Three large scale surveys highlight the complexity of cervical cancer under-screening among women 45–65 years of age in the United States

BACKGROUND: Large scale United States (US) surveys guide efforts to maximize the health of its population. Cervical cancer screening is an effective preventive measure with a consistent question format among surveys. The aim of this study is to describe the predictors of cervical cancer screening in older women as reported by three national surveys. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS 2016), the Health Information National Trends Survey (HINTS 2017), and the Health Center Patient Survey (HCPS 2014) were analyzed with univariate and multivariate analyses. We defined the cohort as women, without hysterectomy, who were 45–65 years old. The primary outcome was cytology within the last 3 years. RESULTS: Overall, Pap screening rates were 71% (BRFSS), 79% (HINTS) and 66% (HCPS), among 41,657, 740 and 1571 women, respectively. BRFSS showed that women 60–64 years old (aPR = 0.88, 95% CI: 0.85, 0.91), and in rural locations (aPR = 0.95, 95% CI: 0.92, 0.98) were significantly less likely to report cervical cancer screening than women 45–49-years old or in urban locations. Compared to less than high school, women with more education reported more screening (aPR = 1.20, 95% CI: 1.13, 1.28), and those with insurance had higher screening rates than the uninsured (aPR = 1.47, 95% CI: 1.33, 1.62). HINTS and HCPS also showed these trends. CONCLUSIONS: All three surveys show that cervical cancer screening rates in women 45–65 years are insufficient to reduce cervical cancer incidence. Insurance is the major positive predictor of screening, followed by younger age and more education. Race/ethnicity are variable predictors depending on the survey.