Cervical cancer screening for survivors diagnosed with cancer before age 25
- First Online:
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
- 7.Zhang Y, Goddard K, Spinelli JJ, Gotay C, McBride ML. Risk of late mortality and second malignant neoplasms among 5-year survivors of young adult cancer: a report of the Childhood, Adolescent, and Young Adult Cancer Survivors Research Program. Journal of cancer epidemiology. 2012;2012:103032. doi:10.1155/2012/103032.PubMedPubMedCentralGoogle Scholar
- 8.Institute of Medicine and National Research Council. Delivering survivorship care. In: Hewitt M, Weiner SL, Simone JV, editors. Childhood cancer survivorship: improving care and quality of life. Washington (DC): The National Academies Press; 2003.Google Scholar
- 10.Children's Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers, Version 3.0. Children’s Oncology Group, Arcadia, CA. 2008. http://www.survivorshipguidelines.org/.
- 11.McBride ML, Rogers PC, Sheps SB, Glickman V, Broemeling AM, Goddard K, et al. Childhood, adolescent, and young adult cancer survivors research program of British Columbia: objectives, study design, and cohort characteristics. Pediatr Blood Cancer. 2010;55(2):324–30. doi:10.1002/pbc.22476.CrossRefPubMedGoogle Scholar
- 13.Brisith Columbia Caner Agency [Creator] (2010): BC Cancer Agency Registry Data Data Extract. Population Data BC [Publisher]. 2012. https://www.popdata.bc.ca/data.
- 16.British Columbia Ministry of Health [Creator] (2013): Consolidation File (MSP Registration & Premium Billing). Data Extract. MOH. Population Data BC [Publisher]. 2012. https://www.popdata.bc.ca/data.
- 17.British Columbia Ministry of Health [Creator] (2013): Medical Service Plan (MSP) Payment Information File. Data Extract. MOH. Population Data BC [Publisher]. 2012. https://www.popdata.bc.ca/data.
- 18.British Columbia Ministry of Health [Creator] (2013): Discharge Abstracts Database (Hospital Separations). Data Extract. MOH. Population Data BC [Publisher]. 2012. https://www.popdata.bc.ca/data.
- 19.Bilkins R, Khan S. PCCF + Version 5 J* User’s Guide Ottawa, ON: Statistics Canada. 2011.Google Scholar
- 20.Rambeau S. Statistics Canada. Geography Division. Census Metropolitan Area and Census Agglomeration Influenced Zones (MIZ) with Census Data. Geography Working Paper Series. Ottawa, Ontario: Statistics Canada, Geography Division; 2000.Google Scholar
- 25.Cancer CPA. Cervical Cancer Screening in Canada: Setting Targets for Program Performance. 2013.Google Scholar
- 27.Castellino SM, Casillas J, Hudson MM, Mertens AC, Whitton J, Brooks SL, et al. Minority adult survivors of childhood cancer: a comparison of long-term outcomes, health care utilization, and health-related behaviors from the childhood cancer survivor study. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(27):6499–507. doi:10.1200/JCO.2005.11.098.CrossRefGoogle Scholar
- 28.Nathan PC, Ness KK, Mahoney MC, Li Z, Hudson MM, Ford JS, et al. Screening and surveillance for second malignant neoplasms in adult survivors of childhood cancer: a report from the childhood cancer survivor study. Ann Intern Med. 2010;153(7):442–51. doi:10.7326/0003-4819-153-7-201010050-00007.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Bellizzi KM, Rowland JH, Jeffery DD, McNeel T. Health behaviors of cancer survivors: examining opportunities for cancer control intervention. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2005;23(34):8884–93. doi:10.1200/JCO.2005.02.2343.CrossRefGoogle Scholar
- 31.Bishop MM, Lee SJ, Beaumont JL, Andrykowski MA, Rizzo JD, Sobocinski KA, et al. The preventive health behaviors of long-term survivors of cancer and hematopoietic stem cell transplantation compared with matched controls. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2010;16(2):207–14. doi:10.1016/j.bbmt.2009.09.015.CrossRefGoogle Scholar
- 33.Kunitake H, Zheng P, Yothers G, Land SR, Fehrenbacher L, Giguere JK, et al. Routine preventive care and cancer surveillance in long-term survivors of colorectal cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol LTS-01. J Clin Oncol. 2010;28(36):5274–9. doi:10.1200/Jco.2010.30.1903.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Khan NF, Carpenter L, Watson E, Rose PW. Cancer screening and preventative care among long-term cancer survivors in the United Kingdom. Br J Cancer. 102(7):1085–90. doi:10.1038/sj.bjc.6605609.
- 40.Watson M, King J, Ajani U, Houston KA, Saraiya M. Cervical cancer screening among women by hysterectomy status and among women aged > = 65 Years-United States, 2000-2010. Mmwr-Morbid Mortal W. 2013;61(51–52):1043–7.Google Scholar
- 43.The Cervical Cancer Screening Program. 2009 Annual Report. The Cervical Cancer Screening Program, Vancouver, BC. 2009. http://www.bccancer.bc.ca/screening/Documents/CCSP_Report-AnnualReport2011.pdf.