The continued occurrence of advanced cervical carcinoma (stage II, III, IV) was studied. Patients were evaluated with regard to age, racial origin, socioeconomic status, geographic distribution, and presenting symptoms. Particular emphasis was placed on the role of screening in disease detection. The disturbing finding was that of the 170 patients reviewed, disease was diagnosed by screening examination in only 20 patients. Furthermore, 62 patients were not diagnosed even though they were exposed to the health care system. Factors which influence obtaining Pap smears are discussed, with suggestions as to how to enhance use of the Pap smear.