Abstract 263: Gynecological Cancer Screening Among Women With Cardiovascular Disease: The Medical Expenditure Panel Survey
Authors: Okunrintemi Victor , Tibuakuu Martin , Shahu Andi , Mehta Puja K , Gulati Martha , Broni Eric , Mathews Lena , Blumenthal Roger S , Michos Erin D 
Published: May 2020

Background:
Cardiovascular disease (CVD) and cancer are the leading causes of mortality among adult women in the United States (US), contributing to over 40% of deaths annually. Although the US Preventive Services Task Force recommends routine age-appropriate breast and cervical cancer screening among adult women, it is unknown if its utilization is influenced by the presence of comorbid conditions like CVD. With recent research suggesting that mammography has the potential to alter the course of both breast cancer and heart disease among women, we investigate the routine use of some of these gynecological cancer screening tools among women with and without CVD.

Methods:
Using the 2006-2015 Medical Expenditure Panel Survey (MEPS), a nationally representative database, we included women ≥21 years with valid responses to the gynecological cancer screening questions. Diagnosis of CVD, was ascertained by ICD9 codes or by self-report, and included individuals with coronary artery disease, stroke, heart failure, cardiac dysrhythmias and/or peripheral arterial disease. We evaluated participant responses to self-administered questionnaires:
[How long since last pap smear test? (women 21-65 yrs)]
and
[How long since last mammogram? (women 50-75 yrs)].
Routine gynecological cancer screen was defined as pap smear test done within the last 3 years (women 21-29 yrs)/within the last 5 years (women 30-65 yrs) or mammogram done within the last 2 years (women 50-75 yrs). A χ2 test was used to assess the proportional differences in the use of these gynecological screening tools among women with and without CVD. Weighted multivariable logistic regression was used to determine the association between the presence of CVD and routine gynecological cancer screening.

Results:
The study sample included 104,053 MEPS participants, 14% with a diagnosis of CVD and 86% without a diagnosis of CVD, translating into 14.6 million and 89.9 million US adult women with and without CVD respectively. While
14%
of women without CVD did not have routine pap smear test, a higher proportion of women with CVD
(21%)
reported that they did not undergo routine pap smear screen (
p <0.001
). There was no difference in the proportion of women with or without CVD who reported routine mammogram screen (22% on each arm, p = 0.33). After adjustments for socio-demographic characteristics and comorbid conditions, US adult women with CVD, were less likely to have routine pap smear test
(OR 0.59 [95% CI 0.54-0.65])
and mammogram screen
(OR 0.90 [95% CI 0.82-0.99])
compared with those without CVD.

Conclusion:
Women with CVD were less likely to undergo routine gynecological cancer screening than their peers without CVD. Further studies are needed to understand the reasons for the reported association and devise ways to promote increased utilization of these gynecological cancer screening tools among this high risk, vulnerable population.