ASPO Abstracts
Cervical cancer screening among primary care patients in an urban public safety net health system
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
Purpose of the study We assessed characteristics associated with recent cervical cancer
screening among women who regularly attend for primary care in an urban safety net
health system.
Methods As part of a randomized trial to evaluate HPV self-sampling, the electronic
health record was used to identify female patients, 30-65 years, with no history of
hysterectomy or cervical cancer, who had attended a health system primary care clinic
≥2 times in past 5 years. Patients were categorized as screened if they had a Pap test in
the past 3.5 years or a Pap/HPV co-test in the past 5.5 years.
Results Of the 49,699 patients in the analysis, 77.7% were screened, predominantly by
Pap/HPV co-testing (95%). All underscreened women (22.3%) had a previous Pap test
on record. In bivariable Poisson regression, Hispanic, Asian, and Other race/ethnicity
women were more likely than White women to be screened (PRs=1.3, 4.7, and 2.7,
respectively, p<0.001), while Black women were less likely (PR=0.9, p<0.01). Spanish-,
Vietnamese-, and Other language-speaking women were more likely than English-
speakers to be screened (PRs=1.6, 1.2, 2.0, respectively, p<0.001). By health coverage,
women with the indigent program were significantly more likely than those with private
insurance to be screened (PR=2.5, p<0.001), while those with Medicaid, Medicare, and
no coverage were significantly less likely (PRs=0.6, 0.6, and 0.7, respectively, p<0.001).
Similar associations between demographic characteristics and screening status were
observed in multivariable analyses, with the exception of Hispanic ethnicity. After
controlling for insurance status and language, Hispanic women were less likely to be
screened compared to White women (PR=0.82, p<0.001).
Conclusion The prevalence of underscreened women in this safety net population was
higher than nationally (22.3% versus 18.9%), despite frequent use of primary care
services. While Hispanic women appear to have higher screening prevalence than White
women, the association is reversed after adjusting for insurance status. This may reflect
higher rates among immigrant women with indigent program coverage. The higher
screening rates among indigent program participants may reflect the lack of option to
receive cervical screening elsewhere.
Keywords: Cervical cancer screening, screening under-attendance, health disparities