Grand Rounds

What Factors Predict Cervical Cancer Screening in Women Between 45 and 65 Years of Age?

BACKGROUND AND PURPOSE:

Harper et al. (Preventive Medicine, 2019) used data from large, nationwide health surveys to determine predictors of cervical cancer screening in older women

Analysis of three US-based, nationwide health surveys
- The Behavioral Risk Factor Surveillance System (BRFSS 2016)
- The Health Information National Trends Survey (HINTS 2017)
- The Health Center Patient Survey (HCPS 2014)
Participants
- Women without hysterectomy
- 45 to 65 years of age
Data analysis
- Analyzed survey data using univariate and multivariate analyses
Primary outcome
- Cytology within the last 3  years

Data from approximately 44,000 women were included in the analyses
Overall cervical cancer screening rates were
- BRFSS: 71% among 41,657 women
- HINTS: 79% among 740 women
- HCPS: 66% among 1571 women
Women in the following demographic categories were less likely to report cervical cancer screening
- 60 to 64  years old vs 45 to 49 years
  - Adjusted prevalence ratios (aPR)  0.88 (95% CI, 0.85 to 0.91)
- Women in rural locations vs urban areas
  - aPR  0.95 (95% CI: 0.92 to 0.98)
Women in the following demographic categories were more likely to report cervical cancer screening
- Women with more vs less than high school education
  - aPR  1.20 (95% CI, 1.13 to 1.28)
- Women with insurance vs uninsured women
  - aPR  1.47 (95% CI, 1.33 to 1.62)
The above data was derived from BRFSS but the trends were similar in the HINTS and HCPS databases
Predictions based on race and ethnicity varied between surveys

All three studies showed that reported screening rates “are insufficient to reduce cervical cancer incidence”
The strongest predictor of cervical cancer screening in women ages 45 to 65 was insurance coverage
- Women of younger age and in urban locations were also more likely to report screening

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