Updated: February 2023

Author: Cancer Program, Vermont Department of Health

Cervical cancer incidence and mortality have declined in the United States since the introduction of cervical cancer screening in the 1950s and 1960s. The annual age-adjusted incidence rate in Vermont is 4.8 cases per 100,000 women, and the age-adjusted mortality rate is 2.2 deaths per 100,000 (for 2015-2019). However, cervical cancer still remains a substantial public health issue.

Cervical cancer most commonly occurs in women age 35 to 55 years. Screening can consist of an HPV test, which tests for the presence of the human papillomavirus (HPV) which can cause cervical cancer, or a Pap test which checks for precancers in the cervix. In contrast to cervical cancer, abnormal cytology test results and precancerous lesions are fairly common and regular screening allows health care professionals to find these precancerous lesions and treat them before cancer develops. 

There has been a decrease in cervical cancer screening rates among Vermont women age 21-65 since 2000. Cancer screening provides an opportunity to find and treat cancers early, leading to a decrease in overall cancer mortality.

In 2018 the USPSTF released new guidelines for screening for cervical cancer. The guidelines recommend screening of females ages 21 to 29 years with cytology (Pap smear) every 3 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting). In the years 2014 and prior, HPV tests were not captured by our current data sources and may have led to an underestimate of screening rates.

This indicator is part of Healthy Vermonters 2020 (the State Health Assessment) that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020.

This indicator is also aligned with the Healthy People 2020 developmental objective C-14 which is to “increase the proportion of women who receive a cervical cancer screening based on the most recent guidelines” (http://www.healthypeople.gov/2020/topics-objectives/topic/cancer/objectives).

It was also included as an objective in the 2020 Vermont State Cancer Plan as well as the current 2025 Vermont Cancer Plan.

Vermonters Taking Action Against Cancer (VTAAC)

Vermont Department of Health Offices of Local Health

American Cancer Society

Centers for Disease Control and Prevention

University of Vermont Cancer Center

American Lung Association

The number of new cancer cases can be reduced, and many cancer deaths can be prevented through a comprehensive strategy:

• Prevention of cancer through promotion of healthy lifestyle behaviors (tobacco prevention, increased physical activity, improved nutrition, sun safety) and vaccinations (such as for human papilloma virus (HPV)).
• Early detection of cancer through screening for breast, cervical, colorectal, skin and lung cancers, to find these diseases at an early stage when treatment works best.
• Effective treatment of cancer to result in better outcomes and decreased mortality.

Within each of these categories there are many proven approaches that decrease cancer incidence and mortality. A comprehensive approach focusing on cancer prevention, early detection and treatment is the most effective way to impact cancer mortality outcomes in Vermont.

The 2025 Vermont Cancer Plan, published by the Vermont Department of Health Comprehensive Cancer Control Program and statewide cancer coalition Vermonters Taking Action Against Cancer (VTAAC), provides a strategic roadmap for reducing the burden of cancer in Vermont. The plan includes measurable objectives as priorities for action in the following areas:

• Health Equity
• Cancer Prevention
• Cancer Early Detection
• Cancer Directed Therapy & Supportive Care
• Survivorship & Advanced Care Planning

Through the Vermont Cancer Plan, the Department of Health focuses and prioritizes the numerous efforts carried out statewide to reduce behaviors that are cancer risk factors, increase early detection of cancers, and provide access to quality cancer treatment for all Vermonters. The combined work of these Departmental Programs and partners influences the overall burden of cancer in Vermont.

Usually women who have had a hysterectomy are excluded from cervical cancer screening calculations.  In 2016, women 45-65 were not asked whether they’ve had a hysterectomy, requiring Vermont to include these women in our cervical cancer screening calculations.  As a result, estimates of the proportion of women meeting PAP test screening recommendations in 2016 are likely underestimates. Due to this, comparisons between data collected in 2016 and all other years should be made with caution.

In addition, in 2015 this indicator was changed from “the percent of female adults age 21 and older receiving cervical cancer screening” to “the percent of female adults age 21-65 receiving cervical cancer screening.” Historical data were updated to reflect the revised age range.

This revision was made in order to align this Healthy Vermonters 2020 indicator with the U.S. Preventive Services Task Force (USPSTF) guidance regarding cervical cancer screening, which recommends against screening women older than age 65 who have had adequate prior screening and are not otherwise at high risk for cervical cancer. This revision also aligns this Healthy Vermonters 2020 indicator with Healthy People 2020 objective C-15.

Data is updated as it becomes available, and timing may vary by data source.

This indicator is age-adjusted to the 2000 U.S. standard population. In U.S. data, age adjustment is used for comparison of regions with varying age breakdowns. In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont are age adjusted. The estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000. For more detailed information on age adjustment visit /www.cdc.gov/nchs/data/statnt/statnt20.pdf.

Due to BRFSS weighting methodology changes beginning in 2011, comparisons between data collected in 2011 and later and that from 2010 and earlier should be made with caution. Differences between data from 2011 forward and earlier years may be due to methodological changes, rather than changes in opinion or behavior.