Where Will You Go?

Fact: Cervical cancer is preventable. Pap smears can detect precancerous changes before they progress. Dangerous cells can usually be removed with a minimally invasive LEEP procedure.

If you have insurance, you can get your annual gynecological exam. You call, make the appointment, get your breasts examined, get your Pap smear, wait a week to hear the all clear and go on about your business. If there’s a problem, you get a colposcopy to look closer at the cervix, perhaps a biopsy. If the cells are pre-cancercous, your doctor schedules a LEEP and removes them. You get follow-ups and hopefully they come back all clear. It’s scary, but your life and your fertility are intact. And you never got cervical cancer.

If you don’t have insurance and need a Pap smear, where will you go?

Fact: Cervical cancer is the 3rd most common cancer worldwide. It’s the 5th most common cancer in the US due to better screening rates that allow cervical cancer to be stopped at the pre-cancerous stage.

If you have the money and your doctor accepts self-pay patients, you can get your Pap the same way. If your Pap is normal, it’ll cost you a couple of hundred dollar in office visits and lab fees. If you need follow up or a LEEP, the cost will mount into the thousands. Your life and your fertility are worth those thousands. If you have the money.

If you don’t have the money for the $200 Pap smear, never mind the costly follow-up procedures, where will you go?

Fact: 300,000 women worldwide die annually of cervical cancer. The vast majority of those deaths occur in regions of the world where access to Paps and follow-up care is limited.

If you’re one of the long-term poor, you may qualify for Medicaid to get your annual exam. If you just lost insurance due to job loss, you may not qualify yet since your income hasn’t been low enough for long enough. You may not want to apply because you’re hoping to get insurance back soon. Your state’s Medicaid program may already be on shaky financial ground, over-subscribed due to so many people, over 50 million Americans, who don’t have private insurance. Medicaid often faces cuts at the Federal level, meaning less money to the states and fewer people to be served.

If you can’t get Medicaid to help cover the cost of a Pap smear, where will you go?

Fact: Cervical cancer mortality in the US has dropped nearly 2% per year since the advent of the Pap smear in 1941. Today only 3,600 American women die of cervical cancer annually, largely due to prevention and early detection of the disease.

There are federally funded Community Health Centers designed to serve the uninsured. They will charge you only what you can afford, based on their formula. There may not be one in your town. You would have to drive to the nearest one. And, due to cuts proposed in the spending bill just passed by the House of Representatives last week, over a hundred of them could potentially shut down in the next few weeks due to lack of funding.

If you can’t go to a Community Health Center for a Pap smear, where will you go?

Fact: The United Kindgom offers a program to provide free annual Pap smears to all women ages 25-64. It is estimated to prevent 3,900 cervical cancer diagnoses each year by allowing cervical cancer to be stopped at the pre-cancerous stage. The US does not have a comparable program.

You might be eligible to get screened under a CDC program called the National Breast And Cervical Cancer Early Detection and Treatment Program. This program operates in all 50 states. If a test turns up a problem requiring follow-up care or cancer treatment, the program allows you to become Medicaid eligible immediately. It could save your life. At current funding levels, it only has enough resources to serve 1 in 5 eligible women. Under the spending bill passed by the House of Representatives last week, CDC funding as a whole would be reduced by 21%, meaning the NBCCEDP’s funding will be reduced ever further.

If you’re not eligible or if you’re one of the four out of five women who can’t get into the program to get a Pap smear, or if your state runs out of money for the program due to CDC cuts where will you go?

Fact: Planned Parenthood centers provide over 1 million Pap smears annually.

There are non-governmental entities that provide health care services but most of them rely on grants or assistance from government health programs to some degree or another. Planned Parenthood is the workhorse of non-profit women’s health services. They offer women a place to go for reproductive heath services at an affordable cost. 83% of Planned Parenthood patients go there seeking preventative services, contraception, pre-natal care, and STD testing. Since 1970, Planned Parenthood has received Title X Family Planning funds from the federal government to provide these services. This money is statutorily banned from paying for abortion services. Fees and private donations pay for abortion services, not tax dollars. Amendments to the spending bill passed out of the House of Representatives last week would ban Planned Parenthood, or any other non-profit provider that performs abortions, from receiving those Title X funds. This is hailed as a victory from abortion foes. But this is a move that could cripple the 850 Planned Parenthood centers serving 5 million American women every year. If they lose this money some centers will shut down. Some services will be reduced. Fewer women will have access to Planned Parenthood, either for abortion services or for the myriad non-abortion services they offer.

If you can’t go to Planed Parenthood for a Pap smear, where will you go?

Fact: I was a Planned Parenthood patient in my early 20’s when I didn’t have insurance. I got my annual exam and birth control pills at a price I could afford. I never got an abortion from Planned Parenthood because, thanks to Planned Parenthood, I always had access to contraception.

Fact: In 2009, I was diagnosed with pre-cancerous cervical dysplasia. I had good insurance at the time. I had a LEEP to remove the pre-cancerous lesions before they became malignancies. Nearly 2 years later, my Paps are normal but I can’t go more than 12 months without getting one because of my risk factor. Waiting too long for a Pap could mean a silent, undetected return of the pre-cancerous changes, and a slow march toward full-blown cervical cancer. It could mean the loss of my fertility, the loss my cervix and uterus. Prolonged failure to test for cervical cancer could mean the loss of my life.

Fact: If I lost my employer-based insurance tomorrow, I could not buy an individual policy because the cervical dysplasia is a preexisting condition and insurers would reject my application. Under the Affordable Care Act, they won’t be able to do that any more but those provisions haven’t been enacted yet and the House of Representatives has voted to repeal them. My back-up plan with regard to my health is to return to Planned Parenthood for annual Paps should I ever lose my insurance.

If I can’t afford a doctor, if I can be denied insurance, if I’m not eligible for medical safety-net programs, and the non-profit health centers in my areas were to close due to a sudden withdrawal of long-term government support, where would I go to protect myself from cervical cancer?

And why doesn’t Congress seem to care?

If you need a Pap and don’t have insurance, call the American Cancer Society’s National Cancer Information Center at 1-800-ACS-2345. They can help you find access to cancer screening in you area.