Trends in uptake of Pap test in Estonia: results from cross-sectional studies in 2004–2020

Abstract

Abstract Background In 2006, Estonia started organized nationwide cervical cancer (CC) screening program, but in 2020 incidence of CC in was still second highest in Europe. An estimated 80% of women have done Pap tests outside the organized screening program. The aim of this study was (1) to describe the trend in lifetime uptake of Pap test and (2) to explore trends in lifetime uptake of Pap test by age group, nationality and education among 25-64-years-old women in Estonia based on data from 2004 to 2020. Methods Data of 6685 women aged 25-64 years who participated in population-based cross-sectional surveys of Health Behavior among Estonian Adult Population in 2004-2020 was analyzed. Uptake of Pap test was determined by asking women whether they have ever had a Pap test. The proportion of women who reported taking a Pap test was calculated for each study year. Chi-square test for trend was used to evaluate statistically significant changes (p < 0.05) in the uptake of Pap test over the study period. Join point regression analysis was used to estimate annual percentage changes for the Pap test uptake trends. Results Proportion of women who reported ever having a Pap test increased from 51.1% in 2004 to 86.8% in 2020 (p < 0.001). Annual percentage change was 2.8% per year (95% CI 0.5 to 5.1%). Uptake of Pap test increased significantly in all age groups, among Estonians as well non-Estonians and across all education levels (p < 0.001). Conclusions Although self-reported uptake of Pap test has increased significantly during 2004-2020, particular attention should be paid to determinants of Pap test uptake to better target CC prevention activities and improve effectiveness of interventions with the further aim to reduce prevalence and mortality of CC in Estonia. Key messages Uptake of Pap test has increased significantly in Estonia according to data from 2004–2020. More research is needed to explore why prevalence of CC is increasing despite of high uptake of Pap test.