Cervical Cancer Screening in the United States, 1993-2010: Characteristics of Women Who Are Never Screened

Background: Regular Pap test screening has contributed to decreasing cervical cancer incidence and mortality over the past decades, yet half of the women diagnosed with cervical cancer have never had a Pap test. Our study aims to examine the cervical cancer screening rate, identify socioeconomic and demographic risk factors associated with adult women who have never had a Pap test, and examine the relationship of screening with use of related health services. Methods: Using Behavioral Risk Factor Surveillance System data (1993-2010), a multivariable survey logistic regression model was fitted to estimate odds ratios for associations between risk factors and the outcome of never screened. Results: Between 1993 and 2010, 81.3% of respondents reported they had a Pap test within 3 years; 6.2% were never screened. For women who had a recent checkup, 5.5% were never screened. Among women who had a hysterectomy, 69.4% had a Pap test within 3 years. The multivariable analysis showed that age, race/ethnicity, education, annual household income, never married, and currently uninsured were significantly (p < 0.001) associated with never screened. Conclusions: Screening programs accompanied by adequate treatment options should target women at high risk for never being screened, which could decrease cervical cancer incidence and mortality.