Cervical cancer screening of underserved women in the United States: results from the National Breast and Cervical Cancer Early Detection Program, 1997-2012

Abstract

Objective: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screens to low-income, uninsured, and underinsured women. We describe the number and proportion of women eligible for cervical cancer screening services and the proportion of eligible women screened over the period 1997-2012.

Methods: Low-income, uninsured, and underinsured women aged 18-64 years who have not had a hysterectomy are eligible for cervical cancer screening through the NBCCEDP. We estimated the number of low-income, uninsured women using data from the US Census Bureau. We adjusted our estimates for hysterectomy status using the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. We used data from the NBCCEDP to describe the number of women receiving NBCCEDP-funded screening and calculated the proportion of eligible women who received screening through the NBCCEDP at the national level (by age group, race/ethnicity) and at the state level by age group. We used the Medical Expenditure Panel Survey to estimate the proportion of NBCCEDP-eligible women who were screened outside the NBCCEDP and the proportion that are not screened.

Results: We estimate that in 2010-2012, 705,970 women aged 18-64 years, 6.5 % (705,970 of 9.8 million) of the eligible population, received NBCCEDP-funded Pap tests. We estimate that 60.2 % of eligible women aged 18-64 years were screened outside the NBCCEDP and 33.3 % were not screened. The NBCCEDP provided 623,603 screens to women aged 40-64 years, an estimated 16.5 % of the eligible population, and 83,660 screens to women aged 18-39 years, representing an estimated 1.2 % of the eligible population. The estimated proportions of eligible women screened in each state ranged from 1.5 to 32.7 % and 5 % to 73.2 % among the 18-64 and 40-64 years age groups, respectively. Changes in the proportion of eligible women screened over the study period were nonsignificant.

Conclusions: Although the program provided cervical screening to over 700,000 women between 2010 and 2012, it served a small percent of those eligible. The proportion of women screened varied substantially across age groups, racial/ethnic groups, and states. Many low-income, uninsured women are not being screened.

Fig. 1

Percentage of low-income uninsured women screened for cervical cancer in the United States, 2010–2012. Source: Authors’ tabulations of modified data from Medical Expenditure Panel Survey 2011, US Census Bureau, Current Population Survey, 2010–2012 Annual Social and Economic Supplements and from NBCCEDP October 2013 data

Fig. 2

Percent of NBCCEDP-eligible women screened for cervical cancer screening by state and DC compared to national average, 2010–2012. Source: Authors’ tabulations of modified data from the US Census Bureau, Current Population Survey, 2010–2012 Annual Social and Economic Supplements, and from NBCCEDP October 2013 data. The modification of the data was the authors’ tabulations of data from 2005 National Health Interview Survey and 2005 Behavioral Risk Factor Surveillance System. Notes: The symbols show the percentage of eligible women screened by each state and District of Columbia. Two states that use different eligibility/implementation criteria are not included. Data points for each age group are sorted by percentage of eligible women screened. The proportion of NBCCEDP-eligible women screened by the NBCCEDP across the US is 1.2 % aged 18–39, 6.5 % aged 18–64, and 16.5 aged 40–64

Fig. 3

Trends in NBCCEDP-eligible population and reach for cervical cancer screening by age group. ^aWomen eligible for NBCCEDP-funded Pap tests include those 18–64 years of age who have a cervix, are uninsured, and have low income (based on eligibility used in each state) aggregated to the nation. The number of eligible women could be underestimated because it excludes those who have health insurance, but whose insurance does not cover cervical cancer screening and those who are uninsured for <1 year. See “Methods” section for details. ^bPercent of all US women in a given age group who were eligible for NBCCEDP-funded Pap tests. ^cPercent of all US women in a given age group who are eligible and who were provided with NBCCEDP-funded Pap tests. Source: Authors’ tabulations of modified data from the US Census Bureau, Current Population Survey, 2010–2012 Annual Social and Economic Supplements, and from NBCCEDP October 2013 data. The modification of the data was the authors’ tabulations of data from 2005 National Health Interview Survey and 2005 Behavioral Risk Factor Surveillance System

Fig. 4

NBCCEDP trends in the percent of eligible women screened for cervical cancer, aged 18–64, by race and ethnicity. ^aWomen eligible for NBCCEDP-funded Pap tests include those 18–64 years of age who have a cervix, are uninsured, and have low income (based on eligibility criteria used in each state) aggregated to the nation. The number of eligible women could be underestimated because it excludes those who have health insurance, but whose insurance does not cover cervical cancer screening and those who are uninsured for <1 year. See “Methods” section for details. ^{a b}Percent of all US women aged 18–64 who were eligible for NBCCEDP-funded Pap tests and who were provided with NBCCEDP-funded Pap tests. Source: Authors’ tabulations of modified data from the US Census Bureau, Current Population Survey, 2010–2012 Annual Social and Economic Supplements, and from NBCCEDP October 2013 data. The modification of the data was the authors’ tabulations of data from 2005 National Health Interview Survey and 2005 Behavioral Risk Factor Surveillance System. Notes: AIAN American Indian or Alaska Native; ANHOPI Asian American, Native Hawaiian, or Pacific Islander. Data are presented in two graphs because of differences in scale. Highest points are marked to point out scale