Does patient health and hysterectomy status influence cervical cancer screening in older women?

BACKGROUND: Decisions to screen older patients for cancer are complicated by the fact that aging populations are heterogeneous with respect to life expectancy. OBJECTIVE: 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. MEASUREMENTS: 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. CONCLUSIONS: 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.