Papanicolaou testing among women in the southern United States

Abstract

Background: Cervical cancer is largely preventable with screening using Papanicolaou (Pap) testing. We examined Pap testing among southern women, mostly of low income and educational status, to determine if rates were similar to those reported nationally and to examine which factors were related to receipt of Pap tests.

Methods: Baseline interview data from 19,046 women aged 40-79 enrolled at community health centers into the Southern Community Cohort were analyzed. The percentages of women reporting a recent Pap test (within the past 3 years) were compared according to sociodemographic, healthcare access, and health-related behavior variables. Logistic regression analyses were employed to compute odds ratios (ORs) and corresponding 95% confidence intervals (95% CI).

Results: Overall, 88% of the women reported having received a recent Pap test. Screening rates were high among all racial/ethnic groups, but highest for African American women. Not having a Pap test was significantly associated with lower education (OR declining to 0.73, 95% CI 0.64-0.85, among those with less than a high school education), lower income (OR declining to 0.61, 95% CI 0.43-0.87, among those with annual household incomes <$15,000), and not having health insurance (OR 0.83, 95% CI 0.71-0.97). The most common reason reported by women as to why they had not a Pap test was cost (25%), followed by reporting a doctor had not recommended the test (22%).

Conclusions: Pap testing was most frequent among African American women. Subsets, such as women with less education, low income, and no health insurance, however, may not be adequately screened for cervical cancer.