Cervical cancer screening for survivors diagnosed with cancer before age 25
The study aims to better understand Pap test utilization for cancer survivors diagnosed before age 25 in British Columbia (BC), Canada.
A population-based cross-sectional data linkage study that included 1285 5-year female cancer survivors diagnosed with cancer before age 25 and 12,185 randomly selected and birth-year-matched BC female residents. Pap participation rates in 2008–2010, both uncorrected and corrected for hysterectomy status, were compared between two groups. Adjusted prevalence ratios (PRadj) were calculated to examine (1) associations between factors and Pap rates in each group and (2) interactions between factors and groups, using log-binomial regression models.
Overall Pap rates, both uncorrected and corrected, were higher for survivors (71.8%; 72.9%) than population (69%; 69.7%). Pap rates were 4.8–5.1 and 17.8–22.4% higher for survivors aged 30–39 and 50–59 respectively. Significantly higher Pap test utilization was associated with previous Pap tests (PRadj = 1.83, 95%CI = 1.76–1.89) and previous cervical procedures (1.20, 95%CI = 1.15–1.25). Hysterectomy rates were doubled for survivors (7.4%) than population (3.7%). This did not affect Pap participation rate comparisons between two groups. In both groups, 51.6–70% of females with hysterectomies still received Pap tests.
Survivors’ Pap test utilization was significantly higher than population, but lower than the Canadian benchmark of 90%. Hysterectomy correction does not affect this observation. Cervical cancer screening is suboptimal for survivors. Females with prior hysterectomies might have received unnecessary Pap tests.
Implications for Cancer Survivors
Survivors without prior hysterectomies should continue to undergo Pap tests recommended by provincial guidelines, to optimize their health.
KeywordsChildhood cancers Survivorship research Pap test Cervical cancer screening Cancer follow-up care
Acute lymphocytic leukemia
Adolescent and Young Adult
British Columbia Cancer Agency
British Columbia Children’s Hospital
Childhood, adolescent and young adult cancer survivor
Cervical Cancer Screening Program
Childhood Cancer Survivor Study
Central nervous system
International Classification of Childhood Cancer
Medical Service Plan
Personal Health Numbers
Prevalence odds ratios
Statistical analysis system
Strengthening the Reporting of Observational Studies in Epidemiology
University of British Columbia
The authors gratefully acknowledge the BC Cancer Registry, BC Cancer Agency, Cervical Cancer Screening Program of BC Cancer Agency, BC Ministry of Health Services, and the BC Children’s Hospital, who approved access and use of the data, facilitated by Population Data BC. All inferences, opinions, and conclusions drawn in this publication are those of the authors and do not reflect the opinions or policies of the Data Steward(s). The first author, Dr. Olivia L. Tseng, was financially supported by the Clinician Scholarship through the Department of Family Practice of University of British Columbia.
Compliance with Ethical Standards
This study was funded by the Canadian Cancer Society (CCS) Research Institute and CCS BC and Yukon Division, Program Project Grant (PPG #19000, 19804).
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
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