Does Patient Health and Hysterectomy Status Influence Cervical Cancer Screening in Older Women?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Decisions to screen older patients for cancer are complicated by the fact that aging populations are heterogeneous with respect to life expectancy.
To examine national trends in the association between cervical cancer screening and age, health and hysterectomy status.
Design and participants
Cross-sectional data from the 1993, 1998, 2000, and 2005 National Health Interview Surveys (NHIS) were used to examine trends in screening for women age 35–64 and 65+ years of age. We investigated whether health is associated with Pap testing among older women using the 2005 NHIS (N = 3,073). We excluded women with a history of cervical cancer or who had their last Pap because of a problem.
The dependent variable was having a Pap test within the past 3 years. Independent variables included three measures of respondent health (the Charlson comorbidity index (CCI), general health status and having a chronic disability), hysterectomy status and sociodemographic factors.
NHIS data showed a consistent pattern of lower Pap use among older women (65+) compared to younger women regardless of hysterectomy status. Screening also was lower among older women who reported being in fair/poor health, having a chronic disability, or a higher CCI score (4+). Multivariate models showed that over 50% of older women reporting poor health status or a chronic disability and 47% with a hysterectomy still had a recent Pap.
Though age, health and hysterectomy status appear to influence Pap test use, current national data suggest that there still may be overutilization and inappropriate screening of older women.
- Walter LC, Lindquist K, Covinsky KE. Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age. Ann Intern Med. 2004;140:681–8.
- Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. J Am Med Assoc. 2001;285:2750–6. CrossRef
- U.S. Preventive Services Task Force. The Guide to Clinical Preventive Services, 2006. Available at: http://www.ahrq.gov/clinic/uspstf/uspstopics.htm#Ctopics. Accessed August 18, 2008.
- Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2006. CA-Cancer J Clin. 2006;56:11–25. CrossRef
- Yasmeen SM, Romano PSMM, Pettinger MM, et al. Incidence of cervical cytological abnormalities with aging in the women’s health initiative: a randomized controlled trial. Obstet Gynecol. 2006;108:410–9.
- Hewitt M, Devesa SS, Breen N. Cervical cancer screening among U.S. women: analyses of the 2000 National Health Interview Survey. Prev Med. 2004;39:270–8. CrossRef
- Swan J, Breen N, Coates RJ, Rimer BK, Lee NC. Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer. 2003;97:1528–40. CrossRef
- Kiefe CI, Funkhouser E, Fouad MN, May DS. Chronic disease as a barrier to breast and cervical cancer screening. J Gen Intern Med. 1998;13:357–65. CrossRef
- Kagay CR, Quale C, Smith-Bindman R. Screening mammography in the American elderly. Am J Prev Med. 2006;31:142–9. CrossRef
- Mandelblatt JS, Gold K, O’Malley AS, et al. Breast and cervix cancer screening among multiethnic women: role of age, health, and source of care. Prev Med. 1999;28:418–25. CrossRef
- Sirovich BE, Welch HG. The frequency of Pap smear screening in the United States. J Gen Intern Med. 2004;19:243–50. CrossRef
- National Research Council. Toward a national health care survey. A data system for 21st century. Washington, DC: National Academy Press; 1992.
- Botman SL, Moore TF, Moriarity CL, Parsons VL. Design and estimation for the National Health Interview Survey, 1995–2004. Vital Health Statistics. 2000;2.
- Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10. CrossRef
- Phillips KA, Morrison KR, Andersen R, Aday LA. Understanding the context of healthcare utilization: assessing environmental and provider-related variables in the behavioral model of utilization. Health Serv Res. 1998;33:571–96.
- Coughlin SS, Breslau ES, Thompson T, Benard VB. Physician recommendation for papanicolaou testing among US women, 2000. Cancer Epidemiol Biomarkers Prev. 2005;14:1143–8. CrossRef
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83. CrossRef
- D’Hoore W, Sicotte C, Tilquin C. Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods of Information in Medicine. 1993;32:382–7.
- Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004;57:1288–94. CrossRef
- Birim O, Maat APWM, Kappetein AP, van Meerbeeck JP, Damhuis RAM, Bogers AJJC. Validation of the Charlson comorbidity index in patients with operated primary non-small cell lung cancer. Eur J Cardio-Thorac Surg. 2003;23:30–4. CrossRef
- Quan HM, Parsons GAR, Ghali WAM. Validity of information on comorbidity derived from ICD-9-CCM administrative data. Med Care. 2002;40:675–85. CrossRef
- Singh BM, Bhaya MM, Stern JM, et al. Validation of the Charlson comorbidity index in patients with head and neck cancer: a multi-institutional study. Laryngoscope. 1997;107:1469–75. CrossRef
- Chaudhry SM, Jin LM, Meltzer DM. Use of a self-report-generated Charlson comorbidity index for predicting mortality. Med Care. 2005;43:607–15. CrossRef
- Rakowski W, Meissner H, Vernon SW, Breen N, Rimer B, Clark MA. Correlates of repeat and recent mammography for women ages 45 to 75 in the 2002 to 2003 Health Information National Trends Survey (HINTS 2003). Cancer Epidemiol Biomark Prev. 2006;15:2093–101. CrossRef
- Clark MA, Rakowski W, Ehrich B. Breast and cervical cancer screening: associations with personal, spouse’s and combined smoking status. Cancer Epidemiol Biomark Prev. 2000;9:513–6.
- Rakowski W, Clark MA, Ehrich B. Smoking and cancer screening for women ages 42–75: associations in the 1900–1994 National Health Interview Surveys. Prev Med. 1999;29:487–95. CrossRef
- SUDAAN user’s manual, release 9.0.1. Research Triangle Park, NC: Research Triangle Institute, 2005.
- Korn EL, Graubard BI. Analysis of Health Surveys. New York: John Wiley and Sons; 1999.
- Vernon SW, Tiro JA, Meissner HI. Behavioral research in cancer screening. In: Miller S, Bowen DJ, Croyle RT, Rowland JH, eds. Handbook of Behavioral Science and Cancer. Washington, DC: American Psychological Association; 2008.
- Hiatt RA, Klabunde C, Breen N, Swan J, Ballard-Barbash R. Cancer screening practices from national health interview surveys: past, present, and future. J Natl Cancer Inst. 2002;94:1837–46.
- Mandelblatt J, Lawrence W, Yi B, King J. The balance of harms, benefits, and costs of screening for cervical cancer in older women: the case for continued screening. Arch Intern Med. 2004;164:245–7. CrossRef
- Lewis C, Kistler C, Amick H, et al. Older adults’ attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities. BMC Geriatrics. 2006;6:10. CrossRef
- Sirovich BE, Woloshin S, Schwartz LM. Screening for cervical cancer: will women accept less? Am J Med. 2005;118:151–8. CrossRef
- Heflin MT, Pollak KI, Kuchibhatla MN, Branch LG, Oddone EZ. The impact of health status on physicians’ intentions to offer cancer screening to older women. J Gerontol A Biol Sci Med Sci. 2006;61:844–50.
- Sirovich BE, Welch HG. Cervical cancer screening among women without a cervix. J Am Med Assoc. 2004;291:2990–3. CrossRef
- Iezzoni LI, McCarthy EP, Davis RB, Harris-David L, O’Day B. Use of screening and preventive services among women with disabilities. Am J Med Qual. 2001;16:135–44. CrossRef
- Lu-Yao G, Stukel TA, Yao SL. Prostate-specific antigen screening in elderly men. JNCI J Natl Cancer Inst. 2003;95:1792–7.
- Klabunde CN, Potosky AL, Legler JM, Warren JL. Development of a comorbidity index using physician claims data. J Clin Epidemiol. 2000;53:1258–67. CrossRef
- Vernon SW, Briss PA, Tiro JA, Warnecke RB. Some methodologic lessons learned from cancer screening research. Cancer. 2004;101:1131–45. CrossRef
- Zapka JG, Lemon SC. Interventions for patients, providers and health care organizations. Cancer. 2004;101:1165–87. CrossRef
- Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74:511–44. CrossRef
- Green LW, Kreuter MW. Health promotion planning. An educational and environmental approach. Mountain View, CA: Mayfield Publishing Company; 1991.
- Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138:273–87.
- Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder Et. The implications of regional variations in medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138:288–98.
- Avorn, JL, Barrett, JF., Davey, PG, McEwen, SA, O’Brien, TF, Levy, SB. Antibiotic resistance: synthesis of recommendations by expert policy groups. World Health Organization; 2001.
- Melanson S, Szymanski T, Rogers S, et al. Utilization of arterial blood gas measurements in a large tertiary care hospital. Am J Clin Pathol. 2007;127:604–9. CrossRef
- Solomon DH, Hashimoto H, Daltroy L, Liang MH. Techniques to improve physicians’ use of diagnostic tests: a new conceptual framework. JAMA J Am Med Assoc. 1998;280:2020–7. CrossRef
- Volk RJ, Hawley ST, Kneuper S, et al. Trials of decision aids for prostate cancer screening: a systematic review. Am J Prev Med. 2007;33:428–34. CrossRef
- Does Patient Health and Hysterectomy Status Influence Cervical Cancer Screening in Older Women?
Journal of General Internal Medicine
Volume 23, Issue 11 , pp 1822-1828
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- cervical screening
- older age
- health status
- Industry Sectors
- Author Affiliations
- 1. Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA
- 2. Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
- 3. VA Health Services Research & Development Center of Excellence on Implementing Evidence-Based Practice, Roudenbush Veterans Affairs Medical Center, Indiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
- 4. Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- 5. Department of Medicine, Robert Wood Johnson Medical School, Cancer Institute of New Jersey, New Brunswick, NJ, USA
- 6. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA