Death from cervical cancer is 6.7 times more common among Native American women in South Dakota than among white women in the state. This is probably related to an increased incidence of the disease. Only 37% of women aged 20 to 65 have received a pap smear in the preceding two years, indicating suboptimal screening for the disease, which is especially acute among older women. Difficulty assuring that appropriate diagnostic tests are obtained after discovery of an abnormal pap smear, barriers to appropriate treatment, and inadequate follow-up after treatment may contribute to excess mortality. The epidemiology and etiology of cervical cancer is discussed and a program for reducing excessive deaths is outlined.