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Cervical cancer screening in the United States, 1993-2010: characteristics of women who are never screened.

BACKGROUND
Regular Pap test screening has contributed to decreasing cervical cancer incidence and mortality over the past decades, yet half of the women diagnosed with cervical cancer have never had a Pap test. Our study aims to examine the cervical cancer screening rate, identify socioeconomic and demographic risk factors associated with adult women who have never had a Pap test, and examine the relationship of screening with use of related health services.


METHODS
Using Behavioral Risk Factor Surveillance System data (1993-2010), a multivariable survey logistic regression model was fitted to estimate odds ratios for associations between risk factors and the outcome of never screened.


RESULTS
Between 1993 and 2010, 81.3% of respondents reported they had a Pap test within 3 years; 6.2% were never screened. For women who had a recent checkup, 5.5% were never screened. Among women who had a hysterectomy, 69.4% had a Pap test within 3 years. The multivariable analysis showed that age, race/ethnicity, education, annual household income, never married, and currently uninsured were significantly (p<0.001) associated with never screened.


CONCLUSIONS
Screening programs accompanied by adequate treatment options should target women at high risk for never being screened, which could decrease cervical cancer incidence and mortality.