incidence of, and mortality associated with, invasive cervical cancer, but this is not being widely applied among certain population groups (NIH, 1996).

Approximately 4,900 American women will die from cervical cancer in 1996 (ACS, 1996). Cervical cancer is the second most common cancer among women worldwide, with more than 450,000 new cases estimated to occur each year (Paavonen et al., 1990). It is the most frequently detected cancer among women in many countries in Africa, Asia, Central America, and South America, where case fatality rates are much higher than those in the United States. In this country, approximately 16,000 new cases of cervical cancer are diagnosed each year, placing it third among reproductive tract cancers in women and seventh among all cancers in women (ACS, 1996).

Although these morbidity and mortality statistics are clearly significant by themselves, they do not capture the physical, mental, or psychosocial trauma experienced by the hundreds of thousands of women who develop precancerous cervical lesions. For example, approximately 5 percent of the 50 million Pap smears performed each year are associated with findings consistent with cervical dysplasia (Kurman et al., 1994). These abnormalities result in enormous anxiety among women and their partners and require diagnostic and treatment procedures, including surgery, that are painful, invasive, and expensive.

An especially disturbing recent finding is the increasing incidence of invasive cervical cancer among European American women under age 50 in the last few years (Krone et al., 1995). This new, ominous trend may be related to the high prevalence of human papillomavirus infection recently reported among young women. In one study, nearly half of female college students tested had evidence of genital human papillomavirus infection (Bauer et al., 1991).

Other STD-Related Cancers

Although carcinomas of the vulva, vagina, anus, and penis each occur considerably less frequently than cervical carcinoma, aggregate numbers of vulvar, vaginal, anal, and penile carcinomas equal nearly half the total numbers of cases of cervical cancer in the United States. These cancers are also strongly associated with human papillomavirus infection. Approximately 60 to 90 percent of cancers at these sites are associated with human papillomavirus, particularly types 16 and 18 (Paavonen et al., 1990). Infection with HIV also may increase the risk that human papillomavirus infection will progress to cancer of the cervix or to the other sites mentioned above.

Reproductive Health Problems

STDs represent a serious threat to the reproductive capability of couples, largely because of the impact of STDs on women. A variety of women's health problems all result from unrecognized or untreated STDs. Reproductive health



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