Effects of Cardiovascular Disease on Compliance with Cervical and Breast Cancer Screening Recommendations Among Adult Women

Abstract

Background: Cardiovascular disease (CVD) is common among women and is a leading cause of death in the United States. This study assessed the impact of CVD on compliance with the US Preventive Services Task Force guidelines for cervical and breast cancer screening among U.S. adult women.

Methods: A cross-sectional study was conducted on 17,408 women using data from the National Health Interview Survey 2013. A total of 11,788 respondents (21-65 years old) with complete information on Pap smear and 11,409 women (40+ years old) with complete information on mammography compliance were included. Multivariate logistic regression models were used to assess the impact of CVD on cervical and breast cancer screening practices.

Results: Women with CVD were marginally more likely to have had a mammogram in accordance with guidelines (odds ratio 1.17; 95% confidence interval 1.04-1.31) than those without CVD. However, compliance with Pap tests was similar (80.6% vs 82.3%, p>0.05) between the two groups. Myocardial infarction was associated with reduced odds of Pap smear compliance (odds ratio: 0.30; 95% confidence interval 0.18-0.51).

Conclusions: Women with prior myocardial infarction should be encouraged to continue receiving regular Pap smears. More research is needed to assess whether observed differences in Pap testing between patients with and without a history of myocardial infarction result from lack of provider recommendation or from patient noncompliance with their recommendations.

FIG. 1.

Flowchart of the numbers of participants included in the analyses of cervical and breast cancer screening use in National Health Interview Survey (NHIS) 2013. CVD, cardiovascular diseases.

FIG. 2.

Compliance with Papanicolaou (Pap) smear and mammogram recommendations by CVD status in U.S. adult women, NHIS 2013. (A) Compliance with Pap smear recommendations; (B) Compliance with mammogram recommendations. Data are presented as proportion of women complied with cervical and breast cancer-screening guidelines. Error bar is 95% confidence interval. Proportion was weighted using sample weights. *Statistical significance for the comparison between people with/without disease, after adjusted for age group, race, immigration status, region of residence, marital status, education level, family income to poverty threshold ratio, health insurance coverage, usual place of care, and visiting an obstetrician/gynecologist in the past year. CVD, any type of cardiovascular diseases; HBP, high blood pressure; MI, myocardial infarction.

FIG. 3.

Compliance with mammogram recommendations by status of hypertension and usual place of care among U.S. adult women, NHIS 2013. Data are presented as proportion of women complied with cervical and breast cancer-screening guidelines. Error bar is 95% confidence interval. Proportion was weighted using sample weights.