The study, conducted with more than 500 patients at clinics at the UCI Medical Center, indicates that physicians and public health departments need to design more sensitive, convenient forms of health care access and find ways to increase awareness of the risks of the disease. The study's results were presented at the annual meeting of the American Public Health Association in Atlanta.

Cervical cancer is second only to breast cancer in incidence among women. It is easily treatable if caught in its early stages. Still, the cancer is one of the deadliest, with 4,900 deaths out of 15,700 new cases every year, according to the National Cancer Institute (NCI). The cancer is associated with the HPV virus and is diagnosed with the help of a screening technique known as the Pap smear.

While Pap smear screening has resulted in a steep drop in deaths from cervical cancer, women from certain ethnic groups and from low-income backgrounds still have high rates of the disease. Researchers have found that lack of follow-up exams after Pap smear screening contributes to these higher rates.

Dr. Alberto Manetta, professor of gynecological oncology, and Sue Howe, an analyst in the College of Medicine, and their colleagues found that Latinas in a community health clinic were far less likely than non-Latinas to know what they need to do after their doctor finds an abnormal Pap smear. Latinas also were less likely to believe that cervical cancer was curable and less likely to return for further treatment after the Pap smear found abnormal growth. The researchers found, in fact, that nearly 40 percent of women with abnormal Pap smears did not return for treatment.

"This study shows us two major reasons why cervical cancer rates are higher in this ethnic group," Manetta said. "First, not enough clinics and offices have sensitive, sensible access to care. This includes bilingual materials and staff, transportation, child-care services and insurance. Second, the program that currently treats cervical cancer is cumbersome, requiring three or four office visits for diagnosis and treatment. We have found that a single visit will eliminate many of these logistical problems and at least raise the rate of detection."

The survey of 376 Latinas and 66 non-Latinas found that 83 percent of Latinas were not familiar with follow-up procedures after an abnormal Pap smear, compared to 68 percent of non-Latinas. About 61 percent of Latinas believed they could return for treatment anytime, compared to 31 percent of non-Latinas. And 31 percent of Latinas felt returning for more visits was very inconvenient, compared to 6 percent of non-Latinas. Nearly half of the Latinas surveyed felt that good health was more a matter of luck than awareness or treatment, compared to 3 percent of non-Latinas. However, both Latinas and non-Latinas reported a high degree of trust in their doctors.

"This high trust indicates that physicians have tremendous potential for educating more of their patients on the importance of screening," Manetta said. "This is an opportunity for providing the bilingual education necessary as well as streamlining the cumbersome process now used for treating cervical cancer."

Manetta and his colleagues are working on a four-year, NCI-sponsored study of how well single-visit programs work at diagnosing and treating cervical cancer. They are exploring what educational and outreach programs may work at encouraging ethnic groups to get the proper screening and diagnosis for the disease.

Manetta and Howe, who now is at San Diego State University, were assisted in the study by F. Allan Hubbell, Jeffrey Schu, Hoda Anton-Culver and Wendy Brewster, all of UCI.