Cancer Causes & Control

, Volume 21, Issue 7, pp 1081–1090 | Cite as

Meeting the cervical cancer screening needs of underserved women: The National Breast and Cervical Cancer Early Detection Program, 2004–2006

  • Florence K. L. Tangka
  • Brett O’Hara
  • James G. Gardner
  • Joanna Turner
  • Janet Royalty
  • Kate Shaw
  • Susan Sabatino
  • Ingrid J. Hall
  • Ralph J. Coates
Original paper

Abstract

Objective

To examine the extent to which the only national organized screening program in the US, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), has helped to meet the cervical cancer screening needs of underserved women.

Methods

Low-income, uninsured women 18–64 years of age are eligible for free cervical cancer screening services through NBCCEDP. We used data from the US Census Bureau to estimate the number of eligible women, based on insurance status and income. The estimates were adjusted for hysterectomy status using the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. We used administrative data from NBCCEDP to obtain the number of women receiving NBCCEDP-funded Papanicolaou (Pap) tests. We then calculated the percentage of NBCCEDP-eligible women who received free cervical cancer screening through NBCCEDP. We also used the NHIS to calculate the percentage of NBCCEDP-eligible women screened nationally and the percentage unscreened.

Results

In 2004–2006, nearly 9% (775,312 of 8.9 million) of NBCCEDP-eligible women, received NBCCEDP-funded Pap test. Rates varied substantially by age groups, race, and ethnicity. NBCCEDP-eligible women 40–64 years of age had a higher screening rate (22.6%) than eligible women 18–39 years of age (2.3%). Non-Hispanic women had a higher screening rate (9.3%) than Hispanic women (7.3%). Among non-Hispanics, the screening rate was highest among American Indian and Alaska Native (AIAN) women (36.1%) and lowest among women of different race combinations (4.6%), The percentage of eligible women screened in each state ranged from 2.0 to 38.4%.

Conclusions

Although NBCCEDP provided cervical cancer screening services to 775,312 low-income, uninsured women, this number represented a small percentage of those eligible. In 2005, more than 34% of NBCCEDP-eligible women (3.1 million women) did not receive recommended Pap tests from either NBCCEDP or other sources.

Keywords

Cervical cancer Pap tests utilization Screening rates Medically underserved 

References

  1. 1.
    US Cancer Statistics Working Group (2009) United States cancer statistics: 1999–2005 incidence and mortality web-based report. US Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, Atlanta. Available at: http://www.cdc.gov/uscs
  2. 2.
    US Preventive Services Task Force (2003) Screening for cervical cancer. In: Guide to preventive clinical services. 3rd ed. Periodic updates. AHRQ Publications Clearinghouse, Rockville (MD) [cited 2008 Sep 29]. Publication No. APPIP02-0001. Available from: http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm
  3. 3.
    Benard VB, Eheman CR, Lawson HW, Blackman DK, Anderson C, Helsel W (2004) Cervical screening in the National Breast and Cervical Cancer Early Detection Program, 1995–2001. Obstet Gynecol 103(3):564–571PubMedGoogle Scholar
  4. 4.
    Swan J, Breen N, Graubard BI et al. (2010) Trends in cancer screening practices in the United States: 1992–2005 National Health Interview Surveys. Cancer (Forthcoming, Summer 2010)Google Scholar
  5. 5.
    US Department of Health and Human Services (2006) Healthy people 2010 progress review [cited 2008 Sep 29]. Available from: http://www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa03-cancer2.htm
  6. 6.
    Tsui J, Saraiya M, Thompson T, Dey A, Richardson L (2007) Cervical cancer among foreign-born women by birthplace and duration in the United States. J Womens Health 16(10):1447–1457CrossRefGoogle Scholar
  7. 7.
    Tangka FK, Dalaker J, Chattopadhyay SK et al (2006) Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002–2003 (United States). Cancer Causes Control 17(9):1145–1154CrossRefPubMedGoogle Scholar
  8. 8.
    Ryerson AB, Benard VB, Major AC (2005) National Breast and Cervical Cancer Early Detection Program: 1991–2002 national report. US Department of Health and Human Services, Atlanta [cited 2008 Sep 29]. Available from: http://www.cdc.gov/cancer/nbccedp/bccpdfs/national_report.pdf
  9. 9.
    Chattopadhyay SK, Hall HI, Wolf RB, Custer WS (1999) Sources of health insurance in the US: analysis of state-level data and implications for public health programs. J Public Health Manag Pract 5:35–46PubMedGoogle Scholar
  10. 10.
    US Department of Health and Human Services (2003) Healthy people 2010, 2nd edn. US Government Printing Office, Washington, DCGoogle Scholar
  11. 11.
    Swan J, Breen N, Coates RJ, Rimer BK, Lee NC (2003) Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer 97(6):1528–1540CrossRefPubMedGoogle Scholar
  12. 12.
    Blackman DK, Bennett EM, Miller DS (1999) Trends in self-reported use of mammograms (1989–1997) and Papanicolaou tests (1991–1997)—Behavioral Risk Factor Surveillance System. MMWR CDC Surveill Summ 48(6):1–22Google Scholar
  13. 13.
    DeNavas-Walt C, Proctor BD, Smith J (2007) Income, poverty, and health insurance coverage in the United States: 2006. US Census Bureau current population reports, P60-231. US Government Printing Office, Washington, DCGoogle Scholar
  14. 14.
    National Center for Health Statistics (2006) Data file documentation, National Health Interview Survey, 2005 (Machine-readable data file and documentation). US Department of Health and Human Services, Hyattsville, MD. Located at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2005/srvydesc.pdf. Accessed: December 30, 2009
  15. 15.
    Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion (2008) Behavioral risk factor surveillance system. [cited 2008 Sep 29]. Available from: http://www.cdc.gov/brfss/index.htm
  16. 16.
    US Census Bureau (2006) Source and accuracy of estimates for income, poverty, and health insurance coverage in the United States. [cited 2008 Sep 29]. Available from: http://www.census.gov/hhes/www/p60_233sa.pdf
  17. 17.
    Merrill RM (2008) Hysterectomy Surveillance in the United States, 1997 through 2005. Med Sci Monit 14(1):CR24–CR31PubMedGoogle Scholar
  18. 18.
    NBCCEDP Program Guidance Manual, Policies and Procedures, August 2007Google Scholar
  19. 19.
    United States Government Accountability Office (2009) Report to Congressional Requesters. MEDICAID. Source of Screening Affect Women’s Eligibility for Coverage of Breast and Cervical Cancer Treatment in Some States. GAO-09-384Google Scholar
  20. 20.
    Song L, Fletcher R (1998) Breast cancer rescreening in low-income women. Am J Prev Med 15(2):128–133CrossRefPubMedGoogle Scholar
  21. 21.
    Coughlin SS, Breslau ES, Thompson T, Benard VB (2005) Physician recommendation for papanicolaou testing among U.S. women, 2000. Cancer Epidemiol Biomarkers Prev 14(5):1143–1148CrossRefPubMedGoogle Scholar
  22. 22.
    Ingrid J, Hall1 C, Ashani T, Danielle B, Ngozi NK (2010) Developing a community-based intervention to increase breast cancer screening and early detection among low-income, African-American women. [cited 2010 Jan 13]. Available from: http://intl-preventionportal.aacrjournals.org/misc/07Disparities_Poster_Session_B.pdf
  23. 23.
    Centers for Disease Control and Prevention (2010) National Breast and Cervical Cancer Early Detection Program. Screening Program Data. [cited 2010 Jan 4]. Available from: http://www.cdc.gov/cancer/nbccedp/data/
  24. 24.
    Centers for Disease Control and Prevention (2010) National Breast and Cervical Cancer Early Detection Program. [cited 2010 Jan 13]. Available from: http://www.cdc.gov/cancer/nbccedp/about.htm
  25. 25.
    Ringel J, Klerman J (2005) Today or last year? How do interviewees answer the CPS health insurance questions? RAND Corporation Working Paper No 288. RAND Corporation Publications Department, Santa Monica, CaliforniaGoogle Scholar
  26. 26.
    Ochner MH, Salvail FR, Ford ES, Ajani U (2008) Obesity and self-reported general health, Hawaii BRFSS: are polynesians at higher risk? Obesity 16(4):923–926CrossRefPubMedGoogle Scholar
  27. 27.
    Centers for Disease Control and Prevention (2010) Publications and information products. [cited 2010 Jan 27]. Available from: http://www.cdc.gov/nchs/nhis/releases.htm
  28. 28.
    Cohen RA, Makuc DM (2008) State, regional, and national estimates of health insurance coverage for people under 65 years of age: National Health Interview Survey, 2004–2006. National health statistics reports; no1. National Center for Health Statistics, Hyattsville, MD. [cited 2010 Jan 27]. Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr001.pdf
  29. 29.
    Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG (2007) Hysterectomy rates in the United States, 2003. Obstet Gynecol 110(5):1091–1095PubMedGoogle Scholar

Copyright information

© US Government 2010

Authors and Affiliations

  • Florence K. L. Tangka
    • 1
  • Brett O’Hara
    • 4
  • James G. Gardner
    • 1
  • Joanna Turner
    • 5
  • Janet Royalty
    • 1
  • Kate Shaw
    • 2
  • Susan Sabatino
    • 1
  • Ingrid J. Hall
    • 1
  • Ralph J. Coates
    • 3
  1. 1.Division of Cancer Prevention and ControlCenters for Disease Control and Prevention, DCPCAtlantaUSA
  2. 2.Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaUSA
  3. 3.Office of Public Health GenomicsCenters for Disease Control and PreventionAtlantaUSA
  4. 4.Data Integration DivisionUS Census BureauWashingtonUSA
  5. 5.Housing and Household Economic Statistics DivisionUS Census BureauWashingtonUSA

Personalised recommendations