Cervical Cancer Screening in the US–Mexico Border Region: A Binational Analysis

Abstract

Cervical cancer mortality is high along the US-Mexico border. We describe the prevalence of a recent Papanicolaou screening test (Pap) among US and Mexican border women. We analyzed 2006 cross-sectional data from Mexico's National Survey of Health and Nutrition and the US Behavioral Risk Factor Surveillance System. Women aged 20-77years in 44 US border counties (n=1,724) and 80 Mexican border municipios (n=1,454) were studied. We computed weighted proportions for a Pap within the past year by age, education, employment, marital status, health insurance, health status, risk behaviors, and ethnicity and adjusted prevalence ratios (APR) for the US, Mexico, and the region overall. Sixty-five percent (95%CI 60.3-68.6) of US women and 32% (95%CI 28.7-35.2) of Mexican women had a recent Pap. US residence (APR=2.01, 95%CI 1.74-2.33), marriage (APR=1.31, 95%CI 1.17-1.47) and insurance (APR=1.38, 95%CI 1.22-1.56) were positively associated with a Pap test. Among US women, insurance and marriage were associated (APR=1.21, 95%CI 1.05-1.38 and 1.33, 95%CI 1.10-1.61, respectively), and women aged 20-34years were about 25% more likely to have received a test than older women. Insurance and marriage were also positively associated with Pap testing among Mexican women (APR=1.39, 95%CI 1.17-1.64 and 1.50; 95%CI 1.23-1.82, respectively), as were lower levels of education (≤8th grade or 9th-12th grade versus some college) (APR=1.74; 95%CI 1.21-2.52 and 1.60; 95%CI 1.03-2.49, respectively). Marriage and insurance were associated with a recent Pap test on both sides of the border. Binational insurance coverage increases and/or cost reductions might bolster testing among unmarried and uninsured women, leading to earlier cervical cancer diagnosis and potentially lower mortality.