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Does Patient Health and Hysterectomy Status Influence Cervical Cancer Screening in Older Women?

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Abstract

Background

Decisions to screen older patients for cancer are complicated by the fact that aging populations are heterogeneous with respect to life expectancy.

Objective

To examine national trends in the association between cervical cancer screening and age, health and hysterectomy status.

Design and participants

Cross-sectional data from the 1993, 1998, 2000, and 2005 National Health Interview Surveys (NHIS) were used to examine trends in screening for women age 35–64 and 65+ years of age. We investigated whether health is associated with Pap testing among older women using the 2005 NHIS (N = 3,073). We excluded women with a history of cervical cancer or who had their last Pap because of a problem.

Measurements

The dependent variable was having a Pap test within the past 3 years. Independent variables included three measures of respondent health (the Charlson comorbidity index (CCI), general health status and having a chronic disability), hysterectomy status and sociodemographic factors.

Main results

NHIS data showed a consistent pattern of lower Pap use among older women (65+) compared to younger women regardless of hysterectomy status. Screening also was lower among older women who reported being in fair/poor health, having a chronic disability, or a higher CCI score (4+). Multivariate models showed that over 50% of older women reporting poor health status or a chronic disability and 47% with a hysterectomy still had a recent Pap.

Conclusions

Though age, health and hysterectomy status appear to influence Pap test use, current national data suggest that there still may be overutilization and inappropriate screening of older women.

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Acknowledgements

The authors wish to thank William Waldron for expert programming.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA

    Helen I. Meissner PhD

  2. Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jasmin A. Tiro PhD, MPH

  3. VA Health Services Research & Development Center of Excellence on Implementing Evidence-Based Practice, Roudenbush Veterans Affairs Medical Center, Indiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Inc., Indianapolis, IN, USA

    David Haggstrom MD, MAS

  4. Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    David Haggstrom MD, MAS

  5. Department of Medicine, Robert Wood Johnson Medical School, Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Grace Lu-Yao PhD

  6. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Nancy Breen PhD

Authors
  1. Helen I. Meissner PhD
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  2. Jasmin A. Tiro PhD, MPH
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  3. David Haggstrom MD, MAS
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  5. Nancy Breen PhD
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Correspondence to Helen I. Meissner PhD.

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Meissner, H.I., Tiro, J.A., Haggstrom, D. et al. Does Patient Health and Hysterectomy Status Influence Cervical Cancer Screening in Older Women?. J GEN INTERN MED 23, 1822–1828 (2008). https://doi.org/10.1007/s11606-008-0775-x

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  • DOI: https://doi.org/10.1007/s11606-008-0775-x

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