Despite overall declines in cervical death rates in the U.S., certain groups of women are significantly more likely to die from the disease, which is likely due to underlying disparities access to health care, according to a new report from the National Cancer Institute.

The investigators found that women living in areas with high death rates from Cervical cancer were less likely to have a usual source of health care or to use preventive services, such as cancer screening.

These women also tended to have low income and education levels, and experienced relatively high rates of other diseases such as breast cancer, Colorectal cancer and Heart disease.

High rates of Cervical cancer “are markers for a lot of other events,” according to study author Dr. Harold P. Freeman, director of the National Cancer Institute’s Center to Reduce Cancer Health Disparities in Rockville, Maryland.

Freeman added that all of the above diseases, like cervical cancer, can be screened for and treated.

In the case of Cervical cancer, annual Pap smears help diagnose cervical cancer in its very early stages, when it can be very effectively treated, he said. It’s a “cancer from which, presumably, no woman should die.”

However, 4,000 women still die every year from cervical cancer, Freeman said, probably because, in part, they have limited access to services to detect the cancer in its early stages.

But to help reduce cervical cancer rates, experts also need to educate women about why it’s important to be screened, and how to do it. “We need to couple education to access,” Freeman told.

In their analysis, Freeman and his team reviewed the available study findings on Cervical cancer rates in the U.S. and the circumstances of women living in areas where death rates remain high.

They found that cervical cancer death rates are generally declining in the U.S., but remain high among African-American women in the south, women living along the Mexican border, white women in Appalachia, American Indians in the Northern Plains, Vietnamese-American women, and Alaska Natives.

“These women tend to have a fragmented health care system,” Freeman noted.

Freeman and his team summarize their findings in the NCI report Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities.

Previous research, also out of the National Cancer Institute, has shown that Cervical cancer rates trended downward between 1975 and 2000, but women in high poverty counties had at least a one-third higher incidence than women in low poverty counties.