Health policy: gaps in access, delivery, and utilization of the Pap smear in the United States.

Emergence of cervical cancer as a public health problem is largely a twentieth-century phenomenon; although primary prevention remains elusive, secondary prevention--through use of Pap smears--has markedly reduced mortality. Yet, major differences persist in both incidence and mortality between black and white women. The "routine" policies of identifying age groups, timing, and sites for Pap testing will have to yield to more targeted approaches. Both providers and individuals at risk have challenges and responsibilities.