Does Patient Health and Hysterectomy Status Influence Cervical Cancer Screening in Older Women?

  • Helen I. Meissner
  • Jasmin A. Tiro
  • David Haggstrom
  • Grace Lu-Yao
  • Nancy Breen
Original Article

DOI: 10.1007/s11606-008-0775-x

Cite this article as:
Meissner, H.I., Tiro, J.A., Haggstrom, D. et al. J GEN INTERN MED (2008) 23: 1822. doi:10.1007/s11606-008-0775-x



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.

Main results

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.


cervical screening hysterectomy older age health status comorbidity 

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Helen I. Meissner
    • 1
  • Jasmin A. Tiro
    • 2
  • David Haggstrom
    • 3
    • 4
  • Grace Lu-Yao
    • 5
  • Nancy Breen
    • 6
  1. 1.Office of Behavioral and Social Sciences ResearchNational Institutes of HealthBethesdaUSA
  2. 2.Department of Clinical SciencesUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.VA Health Services Research & Development Center of Excellence on Implementing Evidence-Based Practice, Roudenbush Veterans Affairs Medical CenterIndiana University Center for Health Services and Outcomes Research, Regenstrief Institute, Inc.IndianapolisUSA
  4. 4.Division of General Internal Medicine and Geriatrics, Department of MedicineIndiana University School of MedicineIndianapolisUSA
  5. 5.Department of Medicine, Robert Wood Johnson Medical SchoolCancer Institute of New JerseyNew BrunswickUSA
  6. 6.Division of Cancer Control and Population SciencesNational Cancer InstituteBethesdaUSA

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