BACKGROUND AND PURPOSE: 

• Individuals in the US receive cervical cancer screening at suboptimal rates but reasons remain unclear 
• Suk et al. (JAMA Network Open, 2022) estimated changes in USPSTF guideline–concordant cervical cancer screening over time and assessed the reasons women do not receive up-to-date screening by sociodemographic factors 

METHODS: 

• Pooled population-based cross-sectional study 
• Population 
  • Women aged 21 to 65 years without previous hysterectomy 
  • Data came from the US National Health Interview Survey from 2005 and 2019 
• Exposures 
  • Age 
  • Race and ethnicity 
  • Sexual orientation 
  • Rurality of residence 
  • Health insurance type 
• Study design 
  • USPSTF screening definitions 
    • For 2005: Screening every 3 years for women aged 21 to 65 years 
    • For 2019: Screening every 3 years with a Papanicolaou test alone for women aged 21 to 29 years | Screening every 3 years with a Papanicolaou test alone or every 5 years with high-risk HPV testing or cotesting for women aged 30 to 65 years 
  • Outcomes were compared across sociodemographic factors in 2019 
    • Outcomes in 2005 were compared with 2019 by age group, race and ethnicity, and insurance type  
    • Comparisons were not available for sexual orientation and rurality of residence because of the lack of data from 2005 
• Primary outcomes 
  • USPSTF guideline–concordant cervical cancer screening rates  
  • Self-reported primary reasons for not receiving up-to-date screening 

RESULTS: 

• 20,557 women (weighted, 113.1 million women) 
  • Aged 30 to 65 years: 76.3%  
  • Had private insurance: 67.0% 
  • Race/ethnicity 
    • Asian: 6.1% 
    • Hispanic: 17.2% 
    • Non-Hispanic Black: 13.1% 
    • Non-Hispanic White: 61.0% 
    • Other races/ethnicities: 2.7% 
• In 2019, women aged 21 to 29 years had a significantly higher rate of overdue screening compared to women who were older (P<0.001) 
  • 21 to 29 years old: 29.1%
  • 30 to 65 years old: 21.2% 
• Significantly higher rates of overdue screening were found among 
  • Those of Asian vs non-Hispanic White race and ethnicity (P=0.01) 
    • Asian: 31.4% 
    • Non-Hispanic White: 20.1% 
  • Those identifying as LGBQ+ vs heterosexual (P<0.001) 
    • LGBT+: 32.0% 
    • Heterosexual: 22.2% 
  • Those living in rural vs urban areas (P=0.04) 
    • Rural: 26.2% 
    • Urban: 22.6% 
  • Those without insurance vs those with private insurance (P<0.001) 
    • Without insurance: 41.7% 
    • Private insurance: 18.1% 
• The most common reason for not receiving timely screening across all groups was lack of knowledge 
  • In women identifying as LGBT+: 47.2% cited as a reason 
  • In women with Hispanic ethnicity: 64.4% 
• Previous receipt of HPV vaccine was not a primary reason for not having up-to-date screening (<1% of responses) 
• From 2005 to 2019, among women aged 30 to 65 years, lack of access decreased significantly as a primary reason for not receiving screening 
  • 2005: 21.8% 
  • 2019: 9.7% 
• Reasons for not receiving screening that increased significantly over the study period included  
  • Lack of knowledge 
    • 2005: 45.2% 
    • 2019: 54.8% 
  • Not receiving recommendations from health care professionals 
    • 2005: 5.9% 
    • 2019: 12.0% 

CONCLUSION: 

• Cervical cancer screening rates in the U.S. decreased from 2005 to 2019, and vary widely based on demographic factors 
• The biggest reported barrier to screening was lack of knowledge and fewer recommendations from health care professionals 
• Findings regarding populations that were overdue for screening were not unexpected
  • Previous research suggests that changing guidelines put higher risk individuals, such as marginalized populations, at even greater risk for underscreening, supporting the findings in this study
• The authors state 

…findings also revealed that barriers to screening significantly varied by sociodemographic factors, suggesting cultural adaptation of interventions will be an important factor in the success of efforts to increase cervical cancer screening uptake among priority populations in the US, including women of Asian race and Hispanic ethnicity, women without insurance, women living in rural areas, and/or women identifying as LGBQ+ 

Learn More – Primary Sources: 

Assessment of US Preventive Services Task Force Guideline–Concordant Cervical Cancer Screening Rates and Reasons for Underscreening by Age, Race and Ethnicity, Sexual Orientation, Rurality, and Insurance, 2005 to 2019