Overuse of Pap Testing Among Older Women and Women with a Hysterectomy

Abstract

Abstract Background: As of 2012, leading national organizations have agreed on evidence-based recommendations for Pap testing. They recommended against Pap testing for women over age 65 years who have had adequate prior screening and are not at high risk and for women without a cervix following a hysterectomy who do not have a history of high-grade precancerous lesion or cervical cancer. Few studies have investigated overuse of Pap testing among US women. Methods A cross-sectional study was conducted using data from the 2010 National Health Interview Survey (NHIS). NHIS is a nationally-representative survey of the civilian non-institutionalized population of the United States that employs a random, stratified, multi-stage cluster sampling design. The survey is conducted annually using computer-assisted in-person interviewing. It includes sections on self-reported participant demographic characteristics, health status, and use of healthcare services. In 2010, the NHIS administered a Cancer Control Supplement with questions on cervical cancer screening, hysterectomy status, and timing of hysterectomy (n = 12,320). All analyses account for the complex survey design of NHIS. Results Approximately 3/5 of women over age 65 years reported a Pap test in the past three years and nearly 2/3 of women reporting a hysterectomy also reported a recent Pap test since their hysterectomy. Adjusted proportions calculated using multivariate logistic regression models showed that among women over age 70 years, higher level of education (p < .05) and no hysterectomy (p < .001) were associated with receipt of a recent Pap test (received within past 3 years after age 65 years). Among women who have undergone a hysterectomy, younger age (p < .001), Hispanic and Black race/ethnicity (p < .001), higher income (p < .001), and private healthcare coverage (p < .01) were associated with receipt of a recent Pap test since hysterectomy. Conclusion: Pap testing in average-risk women over age 65 years and in women who have undergone a hysterectomy is high despite past recommendations. Now that all leading national organizations have released new guidelines in 2012, improved efforts are needed to significantly reduce overuse of Pap testing in the future.