government began tracking states’
efforts to eliminate cervical cancer through the
Campaign, 45 states have introduced legislation or
resolutions toward that goal, including measures to
11
require insurers to cover HPV screening, bills to
create statewide accountable entities, such as
cervical cancer task forces, and resolutions creating
0
Cervical Cancer Awareness months. In many states,
multiple pieces of legislation or resolutions have
been enacted in the past three years.
15
 Report Findings

Women In Government’s Challenge to Eliminate Cervical Cancer Campaign

Legislative progress from January 1, 2004 to November 1, 2006

VT ME
WA
MT ND
MN NH MA
OR NY*
WI RI
ID
MI CT
PA NJ
IA
OH* DE
IL IN
NV WV
UT VA MD*
CO MO
CA* KS* KY
NC
TN*
OK SC
AZ NM AR
MS* AL GA*
HI
LA
TX

FL*
Legislative Activity in 45 States
5 pending bills and/or resolutions
40 enacted bills and/or resolutions
*State has introduced new legislation in 2005/2006 Activity as of November 2006

This year, West Virginia and California became the
fifth and sixth states to require insurers (except
self-funded plans, which do not have to adhere to
state mandates) to cover HPV testing as part of
primary cervical cancer screening, along with
Maryland (2005), New Mexico (2005), Texas
(2005) and North Carolina (2003). The
combination of the Pap test and the HPV test has
been found to be significantly more sensitive in
identifying women with high-grade cervical
disease or cancer than the Pap test alone.15
Statewide accountable entities, such as task forces,
also have emerged as a powerful tool for states to
define the extent of cervical cancer prevention,
detection and treatment awareness and to develop
a comprehensive strategy to combat cervical
cancer, which typically includes consideration of
advanced preventive technologies. In the past year,
five states created cervical cancer elimination task
forces: Michigan, New Jersey, Pennsylvania,
Tennessee, and Vermont.
States continue to use other legislative tools to
promote awareness of cervical cancer. This year
four states passed new legislation creating a
cervical cancer awareness month or program.
In addition, four states introduced, and one of
these states passed, measures to increase funding
for cervical cancer screening and treatment.

16 Partnering For Progress 2007

 Recommended Actions
Based on these report findings, Women In
Government has created a set of recommended
actions to help enable states determine next
steps in the fight to eliminate cervical cancer.
1 some state Medicaid programs and some private
States should continue to build coalitions
among stakeholders to implement cervical
cancer elimination strategies, including vaccines
and screening for vulnerable populations.
By building coalitions and partnerships, groups
can work together using innovative strategies to
reach high-risk populations with integrated
screening and treatment services.
• Partner with state breast and cervical cancer
early detection programs to disseminate
educational information to constituents.
• Partner with women’s clubs, sororities,
advocacy groups, faith-based organizations
and membership associations to use their
expertise and outreach mechanisms for
reaching women.
• Collaborate with comprehensive cancer control
plans to ensure that each state is addressing
advances in cervical cancer prevention.
• Ensure funding for existing state Offices of
Women’s Health and establish offices in states
that do not have one.
• Disseminate disease and screening information
to locations where women gather (e.g., hair and
nail salons, schools, on public transportation).
• Identify and recruit members of the medical
community willing to perform volunteer
screening and immunization services.
• Partner with the private sector to fund outreach
and educational activities.
• Enlist policymakers to support cervical cancer
prevention efforts, funding and legislation.
The “State” of Cervical Cancer Prevention in America
2
States should ensure reimbursement for
increased access to Pap testing, HPV testing,
and the HPV vaccine. Most states cover the cost
of routine Pap tests. Many states also cover HPV
testing in public and private programs. However,
payers do not cover this technology. Taking
maximum advantage of preventive services, such
as cervical cancer screening and vaccination,
depends on the establishment of appropriate
infrastructure and stakeholder preparedness for
implementation.
• Provide legislative support for reimbursement
(public and private, including Medicaid coverage)
of screening and vaccination services.
• Coordinate efforts of legislators, department of
health officials, and public health advocates to
ensure the implementation of immunization
programs for HPV vaccines, in addition to
continued collaboration to enhance current
screening programs.
• Require Medicaid to cover FDA-approved HPV
vaccines for eligible 19-to-26-year-olds.
• Ensure that public health programs are
adequately funded and utilized to ensure that all
other age -appropriate women have access to
cervical cancer screening and immunization.
• Create and work with physicians to ensure
that screening and vaccination services are
carried out as recommended by clinical
practice guidelines.
17
 Recommended Actions
3 4
States should continue to develop and fund
cervical cancer and HPV public education
and awareness programs. Knowledge about
cervical cancer and HPV is essential to
increasing screening and vaccination rates and
reducing cervical cancer incidence and mortality.
Public awareness and educational outreach
increase women’s knowledge of cervical cancer
and prevention strategies; improve access to
health care services; and increase provider
awareness, knowledge and compliance with
recommended screening and treatment
guidelines. Outreach programs should be
linguistically and culturally appropriate and
should include underserved populations.
• Simplify messages regarding HPV and cervical
cancer when speaking with constituents.
• Focus educational outreach efforts on
preventing cervical cancer and removing the
stigma of HPV.
• Utilize the media to mainstream educational
messages for constituents and colleagues.
• Create and execute public information
campaigns through legislative action.
• Create and disseminate educational brochures
and other marketing materials.
• Educate and empower women/constituents/
patients to take responsibility for their
own health.
• Educate parents about the link between HPV and
cervical cancer and the prevalence of the virus.
• Educate the medical community by including the
topics of HPV and cervical cancer in core
curricula for medical and nursing schools and
offer accredited continuing education programs
on cervical cancer prevention for physicians,
nurses, and other health educators.
18 Partnering For Progress 2007
States should work to improve data quality and
collection to evaluate programs and services.
Improving data quality and collection to include
new measures for HPV testing and immunization
will assist state programs in assessing awareness
levels of HPV and cervical cancer and
acceptability of new preventive techniques by
women and their providers. Furthermore, by
improving data quality and collection, public health
programs can more efficiently evaluate the
success of screening and preventive services.
• Establish uniform reporting surveillance and data
collection strategies across county, municipal
and state health agencies.
• Create a state-specific inventory of cervical
cancer prevention programs and stakeholders.
• Track state-specific data (e.g., barriers to
screening at the individual level, Medicaid
issues, and levels of public and private health
insurance coverage).
• Work with state cancer registries, the CDC and
state health departments to improve the quality
of data collection among women receiving
screening services.
• Survey women to assess understanding of HPV
and cervical cancer, Pap and HPV tests, and
HPV vaccines.
• Measure vaccination and screening rates in
each state to evaluate outcomes of educational
campaigns.
 Case Study
Michigan: Collaborating for Success
Michigan has improved its overall standing by
two grades since the first state-by-state cervical
cancer report was published in 2005. That year,
the state scored a grade of Fair, with an
incidence rate of 8.5/100,000 women and a
mortality rate of 2.5/100,000. The state’s cervical
cancer screening rate was 85.6%, which put it in
the middle tier in terms of screening, and the
state did not have a cervical cancer task force or
cervical cancer prevention legislation. Michigan
improved its grade to Good in the 2006 report.
Its incidence rate dropped to 8.1/100,000 and its
mortality rate dropped to 2.1/100,000. The state
also increased its cervical cancer screening rate
to 86.5%, which moved it into the top tier in
terms of screening.
This year, Michigan received a grade of Very
Good, having scored 67% of the total possible
points, up from 44% in the first report. The
cervical cancer incidence rate in the state
plummeted to 7.4/100,000 and the mortality rate
to 1.9/100,000, moving Michigan into the ranks
of the states with the lowest mortality rates. The
state also ranked in the highest tier in terms of
the percentage of women and low-income
women who are screened for cervical cancer.
The “State” of Cervical Cancer Prevention in America
In addition, Gov. Jennifer Granholm created the
Michigan Task Force on Cervical Cancer Awareness
by executive order in February of 2006. The task
force reviewed existing cervical cancer awareness
efforts in the state and is in the process of making
recommendations to the governor for a
comprehensive, statewide public awareness
campaign about the importance of cervical cancer
screenings. Additionally, as this report was going to
press, Michigan cemented its leadership role in
cervical cancer prevention by becoming the first
state to consider legislation that would ensure
widespread access to an HPV vaccine by adding
the new vaccine to the list of required immunizations
for middle school entrance.
How did Michigan achieve this success with its
cervical cancer prevention efforts? And what
lessons can other states learn from the Michigan
experience?
According to State Senator Beverly
Hammerstrom (R-Temperance), who as chair of
the Michigan Senate Health Policy Committee
has been instrumental in increasing cervical
cancer prevention awareness in the state,
collaboration is the key to an effective cervical
cancer prevention effort. Early on in her efforts to
make cervical cancer elimination a priority for the
state, she enlisted the support of key officials
from the state Department of Community
Health—including the director and the heads of
the women’s health and cancer prevention
programs—in addition to her female colleagues
in the state legislature. She took advantage of
Women In Government’s educational outreach
programs to help bring these key stakeholders
up to speed on the issue of cervical cancer and
to inspire their personal involvement and
commitment to the cause.
19
 Case Study

Michigan: Collaborating for Success (continued)

Hammerstrom also introduced a resolution in Beyond this legislation, Hammerstrom said that
2005 urging the creation of a cervical cancer task integrating the HPV vaccine into the state’s
force to coordinate state efforts and create an health system is a continuing educational
awareness education strategy—a step that has process. The first issue the state will have to
proved key in the cervical cancer prevention tackle is funding for the vaccine to ensure that
efforts of many states. In addition, she worked girls without private health insurance will receive
extensively with the medical community, including coverage. She noted that extended coverage for
doctors at the University of Michigan, nurses uninsured and underinsured women between the
groups in the state and the Michigan State ages of 19 and 26, who are too old for coverage
Medical Society. She also leveraged her position under the federal Vaccines for Children program,
as chair of the Senate Health Policy Committee will need to be addressed with the aid of
and a member of Women In Government’s stakeholders such as community health centers
Cervical Cancer & HPV Task Force to reach out to and family planning clinics.
stakeholder groups by speaking to organizations
such as women’s committees, writing op-eds for In the end, Hammerstrom said, the key to
publication in local and state newspapers, and, in success is a strong working partnership between
her words, “just getting out there and making the state legislature, the governor and the
people aware of this issue.” department of health, with the involvement of key
stakeholders.
In September, Hammerstrom introduced the first
state measure that would follow the provisional
recommendation by the federal Advisory
Committee on Immunization Practices that the
HPV vaccine be given routinely to 11- and
12-year-old girls. Under her bill, the HPV vaccine
would be included on the immunization schedule
for girls entering sixth grade, with exemptions as
provided for within the state’s existing vaccine
regulations. Again, collaboration was
Hammerstrom’s watchword as she prepared to
introduce the measure. She enlisted all the female
senators as co-sponsors of the measure and also
did educational outreach with the male members
of the relevant health committees. As a result, the
bill passed the Senate with strong bipartisan
Senator Hammerstrom accepts a Women In Government
support. She noted the need to educate Presidential Leadership Award for her Commitment to
legislators and stakeholders about the vaccine as Cervical Cancer Prevention at the Second Annual HPV &
a women’s health issue. “This is not about how Cervical Cancer Summit.
you get the virus,” she noted, “it is about how you Also pictured: Dr. Donnica Moore and Susan Crosby
protect yourself.” Photo: Marty LaVor

20 Partnering For Progress 2007

 Case Study
The Women In Government Cervical Cancer & HPV Task Force:
A National Collaborative Model
Since 2003, Women In Government has
convened its Cervical Cancer and HPV Task
Force annually to bring together a national,
bi-partisan group of women state legislators
committed to eliminating cervical cancer.
The task force provides state legislators with
education about cervical cancer prevention
issues, such as the societal cost of cervical
cancer, incidence and mortality disparities in
underserved and minority populations, and new
technologies to detect and prevent cervical
cancer. Task force meetings also provide
guidance on effective cervical cancer prevention
communication and outreach strategies and on
varied state legislative initiatives. Just as
importantly, it provides a forum for state
legislators to learn from one another’s
experiences and to collaborate with additional
key stakeholders.
Task force members have found the education
sessions to be critical to deepening their
understanding of the issues surrounding cervical
cancer prevention. They have returned to their
state legislatures to introduce legislation or policy
initiatives that will address the needs or
opportunities specific to their states.
The “State” of Cervical Cancer Prevention in America
Among the outcomes are the creation of cervical
cancer task forces, measures to require
insurance coverage for HPV tests, and cervical
cancer and HPV awareness events.
Most recently, the task force brought their
experience to bear to collaboratively address the
question of implementing the new HPV vaccine
at the state level. The task force considered a
number of questions, including ways to improve
awareness of the vaccine among the public and
providers, funding for the VFC program and other
public programs, and private insurance coverage.
The task force also addressed other policy
issues, including ensuring access for uninsured
populations and whether the HPV vaccine should
be a required vaccine for school entry.
The result of these deliberations was a set of six
policy recommendations for the implementation
of the HPV vaccine, including: VFC coverage;
support of school entrance requirements;
increased health coverage; access for the
uninsured/underinsured not covered by VFC;
public education & awareness; and enhancing
the role of statewide accountable entities.
Women In Government’s full recommendations
are available at:
www.womeningovernment.org /prevention,
and will serve in part as the basis for expanded
scoring indicators in the 2008 edition of this report.
By bringing together educated legislators to
collaboratively address this critical cervical cancer
prevention issue, Women In Government has
ensured that states will have appropriate policy
models to most effectively implement the HPV
vaccine, especially for populations that are
dependent on publicly funded programs.
21
 Case Study
Virginia: Task Force Approach Enhances Cervical Cancer Prevention Efforts
In Virginia, the Governor’s Task Force on Cervical
Cancer was created by Executive Order by former
Virginia Gov. Mark Warner in January of 2005 with
instructions to complete a preliminary report on cervical
cancer prevention by November of 2005. The report
included extensive data analysis of cervical cancer
incidence and mortality in the state broken down by
race, geographic location, and stage of diagnosis,
as well as an overview of current data collection
efforts and a review of screening and treatment
options and programs for uninsured populations.
The task force used this information to create a
series of recommendations to raise awareness of
cervical cancer and reduce incidence and
mortality. The task force called for:
• Additional study of the racial, ethnic and cultural
disparities in cervical cancer incidence to identify
causes and the development of a plan to
address findings;
• Additional funding for cervical cancer screening
and precancerous management services;
• Implementation of a public health education
campaign to address HPV and cervical cancer;
• Exploration of opportunities for broadening
funding for emerging technologies and cervical
cancer screening and management services for
precancerous conditions; and
22 Partnering For Progress 2007
• Following the Centers for Disease Control and
Prevention’s ACIP guidelines regarding the new
HPV vaccine and allocate necessary funding.
The result of the task force deliberations was a
comprehensive, cervical cancer prevention
strategy that addressed key issues specific to
Virginia and accounted for the availability of new
technologies and the need to fund these
technologies to maximize progress. According to
the Virginia Department of Health, which
coordinated the task force activities, the success
of the task force was due to its collaborative
nature. The 19-member task force included
doctors and nurses from the public and private
sectors, as well as representatives from the
pharmaceutical industry, health insurance
companies, nonprofits, and the Department of
Health. Each recommendation was developed
with input from the task force members.
The Department of Health noted that is was
important that the task force represent the diversity
of stakeholders involved in successful cervical
cancer prevention efforts. The diversity of the task
force assisted the state in gaining a macro-level
view of the issues surrounding HPV infection and
cervical cancer with regard to education, access,
cultural diversity, and clinical treatment.
Efforts to enhance cervical cancer prevention
efforts are already paying off in Virginia. In August
2006, the Virginia General Assembly allocated
funding to expand the Virginia Breast and Cervical
Cancer Early Detection Program, which targets
minority and geographically isolated women. The
additional allocation will allow the state to offer
cervical cancer screening to more women over
the age of 18, which was a key recommendation
of the task force.
 Cervical Cancer Prevention Facts
1 2
What is cervical cancer?
Cervical cancer is cancer of the cervix, the part of
the uterus or womb that opens to the vagina.
Before widespread screening using the Pap test
began in the 1950s, cervical cancer was the
leading cause of cancer death in American
women. Today in the United States, the Pap test
has helped reduce cervical cancer death rates by
70%. Recent advances in prevention, including
the HPV test and the HPV vaccine, could help to
wipe out this disease.
The American Cancer Society estimates that, in
2006, about 9,710 women in the United States
will get cervical cancer and about 3,700 women
will die from it. In other countries, cervical cancer
affects approximately 500,000 women each year.
In some parts of the world, it is still the most
common cancer in women.
cervix
Note: Women In Government, a member of the National Cervical
Cancer Public Education Campaign, adapted some of this material
from Gynecologic Cancer Foundation materials, found at:
www.cervicalcancercampaign.org
The “State” of Cervical Cancer Prevention in America
What causes cervical cancer?
The human papillomavirus (HPV) causes almost
all cases of cervical cancer. HPV is a
common sexually transmitted virus that usually
goes away by itself without symptoms or
treatment. Approximately 80% of adults will have
HPV at some point in their lives.
There are two types of HPV: low risk and high
risk. Some low-risk HPV infections can cause
genital warts. Sometimes, if the high-risk type of
HPV does not go away on its own, it may cause
pre-cancerous cells to form. If these abnormal
cells are not found and treated, they may
become cancer. An HPV infection rarely leads to
cervical cancer. In most women, the cells in the
cervix return to normal after the body’s immune
system destroys the HPV infection.
3
Who gets cervical cancer?
Since almost all cervical cancers are caused by
HPV, any woman who has sex can get cervical
cancer. Most women who have had sex have
been infected with HPV at some time in their life.
The women at highest risk for cervical cancer are
women in whom infection with one of the high-
risk types persists for years. Other risk factors for
cervical cancer include smoking and HIV
infection. The women most at risk for the disease
are women who have not been screened
regularly or at all.
23
 Cervical Cancer Prevention Facts
4 5
What cervical cancer screening
options are available?
There are several cervical cancer screening
options:
• Traditional Pap Test (also known as
Pap smear)
Doctors use the Pap test to look for abnormal
cells from a sample of cells from the cervix. The
cervical cells are smeared on a glass slide and
examined under a microscope. The Pap test
looks for cancer cells and cells that might
become cancerous in the future.
• Liquid-based Pap Test
Liquid-based cytology refers to a newer way to
process Pap test results. Instead of smearing
the sample on a glass microscope slide, the
cervical cells are placed in liquid in a small
bottle. Some of the liquid is placed on a slide
and then examined under a microscope.
Research has shown that liquid-based Pap
tests can be more accurate than the
conventional way of preparing the slides
because blood and mucous are removed,
making the cells easier to see.
• The HPV Test
The HPV test checks directly for high-risk HPV.
HPV testing is FDA-approved for use with a
Pap test in routine cervical cancer screening for
women age 30 and older and for women of all
ages as a follow-up to inconclusive Pap test
results, known as ASC-US (atypical squamous
cells of undetermined significance).
Both the Pap and HPV tests use a small, soft
brush to collect cervical cells. Women who get
an HPV test along with their Pap will not notice
any difference in their exam.
24 Partnering For Progress 2007
Who should get an HPV test?
Both the American Cancer Society (ACS) and the
American College of Obstetricians and
Gynecologists (ACOG) state that an HPV test in
conjunction with a Pap test is a reasonable
option for screening women age 30 and older.
Research shows that the two tests together are
more accurate than the Pap test alone at
identifying women with cervical cancer or its
early signs.
Women under 30 should not get the HPV test
with the Pap test unless they receive inconclusive
Pap test results. Young women have more
frequent HPV infections (which are likely to be
temporary) and more frequent changes in sex
partners. Thus, HPV testing as part of routine
screening is not recommended in this age group.
6
Do health plans cover HPV
testing?
Most insurance companies provide coverage for
HPV testing. In fact, some states, such as
California, Maryland, Texas, New Mexico, North
Carolina, and West Virginia, require health plans
to reimburse for HPV testing when used along
with a Pap test in women age 30 and older as
part of routine screening. Most state Medicaid
programs provide coverage of HPV tests as part
of regular cervical cancer screening and all state
Medicaid programs provide coverage of HPV
tests for the follow-up of inconclusive Pap tests.
 Cervical Cancer Prevention Facts
7 8
When should women get
screened?
The ACS and ACOG recommend that:
• Women should be screened for cervical cancer
about 3 years after they start having sexual
intercourse. Screenings should start by the time
a woman is 21 years old.
• Women should be screened every year with a
regular Pap test. As an alternative, the newer
liquid-based Pap test can be used every year
or every 2 years. All women younger than 30
should get cervical cytology (cancer) screening
at least every two years.
• Women age 30 and older who have had 3
normal Pap tests in a row don’t need to get a
Pap test every year. They can get the test every
2 or 3 years, unless they have certain risk
factors, which they should discuss with their
doctor. Or, they can get a Pap test in
conjunction with the recently available HPV test
every 3 years, in accordance with their doctor’s
recommendation. Even though women with
normal results may not need to be screened
every year, they should go to their doctor every
year for a check-up, including a pelvic exam.
• According to ACS, women age 70 and older
who have had 3 or more normal Pap test
results in a row and no abnormal test in the last
10 years can stop getting screened. ACOG
recommends, however, that women over age
70 should still get Pap tests every 2 or 3 years.
Women should talk to their doctor to decide the
best plan for them.
• Women who have had a hysterectomy may still
need to be screened regularly, depending upon
what kind of hysterectomy they had. They
should discuss their situation with their doctor.
The “State” of Cervical Cancer Prevention in America
What are HPV vaccines?
In June 2006, the FDA approved a vaccine
shown in clinical research to be 100% effective at
preventing disease from high-risk types of HPV
(16 and 18) that account for approximately 70%
of all cervical cancers. This vaccine, known as
Gardasil,® also targets the two HPV types that
cause approximately 90% of genital warts. A
second HPV vaccine, known as Cervarix,TM has
been shown in clinical trials to be equally effective
against HPV types 16 and 18 and is expected to
be submitted to the FDA in 2007. These vaccines
will not treat HPV nor prevent disease from HPV
types if a woman has already been infected with
that type.
9
Who should receive HPV
vaccines?
To be most effective, the FDA-approved HPV
vaccine should be given before a female becomes
sexually active. The FDA approved the first HPV
vaccine for girls and women aged 9–26. The
federal Advisory Committee on Immunization
Practices (ACIP) subsequently recommended that
the HPV vaccine be given routinely to females
aged 11 to 12 and as early as age 9 and that girls
and women aged 13 to 26 should be vaccinated if
they have not already received the HPV vaccine.
25
 Cervical Cancer Prevention Facts
10
Are the vaccines safe?
In multiple clinical trials, the vaccines have been
extremely safe. Redness and tenderness at the
vaccination site, along with low-grade fevers have
been the most common side effects for both
vaccines. There have been no serious vaccine-
related side effects thus far.
11
When will the HPV vaccine be
available?
In the private sector, the FDA-approved vaccine is
now available through some health plans and
clinics. The vaccine will be available through
federal programs like the Vaccines for Children
program. Medicaid coverage is determined on a
state-by-state basis and many states are already
preparing to provide the vaccine
12
What will the HPV vaccine cost?
The retail cost of the vaccine is $120 per dose,
and a series of three doses will be needed. The
cost of the vaccine will vary by state, by health
plan, as well as among programs for the uninsured
and underinsured. The Centers for Disease Control
and Prevention has announced that a contract has
been signed to provide the HPV vaccine under the
VFC program for $96 per dose. This contract
expires on March 31, 2007.
26 Partnering For Progress 2007
13
Will health plans cover the vaccines?
When the ACIP recommends a vaccine, many
private insurers and health plans typically will cover
it. Some states, such as California, require insurers
to cover vaccination for those age groups
recommended by the ACIP. In addition, the ACIP
issued a resolution that the FDA-approved HPV
vaccine be included in the federal Vaccine for
Children program, which covers children on
Medicaid, uninsured and underinsured children,
and Native Americans and Alaskan Natives.
14
Will HPV vaccination be required
for school entrance?
Individual states will need to decide if HPV vaccination
will be required for school entrance, in accordance
with existing state exemption laws. As of May 2004,
all 50 states allow vaccination exemptions for medical
reasons, with 48 states allowing exemptions for
religious reasons and 20 states allowing exemptions
for philosophical reasons.
15
Now that we have an HPV vaccine,
will screening still be necessary?
Yes. HPV vaccines should be part of a comprehensive
strategy to eliminate cervical cancer. Screening using
advanced and appropriate technologies, such as HPV
testing, will still be needed to target cervical cancers
caused by HPV types not covered by the vaccine and
for women who have already been exposed to HPV or
who do not receive the vaccine.
 Cervical Cancer Prevention Facts
16
What is Women In Government
doing toward the elimination of
cervical cancer?
Given that cervical cancer is preventable, Women
In Government launched the “Challenge to
Eliminate Cervical Cancer Campaign” in 2004.
This initiative urges state legislators to address
cervical cancer prevention by increasing access
to the most advanced and appropriate screening
and preventive technologies, particularly for
underserved women, and improving education
about this disease and its cause, HPV.
As part of the Campaign, state legislators have
taken unique policy approaches to the goal of
eliminating cervical cancer. Some of their bills and
resolutions call for the creation of task forces
(either stand-alone work groups or bodies
created in coordination with existing state
infrastructure). These groups are designed to:
ensure that screening and preventative measures
correspond with the most up-to-date medical
Women In Government
presents this third annual
report on cervical cancer,
Partnering for Progress
2007: The “State” of
Cervical Cancer Prevention
in America, with the hope
that key stakeholders will continue to work
collaboratively toward the goal of eliminating
cervical cancer. Newly available technologies, like
HPV vaccines and HPV testing, make preventing
The “State” of Cervical Cancer Prevention in America
guidelines; share collective expertise; and
address emerging medical, social and
governmental issues around the elimination of
cervical cancer. Other legislation enacted in the
states requires insurance coverage for the most
advanced cervical cancer screening tests
available. Additionally, some states have
generated awareness resolutions and public
education initiatives and programs. To date, bills
and resolutions targeting cervical cancer
elimination have been introduced in more than 45
states and enacted in 40 states.
Women In Government supports access to
accurate and advanced FDA-approved
technologies, such as the HPV test and the HPV
vaccines, for all age-appropriate girls and
women, regardless of their socioeconomic status.
As part of the Campaign, we look forward to
educating our members, the public and health
care providers about these technologies. Women
In Government also believes that these
technologies should be part of comprehensive
cervical cancer prevention programs that use
both screening and vaccination in the most
effective way possible to eliminate this disease.
cervical cancer a reality. Issues of disparity in
cervical cancer incidence and mortality require all
interested parties to fight to level the playing field
in areas of access to prevention technologies,
insurance coverage, screening practice, and
education. This report provides information and
tools to support progress in fighting this deadly
disease. Women In Government encourages all
who read this report to take the challenge, and
work with us towards the goal of eliminating
cervical cancer.
27
 State Profiles 2007

The “State” of Cervical Cancer Prevention in America 29

 2007: Very Good
(13 out of 18 points)

2006: Very Good

(11 out of 16 points)
Alabama

Population: 4,557,808

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 10.6/100,000 ▲ 1 1
Cervical Cancer Incidence Rate/Race: White: 8.8
Black: 15.9
Cervical Cancer Mortality Rate: 3.0/100,000 – 1 1
Cervical Cancer Mortality Rate/Race: White: 2.4
Black: 5.7

Screening
Cervical Cancer Screening Rate: 87.4% 2 2
Cervical Cancer Screening Rate/Race: White: 86%
Black: 91%
% Uninsured/Unscreened: 18.8% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 18% ▲ 1 1
% Low Income/Uninsured Women: 32%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
HB 568 would establish the Alabama Cervical Cancer Elimination Task Force and require annual reports.
The legislative session ended with the bill in committee. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 2.

State Summary
Alabama saw its cervical cancer
incidence rate increase since the last
report. However, a bill was introduced,
for the second time, to create the Alabama – State Comparison Chart
Alabama Cervical Cancer Elimination
Task Force, although it 13 Points
did not pass. 16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 31

 2007: Good
(11 out of 18 points)

2006: Good
(10 out of 16 points)
Alaska

Population: 663,661

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.2/100,000 ▼ 2 1
Cervical Cancer Incidence Rate/Race: White: 8.8
Black: 15.9
Hispanic: 13.1
Cervical Cancer Mortality Rate: 2.2/100,000 ▲ 1 2
Cervical Cancer Mortality Rate/Race: White: 2.5

Screening
Cervical Cancer Screening Rate: 88.8% 2 2
Cervical Cancer Screening Rate/Race: White: 88%
American Indian /Alaskan: 94%
% Uninsured/Unscreened: 22.6% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 20% – 1 1
% Low Income/Uninsured Women: 39%
▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Alaska experienced a decrease in its
cervical cancer incidence rate but a
slight increase in its cervical cancer
mortality rate. While its rate of
uninsured women is fairly high, the Alaska – State Comparison Chart
state gets high marks for its low rate
of uninsured women who are 11 Points
unscreened for cervical cancer. 16
14
SCORE

12
10
8
6
STATES

32 Partnering For Progress 2007

 2007: Good
(11 out of 18 points)

2006: Good
(10 out of 16 points)
Arizona

Population: 5,939,292

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.2/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: White: 7.0
Hispanic: 9.0
Cervical Cancer Mortality Rate: 2.3/100,000 – 1 1
Cervical Cancer Mortality Rate/Race: White: 2.5

Screening
Cervical Cancer Screening Rate: 85.1% 1 1
Cervical Cancer Screening Rate/Race: White: 86%
Hispanic: 86%
% Uninsured/Unscreened: 23.4% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 20% – 1 1
% Low Income/Uninsured Women: 37%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage mandates. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 2.

State Summary
Arizona’s cervical cancer incidence
rate decreased slightly over the last
report but all the other indicators
held steady. While the incidence rate
is higher for Hispanic women than
White women, both groups have Arizona – State Comparison Chart
comparable screening rates.
11 Points
16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 33

 2007: Good
(10 out of 18 points)

2006: Good
(9 out of 16 points)
Arkansas

Population: 2,779,154

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 10.6/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: n/a
Cervical Cancer Mortality Rate: 3.3/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 3.2
Black: 6.4

Screening
Cervical Cancer Screening Rate: 81.7% 1 1
Cervical Cancer Screening Rate/Race: White: 83%
Black: 86%
% Uninsured/Unscreened: 28.7% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 24% ▲ 0 0
% Low Income/Uninsured Women: 41%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 2.

State Summary
Arkansas saw a decrease in its
incidence and mortality rates over
last year’s report. The state
continues to lag in the rate of
uninsured women, and mortality for
Black women is double that for Arkansas – State Comparison Chart
White women.
10 Points
16
14
SCORE

12
10
8
6
STATES

34 Partnering For Progress 2007

 2007: Good
(9 out of 18 points)

2006: Fair
(7 out of 16 points)
California

Population: 36,132,147

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.1/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 9.5
Black: 7.9
Hispanic: 13.1
Asian/Pacific Islander: 7.8
American Indian/Alaskan: 3.5
Cervical Cancer Mortality Rate: 2.2/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.5
Black: 4.2

Screening
Cervical Cancer Screening Rate: 84.7% 1 1
Cervical Cancer Screening Rate/Race: White: 85%
Black: 90%
Hispanic: 81%
Asian/Pacific Islander: 70%
% Uninsured/Unscreened: 23.3% 1
Medicaid Coverage HPV Testing: Restricted 0 0

Health Care Access

Rate Uninsured Women: 22% ▲ 0 0
% Low Income/Uninsured Women: 40%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
SB 1245 amends the Knox-Keene Health Care Services Plan Act and expands the coverage for an annual cervical
cancer screening test provided by a health care service plan or a health insurance policy to include the HPV screening
test. This bill was signed by Gov. Arnold Schwarzenegger on September 26, 2006. Cumulative score: 2.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous
cervical cancer prevention legislation. California – State Comparison Chart
Cumulative score: 2.
9 Points
State Summary 16

California’s incidence and mortality rates 14

SCORE

dropped since the last report. The state 12

continues to lag in the number of 10
uninsured women but did pass 8
legislation to mandate HPV testing for 6
women with insurance, which increased STATES
its score from Fair to Good.

The “State” of Cervical Cancer Prevention in America 35

 2007: Very Good
(12 out of 18 points)

2006: Very Good

(11 out of 16 points)
Colorado

Population: 4,665,177

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.2/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: White: 6.9
Hispanic: 11.2
Cervical Cancer Mortality Rate: 1.8/100,000 – 2 2
Cervical Cancer Mortality Rate/Race: White: 1.8

Screening
Cervical Cancer Screening Rate: 88.2% 2 2
Cervical Cancer Screening Rate/Race: White: 87%
Hispanic: 88%
% Uninsured/Unscreened: 23.9% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 19% – 1 1
% Low Income/Uninsured Women: 43%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
HJR 1005 urges the state cancer coalition to increase the public’s awareness of the prevalence, causes, and
prevention of cervical cancer and will recognize cervical cancer awareness month. Cumulative score: 2.

State Summary
Colorado recorded a slight decrease
in its cervical cancer incidence rate.
The incidence rate for Hispanic
women is dramatically higher than
for White women and the state ranks Colorado – State Comparison Chart
in the bottom 10 for the number of
low-income, uninsured women. The 12 Points
state has taken steps to increase 16
cervical cancer awareness. 14
SCORE

12
10
8
6
STATES

36 Partnering For Progress 2007

 2007: Very Good
(13 out of 18 points)

2006: Good
(10 out of 16 points)
Connecticut

Population: 3,510,297

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 6.8/100,000 ▲ 2 2
Cervical Cancer Incidence Rate/Race: White: 6.3
Black: 13.2
Hispanic: 19.8
Cervical Cancer Mortality Rate: 1.8/100,000 ▲ 2 2
Cervical Cancer Mortality Rate/Race: White: 1.8
Black: 3.0

Screening
Cervical Cancer Screening Rate: 87.7% 2 2
Cervical Cancer Screening Rate/Race: White: 90%
Black: 81%
Hispanic: 87%
% Uninsured/Unscreened: 16.1% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 12% – 1 1
% Low Income/Uninsured Women: 24%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
HB 5233 would increase funding for breast and cervical cancer detection and screening and provide increased
funding for breast and cervical cancer detection and treatment. The bill was in the Joint Committee on Public
Health when the Legislature adjourned. Cumulative score: 1.

State Summary
Connecticut remains in the top tier in
Connecticut – State Comparison Chart
terms of cervical cancer incidence,
mortality and screening. However, 13 Points
the incidence rate for Hispanic 16
women in the state is more than 14
three times as high as the rate for
SCORE

12
White women.
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 37

 2007: Good
(10 out of 18 points)

2006: Good
(8 out of 16 points)
Delaware

Population: 843,524

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.5/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 6.8
Black: 13.2
Hispanic: 19.8
Cervical Cancer Mortality Rate: 3.5/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 3.2
Black: 5.1

Screening
Cervical Cancer Screening Rate: 87.6% 2 2
Cervical Cancer Screening Rate/Race: White: 92%
Black: 94%
% Uninsured/Unscreened: 22.5% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 14% ▲ 1 1
% Low Income/Uninsured Women: 28%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Delaware’s incidence and mortality
rates dropped since the last report,
but its score relative to other states
remained unchanged. The cervical Delaware – State Comparison Chart
cancer incidence rate for Hispanic
women in Delaware is nearly three 10 Points
16
times that for White women in
the state. 14
SCORE

12
10
8
6
STATES

38 Partnering For Progress 2007

 2007: Fair
(8 out of 18 points)

2006: Good
(8 out of 16 points)
District of Columbia

Population: 550,521

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 10.4/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 6.7
Black: 12.2
Cervical Cancer Mortality Rate: 4.3/100,000 ▼ 0 1
Cervical Cancer Mortality Rate/Race: Black: 5.5

Screening
Cervical Cancer Screening Rate: 88.4% 2 2
Cervical Cancer Screening Rate/Race: White: 91%
Black: 89%
Hispanic: 77%
% Uninsured/Unscreened: 29.2% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 13% ▼ 1 1
% Low Income/Uninsured Women: 22%
▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
The District of Columbia’s cervical
cancer incidence rate dipped slightly
over last year’s report. The District’s
mortality rate is the highest in the
nation, but it also has the second
District of Columbia – State Comparison Chart
lowest rate of low-income,
uninsured women.
8 Points
16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 39

 2007: Good
(11 out of 18 points)

2006: Good
(9 out of 16 points)
Florida

Population: 17,789,864

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 10.0/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 9.6
Black: 14.5
Hispanic: 9.8
Cervical Cancer Mortality Rate: 2.8/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.7
Black: 6.1

Screening
Cervical Cancer Screening Rate: 84.0% 1 1
Cervical Cancer Screening Rate/Race: White: 85%
Black: 80%
Hispanic: 83%
% Uninsured/Unscreened: 28.1% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 23% ▲ 1 0
% Low Income/Uninsured Women: 44%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
HB 9109 is a resolution that designates January 2007 as Cervical Cancer Awareness Month in Florida.
Cumulative score: 1.

State Summary
Florida’s cervical cancer incidence
rate decreased slightly over last
Florida – State Comparison Chart
year’s report. The state ranks in
the bottom ten for the number of 11 Points
low-income, uninsured women. 16
Both incidence and mortality rates 14
for Black women are significantly
SCORE

12
higher than the overall state rate.
10
8
6
STATES

40 Partnering For Progress 2007

 2007: Good
(10 out of 18 points)

2006: Good
(9 out of 16 points)
Georgia

Population: 9,072,576

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 9.6/100,000 ▲ 1 1
Cervical Cancer Incidence Rate/Race: White: 8.6
Black: 13.1
Cervical Cancer Mortality Rate: 2.7/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.5
Black: 4.4

Screening
Cervical Cancer Screening Rate: 87.9% 2 2
Cervical Cancer Screening Rate/Race: White: 87%
Black: 90%
Hispanic: 81%
% Uninsured/Unscreened: 23.5% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 20% ▲ 1 1
% Low Income/Uninsured Women: 39%
▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Georgia saw a slight increase in its
incidence rate. The mortality rate
among Black women is nearly Georgia – State Comparison Chart
double that of White women,
although screening rates for Black 10 Points
16
women are slightly higher than for
White women and the state average. 14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 41

 2007: Good
(11 out of 18 points)

2006: Very Good

(11 out of 16 points)
Hawaii

Population: 1,275,194

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.8/100,000 ▲ 1 2
Cervical Cancer Incidence Rate/Race: White: 9.1
Asian/Pacific Islander: 8.9
Cervical Cancer Mortality Rate: 2.3/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 1.9

Screening
Cervical Cancer Screening Rate: 83.7% 1 1
Cervical Cancer Screening Rate/Race: White: 92%
Hispanic: 86%
Asian/Pacific Islander: 89%
American Indian/Alaskan: 83%
% Uninsured/Unscreened: 29.1% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 11% ▼ 1 1
% Low Income/Uninsured Women: 22%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
HB 233/249/SB 480/1028, which would establish a cervical cancer elimination task force for the state, was
carried over from the 2005 session. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
HR 6/HCR 7/SCR 1, which would recognize January as Cervical Cancer Awareness Month, was in the
House Committee on Health when the Legislature adjourned. Cumulative score: 2.

State Summary
Hawaii saw an increase in its
incidence rate and lost one point in Hawaii – State Comparison Chart
this area, but did consider a
measure to create a Cervical Cancer 11 Points
Awareness Month and a cervical 16
cancer elimination task force. 14
SCORE

12
10
8
6
STATES

42 Partnering For Progress 2007

 2007: Fair
(6 out of 18 points)

2006: Fair
(7 out of 16 points)
Idaho

Population: 1,429,096

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.1/100,000 ▲ 1 2
Cervical Cancer Incidence Rate/Race: White: 7.9
Cervical Cancer Mortality Rate: 2.2/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.2

Screening
Cervical Cancer Screening Rate: 78.8% 0 0
Cervical Cancer Screening Rate/Race: White: 81%
Hispanic: 80%
% Uninsured/Unscreened: 30.4% 0
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 21% – 0 0
% Low Income/Uninsured Women: 39%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Idaho saw an increase in its
incidence rate over the previous
report and lost one point in this area.
The state remains in the bottom tier
for its cervical cancer screening rate
and for its lack of insurance
coverage for women and the
Idaho – State Comparison Chart
percentage of uninsured women
who are unscreened. 6 Points
16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 43

 2007: Very Good
(14 out of 18 points)

2006: Very Good

(12 out of 16 points)
Illinois

Population: 12,763,371

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 9.3/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 8.6
Black: 13.9
Hispanic: 15.3
Cervical Cancer Mortality Rate: 2.8/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.6
Black: 6.2

Screening
Cervical Cancer Screening Rate: 87.4% 2 2
Cervical Cancer Screening Rate/Race: White: 87%
Black: 86%
Hispanic: 82%
% Uninsured/Unscreened: 16.4% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 17% ▲ 1 1
% Low Income/Uninsured Women: 36%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 2.

State Summary
Illinois saw a slight increase in its
cervical cancer incidence rate, with
incidence rates for Black and
Illinois – State Comparison Chart
Hispanic women noticeably higher
than for White women. The state
14 Points
continues to receive high marks in 16
terms of screening and is in the top 14
tier of states in terms of screening
SCORE

12
for uninsured women.
10
8
6
STATES

44 Partnering For Progress 2007

 2007: Good
(10 out of 18 points)

2006: Good
(9 out of 16 points)
Indiana

Population: 6,271,973

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.6/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 8.5
Black: 10.7
Cervical Cancer Mortality Rate: 2.8/100,000 ▲ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.6
Black: 4.3

Screening
Cervical Cancer Screening Rate: 82.4% 1 1
Cervical Cancer Screening Rate/Race: White: 86%
Black: 92%
% Uninsured/Unscreened: 28% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 18% ▲ 1 1
% Low Income/Uninsured Women: 35%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 1.

State Summary
Indiana saw a slight decrease in its
cervical cancer incidence rate and a
slight increase in its cervical cancer
mortality rate but its score on these
indicators did not change relative to Indiana – State Comparison Chart
other states. Mortality for Black
women is significantly higher than 10 Points
16
mortality for White women, although
Black women are screened for 14
SCORE

cervical cancer at a rate almost 10 12

percentage points higher than the 10
state average. 8
6
STATES

The “State” of Cervical Cancer Prevention in America 45

 2007: Fair
(8 out of 18 points)

2006: Good
(9 out of 16 points)
Iowa

Population: 2,966,334

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.4/100,000 ▼ 1 2
Cervical Cancer Incidence Rate/Race: White: 7.1
Hispanic: 13.9
Cervical Cancer Mortality Rate: 2.8/100,000 ▲ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.4

Screening
Cervical Cancer Screening Rate: 86% 2 2
Cervical Cancer Screening Rate/Race: White: 87%
% Uninsured/Unscreened: 30.2% 0
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 12% – 1 1
% Low Income/Uninsured Women: 30%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 1.

State Summary
Iowa saw a slight decrease in its
incidence rate but lost ground
compared to other states, which
resulted in the loss of one point.
The incidence rate for Hispanic
women in the state is nearly twice
that of White women. The state Iowa – State Comparison Chart
continues to be in the top tier in
terms of cervical cancer screening. 8 Points
16
14
SCORE

12
10
8
6
STATES

46 Partnering For Progress 2007

 2007: Very Good
(12 out of 18 points)

2006: Good
(10 out of 16 points)
Kansas

Population: 2,744,687

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 6.6/100,000 ▼ 2 1
Cervical Cancer Incidence Rate/Race: White: 5.9
Black: 17.0
Cervical Cancer Mortality Rate: 2.4/100,000 – 1 1
Cervical Cancer Mortality Rate/Race: White: 2.2

Screening
Cervical Cancer Screening Rate: 86.1% 2 2
Cervical Cancer Screening Rate/Race: White: 85%
Black: 91%
Hispanic: 85%
% Uninsured/Unscreened: 26.3% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 15% ▲ 1 1
% Low Income/Uninsured Women: 32%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 1.

State Summary
Kansas saw a decrease in its
incidence rate of just over 2.5%,
which pushed it into the top tier in
this category. However, the incidence
rate for Black women is nearly three Kansas – State Comparison Chart
times that for White women. The
state receives high marks for 12 Points
screening, and Black women are 16
screened at a higher rate than either 14
White or Hispanic women.
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 47

 2007: Good
(9 out of 18 points)

2006: Fair
(7 out of 16 points)
Kentucky

Population: 4,173,405

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.8/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 8.1
Black: 16.9
Cervical Cancer Mortality Rate: 3.9/100,000 ▲ 1 1
Cervical Cancer Mortality Rate/Race: White: 3.1
Black: 6.1

Screening
Cervical Cancer Screening Rate: 84.9% 1 1
Cervical Cancer Screening Rate/Race: White: 85%
Black: 94%
% Uninsured/Unscreened: 24.3% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 18% – 1 1
% Low Income/Uninsured Women: 33%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
SR 136 recognizes January 2006 as Cervical Cancer Awareness Month. Cumulative score: 1.

State Summary
Kentucky’s incidence rate decreased
from 10.3 in the last report, but its
score did not change relative to other
states. The incidence rate for Black
women in the state is more than Kentucky – State Comparison Chart
twice as high as for White women,
although the screening rate for Black 9 Points
16
women is more than 10 percentage
points higher than for White women. 14
SCORE

Kentucky saw a fairly significant 12

increase in its mortality rate. 10
8
6
STATES

48 Partnering For Progress 2007

 2007: Good
(9 out of 18 points)

2006: Good
(8 out of 16 points)
Louisiana

Population: 4,523,628

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 9.0/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 7.3
Black: 13.7
Hispanic: 8.3
Asian/Pacific Islander: 3.7
Cervical Cancer Mortality Rate: 2.8/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.1
Black: 5.3

Screening
Cervical Cancer Screening Rate: 85.2% 1 1
Cervical Cancer Screening Rate/Race: White: 86%
Black: 89%
Hispanic: 88%
% Uninsured/Unscreened: 23.3% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 27% ▲ 0 0
% Low Income/Uninsured Women: 46%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 1.

State Summary
Louisiana’s indicators held steady
since the last report. The incidence
rate for Black women in the state
Louisiana – State Comparison Chart
remains significantly higher than for
9 Points
White and Hispanic women. The 16
state remains in the bottom tier in 14
terms of the number of uninsured
SCORE

12
women and second-to-last in the
10
nation in the percentage of low-
income, uninsured women. 8
6
STATES

The “State” of Cervical Cancer Prevention in America 49

 2007: Very Good
(13 out of 18 points)

2006: Good
(9 out of 16 points)
Maine

Population: 132,505

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.2/100,000 ▼ 2 1
Cervical Cancer Incidence Rate/Race: White: 7.0
Cervical Cancer Mortality Rate: 2.0/100,000 ▼ 2 1
Cervical Cancer Mortality Rate/Race: White: 1.9

Screening
Cervical Cancer Screening Rate: 88.7% 2 2
Cervical Cancer Screening Rate/Race: White: 88%
% Uninsured/Unscreened: 27.7% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 12% ▼ 1 1
% Low Income/Uninsured Women: 19%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Maine saw decreases in both its
cervical cancer incidence and
mortality rates, which helped it move
from the Good category to the Very
Good category. The state remains in
the top tier in terms of cervical
cancer screening.
Maine – State Comparison Chart

13 Points
16
14
SCORE

12
10
8
6
STATES

50 Partnering For Progress 2007

 2007: Very Good
(12 out of 18 points)

2006: Very Good

(12 out of 16 points)
Maryland

Population: 5,600,388

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 10.9/100,000 ▲ 0 2
Cervical Cancer Incidence Rate/Race: n/a
Cervical Cancer Mortality Rate: 2.0/100,000 ▼ 2 1
Cervical Cancer Mortality Rate/Race: White: 2.0
Black: 4.0

Screening
Cervical Cancer Screening Rate: 88.9% 2 2
Cervical Cancer Screening Rate/Race: White: 91%
Black: 93%
Hispanic: 87%
% Uninsured/Unscreened: 29% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 17% ▲ 1 1
% Low Income/Uninsured Women: 44%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 2.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Maryland saw an increase in its
incidence rate from 7.9 to 10.9, but
different data sources were used for
the two years due to a lack of
reported data. The state saw a Maryland – State Comparison Chart
decrease in its mortality rate from 2.5
to 2 and gained a point in this area. 12 Points
While the state is in the middle tier in 16
terms of the percentage of uninsured 14
women, it is among the bottom five
SCORE

12
states in terms of the percentage of 10
low-income, uninsured women.
8
6
STATES

The “State” of Cervical Cancer Prevention in America 51

 2007: Very Good
(12 out of 18 points)

2006: Very Good

(11 out of 18 points)
Massachusetts

Population: 6,398,743

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 6.6/100,000 ▲ 2 2
Cervical Cancer Incidence Rate/Race: White: 6.3
Black: 9.9
Hispanic: 15.6
Cervical Cancer Mortality Rate: 1.3/100,000 ▼ 2 2
Cervical Cancer Mortality Rate/Race: White: 1.6
Black: 2.8

Screening
Cervical Cancer Screening Rate: 89.3% 2 2
Cervical Cancer Screening Rate/Race: White: 90%
Black: 94%
Hispanic: 90%
Asian/Pacific Islander: 68%
% Uninsured/Unscreened: 23.9% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 12% ▲ 1 1
% Low Income/Uninsured Women: 26%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Massachusetts continues to rank in
the top tier in terms of incidence,
mortality, and screening, although Massachusetts – State Comparison Chart
screening for Asian/Pacific Islander
women lags significantly behind that 12 Points
16
for other racial groups. The incidence
14
rate for Hispanic women is almost
SCORE

12
two-and-one-half times that of
White women. 10
8
6
STATES

52 Partnering For Progress 2007

 2007: Very Good
(12 out of 18 points)

2006: Good
(9 out of 16 points)
Michigan

Population: 10,120,860

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.4/100,000 ▼ 1 2
Cervical Cancer Incidence Rate/Race: White: 6.7
Black: 11.0
Cervical Cancer Mortality Rate: 1.9/100,000 ▼ 2 1
Cervical Cancer Mortality Rate/Race: White: 2.0
Black: 3.5

Screening
Cervical Cancer Screening Rate: 86.5% 2 2
Cervical Cancer Screening Rate/Race: White: 90%
Black: 89%
% Uninsured/Unscreened: 22.3% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 14% – 1 1
% Low Income/Uninsured Women: 27%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
Gov. Jennifer Granholm created the Michigan Task Force on Cervical Cancer Awareness by executive order on
February 16, 2006, as a result of a 2004 resolution calling for its creation. The task force is charged with reviewing
existing state efforts regarding cervical cancer awareness; identifying and making recommendations to promote
effective communications efforts at state and local levels to increase awareness of the importance of regular
cervical cancer screenings; and making recommendations for the development of a comprehensive, statewide plan
to generate public awareness of the importance of cervical cancer screenings. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
A slight increase in the state’s Michigan – State Comparison Chart
cervical cancer incidence rate
12 Points
caused it to lose one point in this 16
area, while it gained one point for a 14
decrease in its mortality rate.
SCORE

12
The governor created a cervical
cancer task force by executive order 10
to help increase awareness of the 8
importance of regular cervical 6
cancer screening. STATES

The “State” of Cervical Cancer Prevention in America 53

 2007: Excellent
(15 out of 18 points)

2006: Very Good

(13 out of 16 points)
Minnesota

Population: 5,132,799

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 6.8/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: White: 6.1
Cervical Cancer Mortality Rate: 1.8/100,000 ▲ 2 2
Cervical Cancer Mortality Rate/Race: White: 1.4

Screening
Cervical Cancer Screening Rate: 87.8% 2 2
Cervical Cancer Screening Rate/Race: White: 87%
% Uninsured/Unscreened: 26.6% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 9% ▲ 2 2
% Low Income/Uninsured Women: 23%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
HB 3880/SB 3188 would expand coverage for breast and cervical cancer screening and treatment under
medical assistance and would appropriate money for that purpose. The bill was sent to the House
Committee on Health Policy and Finance on March 23, 2006. Cumulative score: 1.

State Summary
Minnesota becomes the first state to
receive a grade of Excellent for
scoring 15 out of 18 possible points.
Minnesota is in the top tier for five of
the six health indicators scored and
in the middle tier on one: the Minnesota – State Comparison Chart
percentage of uninsured, unscreened
women. It is the only state with a rate 15 Points
16
of uninsured women below 10%.
The state also has a cervical cancer 14
SCORE

task force and has introduced other 12

legislative measures to fight 10
cervical cancer. 8
6
STATES

54 Partnering For Progress 2007

 2007: Fair
(8 out of 18 points)

2006: Good
(8 out of 16 points)
Mississippi

Population: 2,921,088

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 11.4/100,000 – 0 1
Cervical Cancer Incidence Rate/Race: n/a
Cervical Cancer Mortality Rate: 3.7/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.4
Black: 7.0

Screening
Cervical Cancer Screening Rate: 84.5% 1 1
Cervical Cancer Screening Rate/Race: White: 86%
Black: 88%
% Uninsured/Unscreened: 24.7% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 22% ▲ 0 0
% Low Income/Uninsured Women: 36%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 2.

State Summary
Mississippi’s incidence rate did not
increase from last year’s report, but
its position fell relative to other
states, which caused it to lose one
point. The state remains in the
bottom tier of states in terms of the Mississippi – State Comparison Chart
percentage of uninsured women,
although it ranks in the middle tier in 8 Points
16
terms of the percentage of low-
14
income women who are uninsured.
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 55

 2007: Good
(10 out of 18 points)

2006: Good
(8 out of 16 points)
Missouri

Population: 5,800,310

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.9/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 7.5
Black: 12.1
Cervical Cancer Mortality Rate: 2.8/100,000 ▲ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.4
Black: 5.6

Screening
Cervical Cancer Screening Rate: 84.8% 1 1
Cervical Cancer Screening Rate/Race: White: 86%
Black: 91%
% Uninsured/Unscreened: 27.7% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 14% – 1 1
% Low Income/Uninsured Women: 29%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
HB 1440 authorizes a check-off on state individual and corporate income tax forms for donations for cervical
cancer awareness and treatment. Additionally, the bill provides that the moneys collected will be used to
provide information on cervical cancer, early detection, testing and prevention and to collect statistical
information on such. This bill was signed by Gov. Matt Blunt on July 10, 2006. Cumulative score: 2.

State Summary
Missouri had no change in its
indicators since last year’s report. Missouri – State Comparison Chart
The incidence and mortality rates for
Black women in the state are 10 Points
substantially higher than for White 16
women, although screening rates 14
for Black women are slightly higher.
SCORE

12
10
8
6
STATES

56 Partnering For Progress 2007

 2007: Good
(10 out of 18 points)

2006: Good
(10 out of 16 points)
Montana

Population: 935,670

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.6/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 7.9
Cervical Cancer Mortality Rate: 2.2/100,000 – 1 1
Cervical Cancer Mortality Rate/Race: White: 2.0

Screening
Cervical Cancer Screening Rate: 86.1% 2 2
Cervical Cancer Screening Rate/Race: White: 90%
American Indian/Alaskan: 86%
% Uninsured/Unscreened: 24.9% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 23% ▲ 0 1
% Low Income/Uninsured Women: 38%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Montana’s incidence rate dropped
from 9.1 in the previous report;
however, its score stayed the same
relative to other states. The state lost
one point as its relatively high
percentage of uninsured women
pushed it into the bottom tier on Montana – State Comparison Chart
this indicator.
10 Points
16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 57

 2007: Good
(9 out of 18 points)

2006: Good
(8 out of 16 points)
Nebraska

Population: 1,758,787

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.7/100,000 ▲ 1 2
Cervical Cancer Incidence Rate/Race: White: 8.7
Cervical Cancer Mortality Rate: 2.2/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.1

Screening
Cervical Cancer Screening Rate: 85.8% 2 2
Cervical Cancer Screening Rate/Race: White: 85%
Hispanic: 78%
% Uninsured/Unscreened: 20.4% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 15% ▲ 1 1
% Low Income/Uninsured Women: 34%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Nebraska saw a slight increase in its
cervical cancer incidence rate over
the last report, which resulted in the
loss of one point. Otherwise, its key
indicators held steady; the state has
had no substantial legislative activity
related to cervical cancer prevention. Nebraska – State Comparison Chart

9 Points
16
14
SCORE

12
10
8
6
STATES

58 Partnering For Progress 2007

 2007: Good
(10 out of 18 points)

2006: Good
(8 out of 16 points)
Nevada

Population: 2,414,807

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.9/100,000 ▲ 1 1
Cervical Cancer Incidence Rate/Race: White: 8.8
Black: 9.1
Cervical Cancer Mortality Rate: 2.3/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.6

Screening
Cervical Cancer Screening Rate: 84.7% 1 1
Cervical Cancer Screening Rate/Race: White: 80%
Hispanic: 74%
% Uninsured/Unscreened: 21% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 22% – 0 0
% Low Income/Uninsured Women: 43%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Nevada’s indicators held steady
from the previous report. The state
continues to rank in the lowest tier in
terms of the percentage of uninsured
women and in terms of the
percentage of low-income, Nevada – State Comparison Chart
uninsured women.
10 Points
16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 59

 2007: Good
(10 out of 18 points)

2006: Good
(10 out of 16 points)
New Hampshire

Population: 1,309,940

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.4/100,000 ▲ 1 2
Cervical Cancer Incidence Rate/Race: White: 7.6
Cervical Cancer Mortality Rate: 2.3/100,000 – 1 1
Cervical Cancer Mortality Rate/Race: White: 2.3

Screening
Cervical Cancer Screening Rate: 89.7% 2 2
Cervical Cancer Screening Rate/Race: White: 88%
% Uninsured/Unscreened: 24.8% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 14% – 1 1
% Low Income/Uninsured Women: 37%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
New Hampshire saw an increase in
its cervical cancer incidence rate
versus the last report, which resulted
in the loss of one point. The state
remains in the top tier in terms of
cervical cancer screening but falls
into the middle tier in terms of the
percentage of uninsured women New Hampshire – State Comparison Chart
who are screened.
10 Points
16
14
SCORE

12
10
8
6
STATES

60 Partnering For Progress 2007

 2007: Good
(10 out of 18 points)

2006: Good
(8 out of 16 points)
New Jersey

Population: 8, 717,925

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 9.4/100,000 ▲ 1 1
Cervical Cancer Incidence Rate/Race: White: 8.9
Black: 13.3
Hispanic: 15.2
Asian/Pacific Islander: 5.9
Cervical Cancer Mortality Rate: 2.7/100,000 ▲ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.5
Black: 5.8

Screening
Cervical Cancer Screening Rate: 84.3% 1 1
Cervical Cancer Screening Rate/Race: White: 87%
Black: 87%
Hispanic: 82%
% Uninsured/Unscreened: 23.3% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 17% ▲ 1 1
% Low Income/Uninsured Women: 42%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
SB 544 would require health insurers and the State Health Benefits Program to provide coverage for cervical cancer screening,
including testing for HPV. Sent to the Senate Committee on Health, Human Services, and Senior Citizens on January 10, 2006.
Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
AB 4071 establishes the New Jersey Cervical Cancer Prevention Task Force to evaluate current trends in cancer incidence,
morbidity and mortality, screening, diagnosis, and behaviors that increase risk; to evaluate historic and current cancer-control
strategies; and to establish cancer-reduction goals. This bill was signed by the governor on January 6, 2006. Cumulative score: 2.

• Miscellaneous support of cervical

cancer prevention
There is no miscellaneous cervical cancer
prevention legislation. Cumulative score: 0. New Jersey – State Comparison Chart

State Summary 10 Points

16
New Jersey experienced a slight increase 14
in its cervical cancer incidence rate;
SCORE

incidence rates for Black and Hispanic 12

women are substantially higher than for 10
White women. The state has instituted a 8
cervical cancer task force to examine
incidence and mortality trends, as well as 6
cancer-reduction goals. STATES

The “State” of Cervical Cancer Prevention in America 61

 2007: Good
(10 out of 18 points)

2006: Good
(10 out of 16 points)
New Mexico

Population: 1,928,384

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 6.9/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: White: 7.0
Hispanic: 6.5
American Indian/Alaskan: 7.4
Cervical Cancer Mortality Rate: 2.3/100,000 ▲ 1 2
Cervical Cancer Mortality Rate/Race: White: 2.2

Screening
Cervical Cancer Screening Rate: 84.7% 1 1
Cervical Cancer Screening Rate/Race: White: 86%
Hispanic: 84%
American Indian/Alaskan: 85%
% Uninsured/Unscreened: 28.7% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 27% ▼ 0 0
% Low Income/Uninsured Women: 44%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 2.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 1.

State Summary
New Mexico remains in the top tier
in terms of cervical cancer incidence,
but a slight increase in its mortality
rate caused it to lose one point in New Mexico – State Comparison Chart
this category. The state remains in
the bottom tier in terms of the 10 Points
percentage of uninsured women and 16
has the third-highest percentage of 14
low-income, uninsured women in
SCORE

12
the nation. 10
8
6
STATES

62 Partnering For Progress 2007

 2007: Very Good
(12 out of 18 points)

2006: Very Good

(11 out of 16 points)
New York

Population: 19,254,630

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.6/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 7.3
Black: 13.1
Hispanic: 10.9
Asian/Pacific Islander: 9.3
Cervical Cancer Mortality Rate: 2.6/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.4
Black: 4.9

Screening
Cervical Cancer Screening Rate: 85.4% 1 1
Cervical Cancer Screening Rate/Race: White: 88%
Black: 87%
Hispanic: 90%
% Uninsured/Unscreened: 22.9% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 16% ▼ 1 1
% Low Income/Uninsured Women: 30%
▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
AB 4472 would extend medical assistance to persons with breast and cervical cancer; would provide that resources available
to eligible individuals shall not be considered nor required to be applied toward the payment of the cost of medical care; and
would provide that an individual is eligible for presumptive eligibility in accordance with managed care program provisions.
Passed Assembly, referred to Senate Committee on Health, February 14, 2006. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
AB 9908 expands the breast and cervical cancer detection and education program advisory council from 18 to 21 members.
Signed by Gov. George Pataki, April 25, 2006. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
AB 6955 would grant four hours of excused
leave to public officers and employees of
this state to undertake screening for
cervical cancer. Passed Assembly, referred
to Senate Committee on Rules New York – State Comparison Chart
June 19, 2006. Cumulative score: 2.
12 Points
State Summary 16
14
New York’s indicators remained steady
SCORE

since the last report; the state remains 12

solidly in the middle tier on most indicators. 10
The incidence rate for Black women in the
state is nearly twice as high as the 8
incidence rate for White women and the 6
mortality rate for Black women is twice as STATES
high as for White women.

The “State” of Cervical Cancer Prevention in America 63

 2007: Very Good
(13 out of 18 points)

2006: Very Good

(12 out of 16 points)
North Carolina

Population: 8,683,242

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.4/100,000 ▼ 1 2
Cervical Cancer Incidence Rate/Race: White: 6.0
Black: 9.2
Cervical Cancer Mortality Rate: 2.3/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.4
Black: 4.5

Screening
Cervical Cancer Screening Rate: 88.3% 2 2
Cervical Cancer Screening Rate/Race: White: 91%
Black: 91%
% Uninsured/Unscreened: 21.6% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 18% ▼ 1 1
% Low Income/Uninsured Women: 36%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 2.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
North Carolina’s incidence rate
increased slightly. The state remains
in the top tier for screening; however,
incidence and mortality rates for
Black women remain substantially North Carolina – State Comparison Chart
higher than for White women.
13 Points
16
14
SCORE

12
10
8
6
STATES

64 Partnering For Progress 2007

 2007: Good
(9 out of 18 points)

2006: Good
(9 out of 16 points)
North Dakota

Population: 636,677

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.4/100,000 ▲ 1 2
Cervical Cancer Incidence Rate/Race: White: 7.3
Cervical Cancer Mortality Rate: 2.2/100,000 – 1 2
Cervical Cancer Mortality Rate/Race: White: 1.9

Screening
Cervical Cancer Screening Rate: 83.2% 1 1
Cervical Cancer Screening Rate/Race: White: 83%
% Uninsured/Unscreened: 29.1% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 12% ▼ 1 1
% Low Income/Uninsured Women: 23%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 2.

State Summary
An increase in North Dakota’s
incidence rate over the previous
report caused it to lose one point.
The state’s mortality rate did not
increase since the last report but the
state’s score declined relative to that
of other states, causing it to lose
one point in this area as well. North Dakota – State Comparison Chart

9 Points
16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 65

 2007: Good
(11 out of 18 points)

2006: Good
(9 out of 16 points)
Ohio

Population: 11,464,042

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.7/100,000 ▲ 1 2
Cervical Cancer Incidence Rate/Race: White: 7.3
Black: 9.0
Cervical Cancer Mortality Rate: 2.5/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.5
Black: 4.6

Screening
Cervical Cancer Screening Rate: 86.4% 2 2
Cervical Cancer Screening Rate/Race: White: 88%
Black: 86%
% Uninsured/Unscreened: 22.4% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 14% – 1 1
% Low Income/Uninsured Women: 30%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
HB 617 would create the cervical cancer elimination task force. Sent to the House Committee on Health
July 5, 2006. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Ohio saw a minor increase in its
cervical cancer incidence rate over
the last report for a loss of one point.
The state receives high marks in Ohio – State Comparison Chart
screening and in screening for the
uninsured. 11 Points
16
14
SCORE

12
10
8
6
STATES

66 Partnering For Progress 2007

 2007: Good
(10 out of 18 points)

2006: Good
(8 out of 16 points)
Oklahoma

Population: 3,547,884

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.8/100,000 ▼ 1 0
Cervical Cancer Incidence Rate/Race: White: 8.1
Black: 13.8
Cervical Cancer Mortality Rate: 3.0/100,000 – 1 1
Cervical Cancer Mortality Rate/Race: White: 3.0
Black: 3.8

Screening
Cervical Cancer Screening Rate: 82.9% 1 1
Cervical Cancer Screening Rate/Race: White: 85%
Black: 95%
Hispanic: 86%
American Indian/Alaskan: 87%
% Uninsured/Unscreened: 27.4% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 24% – 0 0
% Low Income/Uninsured Women: 44%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report
Policy Initiatives & Infrastructure
• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
SB 1308 provides for an increase in the membership of the state Breast and Cervical Cancer Prevention and Treatment
Advisory Committee. Signed by the governor April 10, 2006. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
HB 2883 would create and fund the Cervical Cancer Awareness and Treatment Program. Sent to the House Committee
on Health and Human Services on February 7, 2006.
SB 825, which was introduced in 2005, relates to the Belle Maxine Hilliard Breast and Cervical Cancer Treatment Revolving
Fund, which provides screening and treatment for uninsured women. It will modify the name of fund, provides an effective date,
and declares an emergency. Sent to the
Senate Committee on Appropriations on
February 14, 2006. Cumulative score: 2.
Oklahoma – State Comparison Chart
State Summary
10 Points
Oklahoma saw a significant decline in its 16
incidence rate from 12.1 in the last report 14
to 8.8 in this report and gained one point
SCORE

12
in this category. The state remains in the
bottom tier in terms of the percentage of 10
uninsured women and in the percentage 8
of low-income, uninsured women.
6
STATES

The “State” of Cervical Cancer Prevention in America 67

 2007: Good
(9 out of 18 points)

2006: Good
(9 out of 16 points)
Oregon

Population: 3,641,056

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.0/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: White: 6.8
Cervical Cancer Mortality Rate: 2.1/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.2

Screening
Cervical Cancer Screening Rate: 83.5% 1 1
Cervical Cancer Screening Rate/Race: White: 86%
Hispanic: 88%
% Uninsured/Unscreened: 32.9% 0
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 20% ▲ 1 1
% Low Income/Uninsured Women: 40%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Oregon remains in the top tier in
terms of incidence and in the middle
tier in terms of mortality but falls into
the bottom tier in terms of the
percentage of uninsured women who
are not screened for cervical cancer.
Oregon – State Comparison Chart

9 Points
16
14
SCORE

12
10
8
6
STATES

68 Partnering For Progress 2007

 2007: Good
(10 out of 18 points)

2006: Good
(9 out of 16 points)
Pennsylvania

Population: 12,429,616

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.1/100,000 ▼ 1 2
Cervical Cancer Incidence Rate/Race: White: 7.5
Black: 13.0
Cervical Cancer Mortality Rate: 2.1/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.3
Black: 4.8

Screening
Cervical Cancer Screening Rate: 84.3% 1 1
Cervical Cancer Screening Rate/Race: White: 88%
Black: 88%
Hispanic: 89%
% Uninsured/Unscreened: 27.6% 1
Medicaid Coverage HPV Testing: Restricted 0 0

Health Care Access

Rate Uninsured Women: 14% – 1 1
% Low Income/Uninsured Women: 30%
▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
HB 801 directs the Department of Health to establish a Cervical Cancer Task Force to evaluate proposals and make
recommendations for education and prevention of cervical cancer. Will provide for recommendations to raise public awareness on
prevention, early screening and detection of cervical cancer. Signed by Gov. Ed Rendell on July 7, 2006. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
HB 1606 establishes a program for breast and cervical cancer screening services (Pap tests) for eligible women and provides
for powers and duties of the department of health. Signed by Gov. Ed Rendell on November 22, 2005. Cumulative score: 2.

State Summary
Pennsylvania saw a slight decrease in its
incidence rate over the previous report
but lost some ground relative to other Pennsylvania – State Comparison Chart
states for a decrease of one point. The
cervical cancer incidence and mortality 10 Points
rates for Black women are nearly double 16
those for White women in the state, 14
although screening rates are similar.
SCORE

12
Pennsylvania is only one of four states
10
that do not allow unrestricted HPV
testing under Medicaid. 8
6
STATES

The “State” of Cervical Cancer Prevention in America 69

 2007: Very Good
(13 out of 18 points)

2006: Very Good

(12 out of 16 points)
Rhode Island

Population: 1,076,189

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 6.3/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: White: 6.3
Cervical Cancer Mortality Rate: 2.1/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.1

Screening
Cervical Cancer Screening Rate: 88.9% 2 2
Cervical Cancer Screening Rate/Race: White: 90%
Black: 87%
Hispanic: 87%
% Uninsured/Unscreened: 25.1% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 13% ▲ 1 1
% Low Income/Uninsured Women: 24%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 2.

State Summary
Rhode Island’s key indicators remain
essentially unchanged since the last
report. The state remains in the top
tier in terms of incidence and
screening, although it falls into the
middle tier in terms of screening for Rhode Island – State Comparison Chart
the uninsured.
13 Points
16
14
SCORE

12
10
8
6
STATES

70 Partnering For Progress 2007

 2007: Good
(11 out of 18 points)

2006: Good
(9 out of 16 points)
South Carolina

Population: 4,255,083

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 10.1/100,000 ▲ 1 1
Cervical Cancer Incidence Rate/Race: White: 9.3
Black: 13.0
Cervical Cancer Mortality Rate: 3.1/100,000 ▲ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.3
Black: 5.6

Screening
Cervical Cancer Screening Rate: 87.1% 2 2
Cervical Cancer Screening Rate/Race: White: 90%
Black: 88%
% Uninsured/Unscreened: 20.3% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 18% – 1 1
% Low Income/Uninsured Women: 34%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 1.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
South Carolina saw an increase in its
cervical cancer incidence rate. The
cervical cancer mortality for Black
women in the state is more than
twice that for White women, but the South Carolina – State Comparison Chart
state receives high marks in
screening, including screening for 11 Points
uninsured women. 16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 71

 2007: Fair
(7 out of 18 points)

2006: Fair
(7 out of 16 points)
South Dakota

Population: 775,933

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 6.1/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: n/a
Cervical Cancer Mortality Rate: 2.2/100,000 ▲ 1 2
Cervical Cancer Mortality Rate/Race: White: 1.8

Screening
Cervical Cancer Screening Rate: 87.2% 2 2
Cervical Cancer Screening Rate/Race: White: 89%
American Indian/Alaskan: 94%
% Uninsured/Unscreened: 25.2% 1
Medicaid Coverage HPV Testing: Restricted 0 0

Health Care Access

Rate Uninsured Women: 14% ▼ 1 1
% Low Income/Uninsured Women: 28%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
South Dakota saw a slight increase
in its cervical cancer mortality rate,
which caused it to lose one point;
the state remains in the top tier in
terms of incidence. South Dakota is
one of only four states that do not
provide unrestricted HPV screening South Dakota – State Comparison Chart
for Medicaid recipients.
7 Points
16
14
SCORE

12
10
8
6
STATES

72 Partnering For Progress 2007

 2007: Fair
(8 out of 18 points)

2006: Fair
(6 out of 16 points)
Tennessee

Population: 5,962,959

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.3/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: n/a
Cervical Cancer Mortality Rate: 2.9/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.8
Black: 7.0

Screening
Cervical Cancer Screening Rate: 87.3% 2 2
Cervical Cancer Screening Rate/Race: White: 87%
Black: 90%
% Uninsured/Unscreened: 27.6% 1
Medicaid Coverage HPV Testing: Restricted 0 0

Health Care Access

Rate Uninsured Women: 15% ▲ 1 1
% Low Income/Uninsured Women: 26%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
SB 3678 will establish the Tennessee Cervical Cancer Elimination Task Force to review statistical and qualitative
data on the prevalence and burden of cervical cancer; to develop a strategy to raise public awareness on the
causes and nature of cervical cancer and the value of prevention and early detection; and to publish a statewide
comprehensive cervical cancer prevention plan. Signed by Gov. Phil Bredesen on June 20, 2006. Cumulative
score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Tennessee saw a drop in both its
cervical cancer incidence and Tennessee – State Comparison Chart
mortality rates since the last report.
Mortality for Black women in the state 8 Points
16
is two-and-one-half times higher than
14
for White women. The state improved
SCORE

its score by two points when it 12

initiated a cervical cancer task force 10
to chart a statewide cervical cancer 8
prevention plan. 6
STATES

The “State” of Cervical Cancer Prevention in America 73

 2007: Good
(10 out of 18 points)

2006: Good
(9 out of 16 points)
Texas

Population: 22,859,968

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 9.5/100,000 ▼ 1 1
Cervical Cancer Incidence Rate/Race: White: 3.1
Black: 6.1
Hispanic: 14.3
Cervical Cancer Mortality Rate: 3.2/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 3.1
Black: 6.1

Screening
Cervical Cancer Screening Rate: 82.1% 1 1
Cervical Cancer Screening Rate/Race: White: 84%
Black: 85%
Hispanic: 79%
% Uninsured/Unscreened: 25.5% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 29% ▼ 0 0
% Low Income/Uninsured Women: 52%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 2.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Texas saw a drop of just over .5 in its
cervical cancer incidence rate. The
incidence rate for Hispanic women in
Texas – State Comparison Chart
Texas is more than four times as high
as the rate for White women and 10 Points
screening for Hispanic women lags as 16
well. The state has the highest 14
percentage of uninsured women and
SCORE

12
the highest percentage of low-income,
10
uninsured women in the country but
rises to the middle tier in terms of 8
screening for uninsured women. 6
STATES

74 Partnering For Progress 2007

 2007: Fair
(7 out of 18 points)

2006: Good
(8 out of 16 points)
Utah

Population: 2,469,585

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 4.9/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: White: 4.8
Hispanic: 10.2
Cervical Cancer Mortality Rate: 2.2/100,000 ▲ 1 2
Cervical Cancer Mortality Rate/Race: White: 1.8

Screening
Cervical Cancer Screening Rate: 78.2% 0 0
Cervical Cancer Screening Rate/Race: White: 82%
Hispanic: 77%
% Uninsured/Unscreened: 35.8% 0
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 16% ▲ 1 1
% Low Income/Uninsured Women: 31%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no new miscellaneous cervical cancer prevention legislation. Cumulative score: 1.

State Summary
Utah remains in the top tier in terms
of cervical cancer incidence,
although the incidence rate for
Hispanic women is more than twice
that for White women. The state saw
a slight increase in its mortality rate, Utah – State Comparison Chart
which caused it to lose one point.
Utah falls into the bottom tier in 7 Points
terms of cervical cancer screening, 16
both overall and for women who 14
are uninsured.
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 75

 2007: Good
(10 out of 18 points)

2006: Good
(8 out of 16 points)
Vermont

Population: 623,050

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.3/100,000 ▲ 1 2
Cervical Cancer Incidence Rate/Race: White: 8.5
Cervical Cancer Mortality Rate: 2.3/100,000 ▼ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.4

Screening
Cervical Cancer Screening Rate: 87.6% 2 2
Cervical Cancer Screening Rate/Race: White: 89%
% Uninsured/Unscreened: 23.9% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 13% ▲ 1 1
% Low Income/Uninsured Women: 24%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
HB 715 establishes a task force to study the eradication of cervical cancer in the state, including public
awareness of the causes of cervical cancer, risk factors, the value of prevention and early detection, options for
testing, treatment costs and health plan reimbursement, and new technologies; health care providers’ awareness
about screening and prevention options, recommended protocols and schedules for screening and vaccinations,
and new technologies; recommended testing protocols and schedules for cervical cancer screenings and HPV
vaccinations; issues of cost and insurance and health plan coverage; and potential sources of public and private
funding for education, screening, and treatment programs. The task force will make recommendations to the
department of health for specific actions. This bill was signed by Gov. Jim Douglas on April 18, 2006.
Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical
cancer prevention legislation.
Cumulative score: 0.
Vermont – State Comparison Chart
State Summary 10 Points
16
Vermont’s incidence rate increased
from 6.3 in the previous report, 14
SCORE

which caused it to lose one point in 12

this area. The state has created a 10
comprehensive cervical cancer 8
eradication task force.
6
STATES

76 Partnering For Progress 2007

 2007: Very Good
(12 out of 18 points)

2006: Very Good

(11 out of 16 points)
Virginia

Population: 7,567,465

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.6/100,000 ▼ 1 2
Cervical Cancer Incidence Rate/Race: n/a
Cervical Cancer Mortality Rate: 2.5/100,000 ▲ 1 1
Cervical Cancer Mortality Rate/Race: White: 2.1
Black: 4.5

Screening
Cervical Cancer Screening Rate: 87.3% 2 2
Cervical Cancer Screening Rate/Race: White: 87%
Black: 85%
% Uninsured/Unscreened: 22.4% 2
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 17% ▲ 1 1
% Low Income/Uninsured Women: 37%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no new task force or commission. Cumulative score: 2.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Virginia saw a modest decline in its
incidence rate since the previous
report. The cervical cancer mortality
rate for Black women in the state is
more than twice as high as for White
women. The state continues to Virginia – State Comparison Chart
receive high marks for screening in
general and for screening for 12 Points
uninsured women. 16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 77

 2007: Very Good
(11 out of 18 points)

2006: Good
(10 out of 16 points)
Washington

Population: 6,287,759

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 6.7/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: White: 6.3
Black: 8.9
Cervical Cancer Mortality Rate: 2.0/100,000 ▲ 2 2
Cervical Cancer Mortality Rate/Race: White: 1.7

Screening
Cervical Cancer Screening Rate: 85.4% 1 1
Cervical Cancer Screening Rate/Race: White: 86%
Hispanic: 80%
% Uninsured/Unscreened: 27.2% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 17% – 1 1
% Low Income/Uninsured Women: 35%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
SB 5714 establishes an early detection breast and cervical cancer screening program as a voluntary screening
program directed at reducing mortality through early detection to be offered to eligible women only as funds
are available. This bill was signed by the Gov. Christine Gregoire on March 15, 2006. Cumulative score: 2.

State Summary
Washington remains in the top tier
in terms of cervical cancer incidence
and mortality but falls into the
middle tier in terms of screening Washington – State Comparison Chart
and insurance coverage for women.
11 Points
16
14
SCORE

12
10
8
6
STATES

78 Partnering For Progress 2007

 2007: Good
(10 out of 18 points)

2006: Fair
(7 out of 16 points)
West Virginia

Population: 1,816,856

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 9.5/100,000 ▼ 1 0
Cervical Cancer Incidence Rate/Race: White: 9.5
Cervical Cancer Mortality Rate: 4.0/100,000 ▲ 1 1
Cervical Cancer Mortality Rate/Race: White: 3.8

Screening
Cervical Cancer Screening Rate: 82.5% 1 1
Cervical Cancer Screening Rate/Race: White: 84%
% Uninsured/Unscreened: 23.3% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 22% ▲ 0 0
% Low Income/Uninsured Women: 38%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
HB 4379, which requires insurers to cover HPV testing for women over the age of 18, was signed by
Gov. Joe Manchin in March 2006. Cumulative score: 2.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
HCR 21, which passed the House and Senate in February 2006, recognizes January as Cervical Cancer
Awareness Month and encourages women to take advantage of available breast and cervical cancer
screening services. Cumulative score: 2.

State Summary
West Virginia experienced a decrease
in its incidence rate and moved into
the middle tier in terms of mortality
and screening, including screening
for women who are uninsured, which West Virginia – State Comparison Chart
moved it from the Fair category to
the Good category. 10 Points
16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 79

 2007: Good
(10 out of 18 points)

2006: Good
(8 out of 16 points)
Wisconsin

Population: 5,536,201

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 7.2/100,000 ▼ 2 2
Cervical Cancer Incidence Rate/Race: White: 7.0
Black: 12.8
Cervical Cancer Mortality Rate: 1.8/100,000 ▲ 2 2
Cervical Cancer Mortality Rate/Race: White: 1.8
Black: 4.0

Screening
Cervical Cancer Screening Rate: 85.7% 1 1
Cervical Cancer Screening Rate/Race: White: 88%
Black: 87%
% Uninsured/Unscreened: 27.2% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 12% ▲ 1 1
% Low Income/Uninsured Women: 26%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no coverage or screening mandates in place. Cumulative score: 0.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
SJR 59 establishes January as Cervical Cancer Awareness Month. Cumulative score: 1.

State Summary
Wisconsin saw a slight decrease in
its incidence rate. The state remains
in the top tier in terms of mortality,
but the mortality rate for Black
women is twice as high as the rate Wisconsin – State Comparison Chart
for White women, although
screening rates are similar. 10 Points
16
14
SCORE

12
10
8
6
STATES

80 Partnering For Progress 2007

 2007: Good
(9 out of 18 points)

2006: Good
(8 out of 16 points)
Wyoming

Population: 509,294

Incidence & Mortality 2007 Score 2006 Score

Cervical Cancer Incidence Rate: 8.9/100,000 ▲ 1 2
Cervical Cancer Incidence Rate/Race: n/a
Cervical Cancer Mortality Rate: 2.9/100,000 – 1 1
Cervical Cancer Mortality Rate/Race: White: 2.9

Screening
Cervical Cancer Screening Rate: 85.9% 2 2
Cervical Cancer Screening Rate/Race: White: 81%
Hispanic: 80%
% Uninsured/Unscreened: 25.5% 1
Medicaid Coverage HPV Testing: Unrestricted 2 2

Health Care Access

Rate Uninsured Women: 19% ▼ 1 0
% Low Income/Uninsured Women: 35%

▲ Rate increased over last report ▼ Rate decreased over last report – Rate stayed the same since last report

Policy Initiatives & Infrastructure

• Coverage mandates for cervical cancer screening
There are no new coverage or screening mandates. Cumulative score: 1.
• Task force/commissions for cervical cancer prevention
There is no task force or commission. Cumulative score: 0.
• Miscellaneous support of cervical cancer prevention
There is no miscellaneous cervical cancer prevention legislation. Cumulative score: 0.

State Summary
Wyoming saw an increase in its
incidence rate, which resulted in the
loss of one point. The state remains
in the top tier in terms of screening
but falls into the middle tier in terms
of screening uninsured women.
Wyoming – State Comparison Chart

9 Points
16
14
SCORE

12
10
8
6
STATES

The “State” of Cervical Cancer Prevention in America 81

 Appendixes

The “State” of Cervical Cancer Prevention in America 83

 Appendix A: State Score Comparison Chart
State Incidence Incidence Mortality Rate Mortality Pap Pap % Uninsured/ % Uninsured/ Unrestricted Unrestricted Uninsured Uninsured
Rate Score per 100K Score Screening Screening Unscreened Unscreened HPV Testing HPV Testing Rate (%) Score
Rate (%) Score Score Score

AL 10.6 1 3.0 1 87.4 2 18.8 2 yes 2 18 1

AK 7.2 2 2.2 1 88.8 2 22.6 2 yes 2 20 1
AZ 7.2 2 2.3 1 85.1 1 23.4 1 yes 2 20 1
AR 10.6 1 3.3 1 81.7 1 28.7 1 yes 2 24 0
CA 8.1 1 2.2 1 84.7 1 23.3 1 no 0 22 0
CO 7.2 2 1.8 2 88.2 2 23.9 1 yes 2 19 1
CT 6.8 2 1.8 2 87.7 2 16.1 2 yes 2 12 1
DE 7.5 1 3.5 1 87.6 2 22.5 2 yes 2 14 1
DC 10.4 1 4.3 0 88.4 2 29.2 1 yes 2 13 1
FL 10.0 1 2.8 1 84.0 1 28.1 1 yes 2 23 1
GA 9.6 1 2.7 1 87.9 2 23.5 1 yes 2 20 1
HI 8.8 1 2.3 1 83.7 1 29.1 1 yes 2 11 1
ID 8.1 1 2.2 1 78.8 0 30.4 0 yes 2 21 0
IL 9.3 1 2.8 1 87.4 2 16.4 2 yes 2 17 1
IN 8.6 1 2.8 1 82.4 1 28.0 1 yes 2 18 1
IA 7.4 1 2.8 1 86.0 2 30.2 0 yes 2 12 1
KS 6.6 2 2.4 1 86.1 2 26.3 1 yes 2 15 1
KY 8.8 1 3.9 1 84.9 1 24.3 1 yes 2 18 1
LA 9.0 1 2.8 1 85.2 1 23.3 1 yes 2 27 0
ME 7.2 2 2.0 2 88.7 2 27.7 1 yes 2 12 1
MD 10.9 0 2.0 2 88.9 2 29.0 1 yes 2 17 1
MA 6.6 2 1.3 2 89.3 2 23.9 1 yes 2 12 1
MI 7.4 1 1.9 2 86.5 2 22.3 2 yes 2 14 1
MN 6.8 2 1.8 2 87.8 2 26.6 1 yes 2 9 2
MS 11.4 0 3.7 1 84.5 1 24.7 1 yes 2 22 0
MO 7.9 1 2.8 1 84.8 1 27.7 1 yes 2 14 1
MT 7.6 1 2.2 1 86.1 2 24.9 1 yes 2 23 0
NE 8.7 1 2.2 1 85.8 2 20.4 2 yes 2 15 1
NV 8.9 1 2.3 1 84.7 1 21.0 2 yes 2 22 0
NH 7.4 1 2.3 1 89.7 2 24.8 1 yes 2 14 1
NJ 9.4 1 2.7 1 84.3 1 23.3 1 yes 2 17 1
NM 6.9 2 2.3 1 84.7 1 28.7 1 yes 2 27 0
NY 8.6 1 2.6 1 85.4 1 22.9 1 yes 2 16 1
NC 7.4 1 2.3 1 88.3 2 21.6 2 yes 2 18 1
ND 7.4 1 2.2 1 83.2 1 29.1 1 yes 2 12 1
OH 7.7 1 2.5 1 86.4 2 22.4 2 yes 2 14 1
OK 8.8 1 3.0 1 82.9 1 27.4 1 yes 2 24 0
OR 7.0 2 2.1 1 83.5 1 32.9 0 yes 2 20 1
PA 8.1 1 2.1 1 84.3 1 27.6 1 no 0 14 1
RI 6.3 2 2.1 1 88.9 2 25.1 1 yes 2 13 1
SC 10.1 1 3.1 1 87.1 2 20.3 2 yes 2 18 1
SD 6.1 2 2.2 1 87.2 2 25.2 1 no 0 14 1
TN 8.3 1 2.9 1 87.3 2 27.6 1 no 0 15 1
TX 9.5 1 3.2 1 82.1 1 25.5 1 yes 2 29 0
UT 4.9 2 2.2 1 78.2 0 35.8 0 yes 2 16 1
VT 8.3 1 2.3 1 87.6 2 23.9 1 yes 2 13 1
VA 7.6 1 2.5 1 87.3 2 22.4 2 yes 2 17 1
WA 6.7 2 2.0 2 85.4 1 27.2 1 yes 2 17 1
WV 9.5 1 4.0 1 82.5 1 23.3 1 yes 2 22 0
WI 7.2 2 1.8 2 85.7 1 27.2 1 yes 2 12 1
WY 8.9 1 2.9 1 85.9 2 25.5 1 yes 2 19 1

84
 Appendix A: State Score Comparison Chart
State 2006 2007 Cumulative 2006 2007 Cumulative 2006 2007 Cumulative Total Score Percent 2007 Grade
Screening Screening Screening Task Force Task Force Task Force Miscellaneous Miscellaneous Miscellaneous [score/18] (Ex=84-100%;
Mandate Mandate Mandate Initiative Initiative Initiative Initiative Initiative Initiative VG=67-83%;
Score Score < 21 Score Score Score <2 2 Score Score Score< 2 3 G=50-66%;
F<50%
AL 0 0 1 0 1 1 0 0 2 13 72 Very Good
AK 0 0 1 0 0 0 0 0 0 11 61 Good
AZ 0 0 0 1 0 1 2 0 2 11 61 Good
AR 0 0 0 2 0 2 2 0 2 10 56 Good
CA 1 2 2 0 0 1 1 0 2 9 50 Good
CO 0 0 0 0 0 0 1 1 2 12 67 Very Good
CT 1 0 1 0 0 0 0 1 1 13 72 Very Good
DE 0 0 1 0 0 0 0 0 0 10 56 Good
DC 0 0 1 0 0 0 0 0 0 8 44 Fair
FL 0 0 1 0 0 2 1 1 1 11 61 Good
GA 0 0 1 1 0 1 0 0 0 10 56 Good
HI 0 0 1 1 0 1 1 1 2 11 61 Good
ID 0 0 1 1 0 1 0 0 0 6 33 Fair
IL 0 0 1 0 0 2 2 0 2 14 78 Very Good
IN 0 0 1 0 0 1 0 0 1 10 56 Good
IA 0 0 0 0 0 0 1 0 1 8 44 Fair
KS 0 0 1 0 0 1 1 0 1 12 67 Very Good
KY 0 0 0 0 0 1 0 1 1 9 50 Good
LA 0 0 1 0 0 1 0 0 1 9 50 Good
ME 0 0 1 2* 0 2 0 0 0 13 72 Very Good
MD 2 0 2 0 0 2 0 0 0 12 67 Very Good
MA 0 0 0 0 0 2 0 0 0 12 67 Very Good
MI 0 0 0 0 2 2 0 0 0 12 67 Very Good
MN 0 0 1 2 0 2 0 1 1 15 83 Excellent
MS 0 0 0 1 0 1 0 0 2 8 44 Fair
MO 0 0 1 0 0 0 1 2 2 10 56 Good
MT 0 0 1 2 0 2 0 0 0 10 56 Good
NE 0 0 0 0 0 0 0 0 0 9 50 Good
NV 0 0 1 2 0 2 0 0 0 10 56 Good
NH 0 0 0 2 0 2 0 0 0 10 56 Good
NJ 0 1 1 1 2 2 0 0 0 10 56 Good
NM 2 0 2 0 0 0 0 0 1 10 56 Good
NY 1 1 1 2 2 2 1 1 2 12 67 Very Good
NC 0 0 2 0 0 2 0 0 0 13 72 Very Good
ND 0 0 0 0 0 0 1 0 2 9 50 Good
OH 1 0 1 0 1 1 0 0 0 11 61 Good
OK 0 0 0 1 2 2 1 1 2 10 56 Good
OR 0 0 1 1 0 1 0 0 0 9 50 Good
PA 0 0 1 1 2 2 1 2 2 10 56 Good
RI 0 0 1 0 0 1 0 0 2 13 72 Very Good
SC 0 0 1 0 0 1 0 0 0 11 61 Good
SD 0 0 0 0 0 0 0 0 0 7 39 Fair
TN 0 0 0 0 2 2 0 0 0 8 44 Fair
TX 2 0 2 2 0 2 0 0 0 10 56 Good
UT 0 0 0 0 0 0 1 0 1 7 39 Fair
VT 0 0 0 0 2 2 0 0 0 10 56 Good
VA 0 0 1 2 0 2 0 0 0 12 67 Very Good
WA 0** 0 0 0 0 0 0 2 2 11 61 Good
WV 0 2 2 0 0 0 0 1 2 10 56 Good
WI 0 0 0 0 0 0 0 1 1 10 56 Good
WY 0 0 1 0 0 0 0 0 0 9 50 Good
* Maine should have been awarded 2 points in the 2006 report for a task force measure that passed and was signed by the governor in 2005.
** Washington was mistakenly awarded 1 point in this category in 2006.
1 The Cumulative Screening Mandate score includes scores for the 2005 report that are not reflected in this chart.
2 The Cumulative Task Force Initiative score includes scores for the 2005 report that are not reflected in this chart.
3 The Cumulative Miscellaneous Initiative score includes scores for the 2005 report that are not reflected in this chart. 85
 Appendix B: Methodology and Data Sources
Partnering for Progress 2007 includes the same
eight measurable activities and outcomes regarding
cervical cancer prevention included in previous
reports and one new addition—a measure of the
percent of uninsured women who do not receive
cervical cancer screening. Also included are
several new breakdowns by racial/ethnic category
that are not scored, as well as a measure of the
number of uninsured, low-income women in each
state that also is not scored.
Scored Categories
Indicators were selected to reflect current
performance in cervical cancer prevention, as well
as to reflect the strength of states’ focus on this
issue and ability to incorporate new advances in
prevention. The report analyzes each state’s
performance based on nine factors: incidence,
mortality, Pap screening rates, screening rates for
uninsured women, Medicaid coverage of HPV
testing, the rate of uninsured women, legislation
mandating cervical cancer screening coverage,
legislation creating cervical cancer task
forces/commissions, and miscellaneous legislation.
Each factor was scored from 0 to 2 points
for a total of 18 possible points (100%)
as follows:
Grades of 84% to 100%
(15 to 18 points): . . . . . . . . . . . . . . . . . . . . . . . Excellent
Grades of 67% to 83%
(12 to 14 points): . . . . . . . . . . . . . . . . . . . . . . . Very Good
Grades of 50 to 66%
(9 to 11 points): . . . . . . . . . . . . . . . . . . . . . . . . . Good
Grades below 50%
(less than 9 points): . . . . . . . . . . . . . . . . . . . . Fair
86 Partnering For Progress 2007
Incidence and Mortality
The most direct indicators of cervical cancer
prevention efforts are incidence rates (the number
of new cases of invasive cancer each year per
100,000 women) and mortality rates (the number
of deaths each year per 100,000 women).
Cervical cancer incidence data are from the
January 2005 data submission to the Center for
Disease Control and Prevention’s (CDC) State
Cancer Registry and the National Program of
Cancer Registries Cancer Surveillance System
(NPCR-CSS).16 The data are from 2002 or 2003,
which ever is the state’s most recent submission.
Incidence rates were age-adjusted to the 2000
U.S. standard population by five-year age
groups. The following states did not meet United
States Cancer Statistics data quality standards
for one or more years during the period of data
collection: Arkansas, Maryland, Mississippi,
South Dakota, Tennessee, Virginia and Wyoming.
For these states, data were collected from the
most current three-year period available from the
North American Association of Central Cancer
Registries.17 Stratifications by race were derived
from the same sources.
Cervical cancer incidence rates ranged from 4.9 to
11.4 cases per 100,000 women. Because the
lowest recorded incidence rate for this report
dropped below the bottom scoring range of the
previous two reports, the incidence range used for
scoring this report was dropped by one point to
capture the new range.
Scoring cervical cancer incidence rates
• 2 points for rates of 4.0 to 7.3/100,000
• 1 point for rates of 7.4 to 10.7/100,000
• 0 points for rates of 10.8 to 14.0/100,000
 Appendix B: Methodology and Data Sources
Cervical cancer mortality rate data are from the
National Cancer Institute and CDC State Cancer
Profiles website.18 All data from this source are
from 2003. Death rates were calculated by the
NCI using its SEER*Stat system and were age-
adjusted to the 2000 U.S. standard population
by five-year age groups. Some states had fewer
than 15 cases in one year and so data were
suppressed to ensure confidentiality. For these
states, data from the same source were used;
however, the collection time period was typically
four years rather than one so that cases could
be collectively reported and confidentiality
preserved. States using these data were: Alaska,
Delaware, District of Columbia, Hawaii, Idaho,
Maine, Montana, Nebraska, North Dakota,
Rhode Island, South Dakota, Vermont, and
Wyoming. Stratifications by race were derived
from the same sources.
As one goal of the Healthy People 2010 initiative
was to decrease the cervical cancer mortality
rate to two deaths per 100,000 women, this goal
was used to determine scoring increments for
cervical cancer mortality.
Scoring cervical cancer mortality rates
• 2 points for rates of 0.0 to 2.0/100,000
• 1 point for rates of 2.1 to 4.1/100,000
• 0 points for rates of 4.2 to 6.2/100,000
The “State” of Cervical Cancer Prevention in America
Access and Utilization
Last year, three factors were selected to
represent and measure access and utilization of
cervical cancer preventive health care services.
The same measures were used for this year’s
report: rates of Pap testing, Medicaid coverage
of HPV testing, and insurance coverage of
women. In addition, a new measure, the rate of
uninsured, unscreened women, was added.
Rates of women screened for cervical cancer
were collected from the CDC’s 2004 Behavioral
Risk Factor Surveillance System (BRFSS) Data.19
All states and the District of Columbia collected
this information, with the exception of Hawaii.
Stratification by race was derived from the same
source. The Pap test rate for Hawaii was
collected from the most recent data available
from the National Healthcare Quality Report
(2000).20 The racial/ethnic breakdown of the
percent of women who had a Pap test within the
past three years was provided by a Kaiser Family
Foundation analysis of the 2000 BRFSS data.21
A target of Healthy People 2010 was to
increase the proportion of women aged 18 and
older who had received a Pap test within the
preceding three years to 90%. That goal was
used to establish the scoring ranges for cervical
cancer screening.
Scoring percent of women screened
for cervical cancer
• 2 points if 85.8% to 90.0% of women
were screened
• 1 point if 81.4% to 85.7% of women
were screened
• 0 points if 77.0% to 81.3% of women
were screened
87
 Appendix B: Methodology and Data Sources

Because women who lack health insurance are
at risk of going without routine cervical cancer
prevention services, this year’s report tracks the
percent of uninsured women who have not had a
Pap test within the past three years. This data is
drawn from an analysis of 2004 Behavioral Risk
Factor Surveillance System data conducted by
the State Health Access Data Assistance Center
for the Robert Wood Johnson Foundation.22 No
data were available for Arizona or Hawaii; 2002
American Cancer Society data were used for
these states.
The percentage of uninsured women who had
not received a Pap test ranged from 16.1% to
35.8%. The lowest rate was used as the top
score, and the range was divided into three
equal increments.
Scoring percent of uninsured women
with no Pap test
• 2 points if 16.1% to 22.6% of women
were unscreened
• 1 point if 22.7% to 29.2% of women were
unscreened
• 0 points if 29.3% to 35.8% of women
were unscreened
indicates reimbursement is provided only when
an HPV test is used as a follow-up test to resolve
an ASCUS Pap test result. Data for this measure
were based on the Medicaid Coverage Survey
2004-2005, Boston Healthcare Associates.
Scoring Medicaid coverage of HPV tests
• 2 points if coverage is unrestricted
• 0 points if coverage is restricted
Insurance coverage is a strong predictor of
obtaining recommended screening and preventive
services. Insurance coverage data for women ages
18 to 64 by state were based on Urban Institute
and Kaiser Commission on Medicaid and the
Uninsured estimates derived from data pooled from
the March 2003 and 2004 Current Population
Surveys; U.S. figures were based on March 2004
Survey data. Numbers were rounded.23
A target of Healthy People 2010 was to increase
the proportion of people with health insurance to
100%. This was used as the goal for scoring
health insurance coverage.

Scoring percent of women not covered

by health insurance
HPV testing is now included as an option in the
screening guidelines of leading medical groups as
an adjunct to the Pap test for routine cervical • 2 points for 0 to 10% uninsured
cancer screening for women age 30 and over or • 1 point for 11 to 20% uninsured
to follow up an ASC-US (inconclusive) Pap test
result. Each state Medicaid program makes the • 0 points for 21 to 30% uninsured
individual decision as to whether it will cover HPV
testing for women who receive Medicaid.
Unrestricted coverage means that Medicaid
reimburses health care providers when they use
the HPV test for primary (routine) screening when
deemed medically necessary. Restricted coverage

88 Partnering For Progress 2007

 Appendix B: Methodology and Data Sources

Policy Initiatives and Legislation or resolutions creating a central

Infrastructure
Three items measure policy initiatives and
infrastructure dedicated to eliminating cervical
cancer: cervical cancer screening mandates,
the creation of central accountable entities to
fight cervical cancer, and miscellaneous cervical
cancer prevention and awareness initiatives.
For these measures, a LexisNexis® State Capital
search was conducted using the keywords
“cervical cancer” and “HPV” as search criteria.
All states were searched and legislation was
collected for the time period January 1, 2006,
to October 1, 2006. The cumulative score
represents the highest score achieved in either
year under observation, up to a maximum of 2
points for each measure. It should be noted that
the maximum number of points a state could
achieve for introducing, but not passing, an
initiative was 1 point (i.e., states that introduced,
but did not pass initiatives in both 2005 and
2006 could only achieve 1 point total). Scores in
this category are cumulative and cannot exceed
2 points for any of the three scored categories.
accountable entity (e.g., task force, commission,
study committee or council) to address cervical
cancer prevention is also tracked as an important
marker of prevention efforts. This indicator tracks
legislation or resolutions creating a task force,
commission, study committee, or council to evaluate
new opportunities to eliminate cervical cancer.
Scoring legislation or resolutions to
create a central accountable entity to
address cervical cancer prevention
• 2 points for enacted legislation
• 1 point for enacted resolutions or
legislation introduced but not enacted
• 0 points for no legislation
Legislation or resolutions for additional support of
cervical cancer prevention initiatives are also
tracked. For examples of additional prevention
initiatives, refer to individual State Profiles.

Legislation mandating cervical cancer screening

coverage by public payers and private insurance
Scoring miscellaneous cervical cancer
companies is important to prevention efforts.
prevention legislation or resolutions

• 2 points for enacted legislation

Scoring legislation mandating coverage • 1 point for resolutions introduced or passed
of cervical cancer screening OR legislation introduced but not enacted
• 0 points for no legislation
• 2 points for enacted legislation mandating
coverage of HPV and Pap testing
• 1 point for legislation introduced
(not enacted) covering Pap and HPV
tests OR covering Pap tests alone
• 0 points for no legislation

The “State” of Cervical Cancer Prevention in America 89

 End Notes

1 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2002 Incidence and Mortality Web-based Report Version.
Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2005.
Available at: www.cdc.gov/cancer/npcr/uscs/.

2 http://www.statecancerprofiles.cancer.gov/recenttrend/recenttrend.php?0&00&0&9599&001&999&00&2&0&0&2#graph

3 Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries, New England Journal of Medicine, 2005;353:2158–68.

4 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2002 Incidence and Mortality Web-based Report Version.
Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2005.
Available at: www.cdc.gov/cancer/npcr/uscs/.

5 U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999-2002 Incidence and Mortality Web-based Report Version.
Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2005.
Available at: www.cdc.gov/cancer/npcr/uscs/.

6 National Cancer Institute, Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities,
http://crchd.nci.nih.gov/meetings/Excess%20CervCanMort.pdf.

7 Kaiser Commission on Medicaid and the Uninsured, The Uninsured: A Primer, Oct. 19, 2006.

8 Kaiser Family Foundation, 2004.

9 Kaiser Family Foundation, Percent of Women Ages 18–64 Who Report Pap Smear with the Last Three Years by Race/Ethnicity, 2000.

10 The Henry J. Kaiser Family Foundation. Medicaid’s Role for Women. May 2006.
http://www.kff.org/womenshealth/upload/Medicaid-s-Role-for-
Women.pdf#search=%22%22Medicaid’s%20role%20for%20women%22%22 (accessed Oct. 3, 2006).

11 Centers for Disease Control and Prevention, Women Receiving NBCCEDP-funded Pap smears 2000–2005,
http://www.cdc.gov/cancer/nbccedp/data/summaries/national_aggregate.htm#cervical.

12 National Cancer Institute and Centers for Disease Control and Prevention State Cancer Profiles,
http://statecancerprofiles.cancer.gov/cgi-in/incidencerates/incidencerates.pl?00&057&00&2&001&1&1&1 (accessed Sept. 13, 2006).

13 Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries, New England Journal of Medicine, 2005;353:2158–68.

14 The Henry J. Kaiser Family Foundation. Women’s Health Insurance Coverage. March 2006.
http://www.kff.org/womenshealth/upload/6000-04.pdf (accessed Oct. 3, 2006).

15 Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries, New England Journal of Medicine, 2005;353:2158–68.

16 National Cancer Institute and Centers for Disease Control and Prevention State Cancer Profiles,
http://statecancerprofiles.cancer.gov/cgi-in/incidencerates/incidencerates.pl?00&057&00&2&001&1&1&1 (accessed Sept. 13, 2006).

17 The North American Association of Central Cancer Registries, http://www.naaccr.org/index.asp?Col_SectionKey=11&Col_ContentID=50

(accessed Sept. 13, 2006).

18 National Cancer Institute and Centers for Disease Control and Prevention State Cancer Profiles,
http://statecancerprofiles.cancer.gov/cgi-bin/deathrates/deathrates.pl?00&057&00&2&001&1&1&1 (accessed Sept. 15, 2006).

19 CDC 2004 Behavioral Risk Factor Surveillance System, http://apps.nccd.cdc.gov/brfss/list.asp?cat=WH&yr=2004&qkey=4426&state=All

(accessed Aug. 23, 2006).

20 National Healthcare Quality Report. Hawaii State Summary, http://qualitytools.ahrq.gov/qualityreport/state/stateData.aspx?state=HI

(accessed Nov. 3. 2005).

21 Kaiser Family Foundation, Percent of women ages 18–64 who reporting they had a Pap smear within the last three year, by
race/ethnicity, 2000, http://www.statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=women (accessed Sept. 14,
2006).

22 State Health Access Data Assistance Center, The Coverage Gap: A State-by-State Report on Access to Care, Table 6, “2004 Percent &
Number of Uninsured and Insured Women Age 18-64 Who Have Not Had a Pap Smear in the Past Three Years.”

23 Kaiser Family Foundation, Health Insurance Coverage of Women Ages 18 to 64, by State, 2002–2003.
http://www.kff.org/womenhealth/upload/Health-Insurance-Coverage-of-Women-Ages-18-to-64-by-State-2002-2003-November-2004-
Update.pdf (accessed Aug. 15, 2006).

90 Partnering For Progress 2007

 Resources

• Women In Government Challenge to Eliminate • The HPV Test

Cervical Cancer Campaign http://www.thehpvtest.com
http://www.womeningovernment.org/prevention
• Immunization Action Coalition
• Advisory Committee on Immunization Practices (ACIP) http://www.immunize.org
http://www.cdc.gov/nip/acip
• International Network for Cancer Treatment and Research
• Agency for Healthcare Research and Quality http://www.inctr.org
http://www.ahrq.gov
• Lance Armstrong Foundation
• American Cancer Society www.livestrong.org
http://www.cancer.org
• Make the Connection
• American College of Obstetricians and Gynecologists http://www.maketheconnection.org
http://www.acog.org
• National Alliance for Hispanic Health
• American Medical Women’s Association http://www.hispanichealth.org
http://www.amwa-doc.org
• National Association for Public Health Statistics and
• American Social Health Association Information Systems
http://www.ashastd.org http://www.naphsis.org

• American Society for Colposcopy and Cervical Pathology • National Cancer Institute
http://www.asccp.org http://www.cancer.gov

• Association of Cancer Online Resources • National Center for Health Statistics (CDC)
http://www.acor.org http://www.cdc.gov/nchs

• Association of Reproductive Health Professionals • National Cervical Cancer Public Education Campaign
http://www.arhp.org http://www.cervicalcancercampaign.org

• Association of State and Territorial Health Officials • National Council of Women’s Organizations
http://www.astho.org http://www.ncwo-online.org

• The Balm In Gilead: ISIS Project • National Lieutenant Governors Association

http://www.theisisproject.org http://www.nlga.us/Projects.htm

• Cancer Care • National Network for Immunization Information

http://www.cancercare.org http://www.immunizationinfo.org

• Cancer Index: A Guide to Internet Resources for Cancer • National Women’s Health Resource Center
http://www.cancerindex.org http://www.healthywomen.org

• CancerSource.com • Oncolink
http://www.cancersource.com http://www.oncolink.com

• Cancer Treatment Centers of America • Oncology Channel

http://www.cancercenter.com http://www.oncologychannel.com/cervicalcancer

• C-Change: Collaborating to Conquer Cancer • Planned Parenthood

http://www.c-changetogether.org http://www.plannedparenthood.org

• Center for Advancement in Cancer Education • PopSmear.org

http://www.beatcancer.org http://www.popsmear.org
• Society of Gynecologic Oncologists
• Center for Cancer Research and Prevention
http://www.sgo.org
http://www.preventcancer.org
• Tamika and Friends, Inc.
• Centers for Disease Control and Prevention
http://www.tamikaandfriends.org
http://www.cdc.gov/cancer/nbccedp/index.htm
http://www.cdc.gov/std/hpv • The Ulman Cancer Fund for Young Adults
http://www.ulmancancerfund.org
• Coalition of Labor Union Women (CLUW)
http://www.cluw.org • U.S. Food and Drug Administration: Office of Women’s Health
http://www.fda.gov/womens
• Directors of Health Promotion and Education (formerly
http://www.healthstatus2010.com/owh
the Association of State and Territorial Directors of Health
Promotion and Public Health Education) • Vaccines For Children Program
http://www.astdhpphe.org http://www.cdc.gov/nip/vfc
• Gynecologic Cancer Foundation • Women’s Cancer Network
http://www.thegcf.org http://www.wcn.org
• Henry K. Kaiser Family Foundation’s Statehealthfacts.org • Women’s Research and Education Institute
http://www.statehealthfacts.org http://www.wrei.org
 Key things you should know
about HPV and Cervical Cancer

• Cervical cancer is highly preventable– screening and vaccination are key.

• Cervical cancer is almost always caused by a common virus –

human papillomavirus (or “HPV”).

• Most women will have HPV, but few will develop cervical cancer.

• Only HPV infection that persists can lead to cancer.

• A Pap test looks for changes in the cervix that might lead to cancer.

• An HPV test used with a Pap test in women 30 and over can better
identify women at risk for cancer.

• An HPV vaccine is now available to prevent 70% of cervical cancers.

• Women should talk to their healthcare providers about the most

advanced and appropriate technologies available for cervical cancer
screening and immunization.

Women In Government
2600 Virginia Ave., NW Suite 709
Washington, DC 20037

resourcecenter@womeningovernment.org
www.womeningovernment.org/prevention
1.888.333.0164