Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #173 

June 2007 

Use of the Pap Test as a Cancer 

Screening Tool among Women Age 18–

64, U.S. Noninstitutionalized 

Population, 2005 

Anita Soni, PhD 

Introduction 

The main purpose of the Pap test (also called the Pap smear test) is 

to detect cancer or abnormal cells that may lead to cancer. It can 

also find non-cancerous conditions, such as infection and inflammation. Cervical cancer can usually be prevented if women are 

screened regularly with a Pap test. The U.S. Preventive Services

Task Force (USPSTF) found evidence that cervical cytology (Pap 

smear) screening reduces the incidence of and mortality from 

cervical cancer. The USPSTF suggests Pap smear screening at 

least every three years for women age 18–64. 

This Statistical Brief provides estimates of the extent to which 

women age 18–64 did not receive Pap smear screening for cervical

cancer detection in 2005. The estimates presented are derived from

data collected in the MEPS Household Component questionnaire. All 

differences discussed in the text are statistically significant at 0.05 or

better. 

Findings 

Evidence has been found that screening with cervical cytology (Pap

smear) reduces the incidence of and mortality from cervical cancer. 

The Pap test every three years has been recommended for all 

women age 18–64. In 2005, approximately 13 million women age 

18–64 reported not having received the Pap test within the last three years. 

Highlights 

 Almost 14 percent of 

women age 18–64 reported

not having received a Pap 

smear test within the last

three years. 

 Asian non-Hispanic women 

were least likely to have 

received the Pap test within

the last three years as

compared with Hispanic, 

white non-Hispanic, or 

black non-Hispanic women.

 One-fourth of women who 

were uninsured failed to 

receive the Pap test within 

the last three years. 

 Women who were less 

educated were more likely 

not to have received the 

Pap test within the last

three years. 

 Single (never married) 

women were nearly twice 

as likely not to have 

received the Pap test within

the last three years as

compared with those who 

were married. 

Age 

Women age 30–39 were the least likely not to have received a Pap test in the last three years as 

compared with women age 40–49 or 50–64 (9.3 percent versus 12.1 percent and 17.2 percent, 

respectively) (figure 1). 

Race/ethnicity

Asian non-Hispanic women were more likely not to have received a Pap test within the last three years 

(21.5 percent) as compared with white non-Hispanic (13.5 percent), black non-Hispanic (9.9 percent), or

Hispanic (15.6 percent) women (figure 2).
Insurance status 

Women age 18–64 who were uninsured were more likely to not have received a Pap test within the last 

three years (25.4 percent) as compared with those who were covered by private insurance (11.4 percent) 

or public insurance (14.9 percent) (figure 3). 

Educational level 

Women age 18–64 who were less educated were more likely not to have received a Pap test within the 

last three years. A higher percentage of women with less than high school education reported not having 

received a Pap test within the last three years as compared with those who had completed high school or 

those who had some college education (23.1 percent versus 15.5 percent and 9.9 percent, respectively) 

(figure 4). 

 

Marital status 

Women age 18–64 who were single (never married) were nearly twice as likely not to have received a 

Pap test within the last three years as those who were married (19.0 percent versus 10.3 percent, 

respectively) (figure 5). 

Data Source 

The estimates in this Statistical Brief were derived from the MEPS 2005 full-year population 

characteristics data file (HC-090). 

Definitions 

The question related to receiving a Pap test was asked in the Preventive Care section of MEPS-HC. 

Pap test 

The Pap test (sometimes called a Pap smear) is a way to examine cells collected from the cervix. The 

main purpose of the Pap test is to detect cancer or abnormal cells that may lead to cancer. It can also find 

non-cancerous conditions, such as infection and inflammation. 

Racial and ethnic classifications 

Classification by race/ethnicity is based on information reported for each family member. Respondents 

were asked if each family member was Hispanic or Latino. Respondents were also asked which race or 

races best describes each family member. Race categories include white, black/African American, 

American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and other. Based on 

these questions, sample persons were classified into the following race/ethnicity categories: Hispanic, 

white non-Hispanic single race, black non-Hispanic single race, Asian non-Hispanic single race, and other 

(Hawaiian/pacific Islander non-Hispanic, American Indian/Alaska Native non-Hispanic, and multiple races 

non-Hispanic). 

Marital status 

The category “No Longer Married” includes the women who are widowed, divorced or separated. 

Educational level 

Educational level indicates a person’s number of years of education at the time of the first MEPS 

interview: 

- Less than high school = Less than 12 years of education 

- High school graduate = Completed 12 years of education 

- At least some college = More than 12 years of education 

Within the last three years 

This refers to the three years before the MEPS interview in which this question was asked. 

Health insurance status 

Individuals under age 65 were classified in the following three insurance categories based on household 

responses to health insurance status questions: 

- Any private health insurance: Individuals who, at any time during the year, had insurance that provides 

coverage for hospital and physician care (other than Medicare, Medicaid, or other public 
hospital/physician coverage) were classified as having private insurance. Coverage by TRICARE 

(Armed Forces–related coverage) was also included as private health insurance. Insurance that 

provides coverage for a single service only, such as dental or vision coverage, was not included. 

- Public coverage only: Individuals were considered to have public coverage only if they met both of the 

following criteria: 1) they were not covered by private insurance at any time during the year, and 2) they 

were covered by one of the following public programs at any point during the year: Medicare, Medicaid, 

or other public hospital/physician coverage. 

- Uninsured: The uninsured were defined as people not covered by private hospital/physician insurance, 

Medicare, TRICARE, Medicaid, or other public hospital/physician programs at any time during the entire 

year or period of eligibility for the survey. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

References 

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care,

July 2003: 41(7) Supplement: III-5–III-12. 

For information on the Pap test, see the following: 

Pap test facts: http://www.4woman.gov/faq/pap.htm#pap04 

Pap tests: What they are and what the results mean. 

http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/138.html 

Recommendations and Rationale: Screening for Cervical Cancer. U.S. Preventive Services Task Force 

(USPSTF). http://www.ahrq.gov/clinic/uspstf/uspscerv.htm 

The Pap test: Questions and Answers. http://www.cancer.gov/cancertopics/factsheet/Detection/Pap-test 

Suggested Citation 

Soni, A. Use of the Pap Test as a Cancer Screening Tool among Women Age 18–64, U.S. Noninstitutionalized Population, 2005. Statistical Brief #173. June 2007. Agency for Healthcare Research and Quality, 

Rockville, Md. http://www.meps.ahrq.gov/ mepsweb/data_files/publications/st173/ stat173.pdf 

∗ ∗ ∗

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 
tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2005

13.9

15.6

9.3

17.2

12.1

0

5

10

15

20

25

30

All women 18-64 18-29 30-39 40-49 50-64

Did not receive Pap test within last three years

Percent

Figure 1. Percentage of women age 18-64 without Pap test

screening in the past three years, by age, 2005

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2005

21.5

19.6

9.9

13.5

15.6

0

5

10

15

20

25

30

Hispanic White nonHispanicBlack nonHispanicAsian nonHispanicOther nonHispanic

Did not receive Pap test within last three years

Percent

Figure 2. Percentage of women age 18-64 without Pap test

screening in the past three years, by race/ethnicity, 2005

Statistical Brief #173: Use of the Pap Test as a Cancer Screening Tool among Women Age 18–64, U.S. 

Noninstitutionalized Population, 2005 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2005

11.4

14.9

25.4

0

5

10

15

20

25

30

Private Public Uninsured

Did not receive Pap test within last three years

Percent

Figure 3. Percentage of women age 18-64 without Pap test

screening in the past three years, by insurance status, 2005

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2005

23.1

15.5

9.9

0

5

10

15

20

25

30

Less than high school Completed high school At least some college

Did not receive Pap test within last three years

Percent

Figure 4. Percentage of women age 18-64 without Pap test

screening in the past three years, by education, 2005

Statistical Brief #173: Use of the Pap Test as a Cancer Screening Tool among Women Age 18–64, U.S. 

Noninstitutionalized Population, 2005 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2005

19.0

10.3

17.5

0

5

10

15

20

25

30

Single (never married) Married No longer married

Did not receive Pap test within last three years

Percent

Figure 5. Percentage of women age 18-64 without Pap test

screening in the past three years, by marital status, 2005

Statistical Brief #173: Use of the Pap Test as a Cancer Screening Tool among Women Age 18–64, U.S. 

Noninstitutionalized Population, 2005