Women aged 30 years and younger in the United States are undergoing cervical cancer screening in line with recent national recommendations, findings from a new report from the Centers for Disease Control and Prevention demonstrated.
For example, between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage of women aged 22-30 years who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.
However, in what researchers described as an "unfavorable trend," the prevalence of women aged 22-30 years who reported having never been screened increased from 6.6% in 2000 to 9% in 2010. "More effort is needed to promote acceptance of the latest evidence-based recommendations so that all women receive the maximal benefits of cervical cancer screening," researchers led by Dr. Mona Saraiya reported in the Jan. 4 edition of Morbidity and Mortality Weekly Report.
In 2012, recommendations from the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force called for Pap screening to begin no earlier than age 21 and within an interval of 3 years between routine Pap tests for women aged 22-30 years. The purpose of the current analysis was to evaluate trends in Pap testing before the 2012 guidelines were introduced.
Dr. Saraiya, a medical officer in the Centers for Disease Control and Prevention (CDC) Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch, and her associates collected data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey of adults aged 18 years and older (MMWR 2013;61:1038-42). Between 2000 and 2010, 125,297 female respondents in all 50 states and the District of Columbia were asked, "Have you ever had a Pap test?" The researchers analyzed Pap test status by age group, race/ethnicity, U.S. Census region, and health care coverage status.
Between 2000 and 2010, the percentage of women aged 18-21 years who reported never being screened increased from 26.3% to 47.5%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 65% to 41.5%. During the same time period, the percentage of women aged 22-30 years who reported never being screened increased from 6.6% to 9.0%, while the percentage who reported having a Pap test within the preceding 12 months decreased from 78.1% to 67%.
The researchers acknowledged certain limitations of the survey, including the fact that the data were self-reported, and that it "did not consider whether Pap testing behaviors varied by human papillomavirus (HPV) vaccination status or by timing of sexual initiation."
In a separate study of BRFSS data from the same time period, CDC researchers led by Meg Watson, M.P.H., found that Pap test use among women aged 30 years and older who have had a hysterectomy decreased from 73.3% in 2000 to 58.7% in 2010, while recent Pap testing (within 3 years) decreased among women aged 65 years and older without a hysterectomy, from 73.5 % in 2000 to 64.5 % in 2010 (MMWR 2013;61:1043-7). However, women aged 30-64 years who did not have health insurance and had not had a hysterectomy were less likely to have received a Pap test within the previous 3 years – from 74.4 % in 2000 to 68.7 % in 2010.
"Women not receiving recommended screening and follow-up are at increased risk for cervical cancer mortality," the researchers noted. "Underscreening among women with less education, no usual source of health care, and no health care coverage is well documented and a persistent cause of health disparities."
Both studies were funded by the CDC.