Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey☆
Introduction
Cervical cancer is one of the most preventable of cancers, and widespread adoption of the Papanicolaou (Pap) test can be credited with halving the annual malignant cervical cancer incidence rate (from 17.2 to 8.0 per 100,000) and mortality rate (from 6.2 to 2.9) from 1973 to 1999 [1], [2], [3]. Even so, in 2000 there were an estimated 12,800 new U.S. cases of cervical cancer and 4,600 deaths due to cervical cancer [4]. One-half of women with newly diagnosed invasive cervical cancer have never had a Pap test, and another 10% have not had a test in the past 5 years [1].
This study takes advantage of data from the latest National Health Interview Survey (NHIS) Cancer Control Supplement to identify which women are not being tested and the reasons they report for not having been tested. It is important to identify which women are not being tested because although overall national rates of Pap testing are high [5], [6], [7], rates are much lower among certain groups of women, for example, those who lack insurance or a usual source of care [5], [7], [8], [9]. Programs, policies, and interventions are needed to specifically target groups of women with lower rates.
In addition to sociodemographic and health care access indicators that have been shown to be predictors of screening use, the 2000 NHIS included several measures of health status and cancer risk, and analyses are presented showing Pap test use by disability status, prior history of cancer, perceived risk of cancer, and smoking status. Previous research has shown higher rates of cervical cancer screening among women with a family history of cancer [7], and lower rates of use among women who have disabilities [10], [11] or who currently smoke [7]. The NHIS provides valuable information on reasons why women without a recent Pap test are not tested and whether such women had received a recommendation to be tested from a doctor or health professional. The NHIS is the official assessment tool for the Department of Health and Human Services' “Healthy People” objectives related to cervical cancer [12], [13]. The 2000 objective was to increase to at least 85% the proportion of all women age 18 and older who had received a Pap test within the preceding 3 years [12].
Section snippets
Data sources
The NHIS is a principal source of information on the health of the U.S. noninstitutionalized, civilian household population [14]. The survey provides national data on the incidence of illness and accidental injuries, the prevalence of chronic conditions and impairments, the extent of disability, and the utilization of health care services derived from personal interviews in the home. A Cancer Control Module to the 2000 NHIS was administered to 32,374 individuals age 18 and older, 18,388 of them
Results
In 2000, 83.3% of women age 18 and older and without a history of hysterectomy reported that they had had a Pap test within the past 3 years (Table 1). Among all women age 18 and older (with and without a history of hysterectomy), 81.3% had had a recent Pap test.
Discussion
In 1990, national health objectives for the year 2000 were established as part of an initiative to invigorate health promotion and disease prevention efforts and bring about measurable improvements in morbidity and mortality. A “Healthy People” objective designed to do this for cervical cancer is to increase to at least 85% the proportion of all women age 18 and older who had received a Pap test within the preceding 3 years [12]. This was not quite achieved. Rates of use did exceed 85%, but
Limitations
One caution to interpreting results of cancer screening behavior from surveys is the problem of respondents correctly reporting their actual behavior. A fairly extensive literature suggests that women overreport their use of Pap tests when asked about them on surveys [46], [47], [48], [49], [50]. Sources of overreporting can be traced to difficulties in correctly dating events in memory and the desire of respondents to provide socially desirable answers (i.e., use of recommended preventive
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The analysis, opinions and assertions contained herein are those of the author and are not to be construed as reflecting the views or position of the National Academy of Sciences, the Institute of Medicine, the National Research Council, or the National Research Institute.