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Chronic conditions barrier to cervical cancer screening

A large proportion of women with health insurance and access to regular health care who reported having one or more chronic conditions were less likely to receive recommended cervical cancer screening, according to findings published in Preventing Chronic Disease: Public Health Research, Practice, and Policy.

“Cervical cancer screening can save lives when abnormal cervical lesions and early cancers are detected and treated; however, many women are not screened as recommended,” Anatasha Crawford, PhD, MPH, from the Division of Cancer Prevention and Control at the CDC, and colleagues wrote.

“Over half of all new cervical cancers are estimated to occur in women who have never or rarely been screened,” they added.

Crawford and colleagues used data from the 2014 nationwide Behavioral Risk Factor Surveillance System telephone survey to investigate nonfinancial barriers to cervical cancer screening. Women aged 40 to 65 years with medical insurance and at least one regular health care provider were included in the analysis. Women who were pregnant at the time of the survey and women who had a hysterectomy were excluded.

The participants reported when they ever had a Pap test. Those reporting never having a Pap test or not having one in more than 5 years were categorized as never or rarely screened. These participants were compared with participants screened regularly (every 3 years).

Participants also reported if they had the following chronic conditions: heart attack, heart disease, stroke, asthma, skin cancer, cancer other than skin, chronic obstructive pulmonary disease (COPD), arthritis, depression, kidney disease and diabetes.

When comparing women screened regularly with those who were never or rarely screened, all variables were significant, with the exception of asthma and cancer other than skin. Women who were aged 60 to 65 years (27.6%), of Asian/Pacific Islander descent (7%), have never been married (16.2%), have obesity (37.3%), currently smoke (25.6%) and have an annual income of less than $10,000 (11%) comprised a large number of participants who were never or rarely been screened for cervical cancer, compared with participants screened regularly.

In addition, compared with women who received timely screening, women who never or rarely received cervical cancer screenings more often reported having one of seven chronic conditions including heart disease (4.9%), COPD (13.7%), arthritis (38.1%), depression (31.4%), kidney disease (3.8%) or diabetes (15.4%) than women who were regularly screened (P < .01). These women also had a higher incidence of heart attack (4.2%) or stroke (4.5%). Cervical cancer screening was more common among women with skin cancer, although women with other types of cancer did not differ significantly in the frequency of screening.

Women who received regular screening were significantly more likely to partake in preventive care measures such as mammogram (83.2%), clinical breast examination (73.6%) and colorectal cancer screening (69.9%) than those who never or rarely received screening. Women who were never or rarely screened were significantly more likely to have more than one or two chronic conditions, while women who received regular screening were more likely to have no chronic conditions (48%).

“The primary reason women adhere to timely cancer screening is because of encouragement from a provider; however, disease management for women with multiple chronic conditions is given greater priority than disease prevention,” they concluded. “Additional research is recommended to determine if physicians can effectively balance managing patients’ chronic conditions and ensuring that patients receive recommended preventive care services.” – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.