Elsevier

Preventive Medicine

Volume 39, Issue 2, August 2004, Pages 270-278
Preventive Medicine

Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey

https://doi.org/10.1016/j.ypmed.2004.03.035Get rights and content

Abstract

Background. Cervical cancer screening is not fully utilized among all groups of women in the United States, especially women without access to health care and older women.

Methods. Papanicolaou (Pap) test use among U.S. women age 18 and older is examined using data from the 2000 National Health Interview Survey (NHIS).

Results. Among women who had not had a hysterectomy (n = 13,745), 83% reported having had a Pap test within the past 3 years. Logistic regression analyses showed that women with no contact with a primary care provider in the past year were very unlikely to have reported a recent Pap test. Other characteristics associated with lower rates of Pap test use included lacking a usual source of care, low family income, low educational attainment, and being unmarried. Having no health insurance coverage was associated with lower Pap test use among women under 65. Despite higher insurance coverage, being age 65 and older was associated with low use. Rates of recent Pap test were higher among African-American women.

Conclusions. Policies to generalize insurance coverage and a usual source of health care would likely increase use of Pap testing. Also needed are health system changes such as automated reminders to assist health care providers implement appropriate screening. Renewed efforts by physicians and targeted public health messages are needed to improve screening among older women without a prior Pap test.

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

References (53)

  • National Institutes of Health Consensus Program
  • R.D Hunter

    Carcinoma of the cervix

  • American Cancer Society

    Cancer facts and figures—2000

    (2000)
  • N Breen et al.

    Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys

    J. Natl. Cancer Inst.

    (2001 (Nov.))
  • Blackman DK, Bennett EM, Miller DS, Trends in self-reported use of mammograms (1989–1997) and Papanicolaou tests...
  • E Selvin et al.

    Breast and cervical cancer screening: sociodemographic predictors among white, black, and Hispanic women

    Am. J. Public Health

    (2003 (April))
  • L.I Iezzoni et al.

    Use of screening and preventive services among women with disabilities

    Am. J. Med. Qual.

    (2001 (Jul.–Aug.))
  • Centers for Disease Control and Prevention

    Use of cervical and breast cancer screening among women with and without functional limitations—United States, 1994–1995

    MMWR

    (1998 (Oct.))
  • National Center for Health Statistics

    Healthy people 2000 final review

    (2001)
  • Centers for Disease Control and Prevention and National Institutes of Health, Healthy People 2010....
  • US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics

    2000 National Health Interview Survey (NHIS) public use data release

    (2002)
  • US Preventive Services Task Force. Cervical Cancer—Screening. Release Date: January 2003....
  • D Saslow et al.

    American Cancer Society guideline for the early detection of cervical neoplasia and cancer

    CA A Cancer J. Clin.

    (2002)
  • StataCorp

    Stata statistical software: release 6.0

    (1999)
  • US Department of Health and Human Services, Centers for Disease Control and Prevention

    The national breast and cervical cancer early detection program: at-a-glance 2000

    (2000)
  • Cited by (143)

    • Effect of 2 Interventions on Cervical Cancer Screening Guideline Adherence

      2021, American Journal of Preventive Medicine
      Citation Excerpt :

      After the Pap smear was widely accepted for cervical cancer screening in the 1950s, the U.S. experienced a 60% reduction in cervical cancer incidence with annual screening.1–3

    View all citing articles on Scopus

    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.

    View full text