Abstract B83: Factors which affect cervical cancer screening in an underinsured safety net population
Authors: Komenaka Ian , Heberer Meredith , Nodora Jesse , Hsu Chiu-Hsieh , Bouton Marcia , Gandhi Sonal , Martinez Maria Elena 
Published: May 2015

Background: Cervical cancer is the considered one of the most preventable and treatable female cancers. Guidelines for cervical cancer screening have changed for young (less than 21 years) women in 2009 and for all women more recently in 2012. Compliance with cervical cancer screening varies significantly in published studies. Much less is known about racial/ethnic minority groups and patients from underinsured populations. Most studies show lower compliance with cervical cancer screening in these populations. In addition, cervical cancer incidence is higher in many of these populations compared to non-Hispanic White (NHW) or high SES populations. The current study was performed to determine factors which influence use of Papanicolaou cytology smears (Pap-smears) for cervical cancer screening in an underinsured, racial/ethnic minority patient population.

Methods: From January 2012 to May 2013, all patients seen at the Breast Clinic in a safety net hospital were evaluated to determine their use of Pap-smears. Sociodemographic variables were collected on all patients. Health literacy was assessed using the Newest Vital Sign (NVS) instrument.

Results: Over the time period studied, 1377 consecutive patients were seen. 59 patients were excluded because they were not yet sexually active or had hysterectomy for an indication other than cervical cancer. Of the remaining 1318 patients, the average age was 45 years. Only 17% were NHW while 10% were African American and 67% were Hispanic/Latina. Only 45% spoke English as their primary language. 92% were underinsured (24% Medicaid and 68% uninsured). The mean annual income was $13,188.

Overall 39% underwent a Pap-smear in past year. When evaluated by health literacy, significantly more patients with adequate health literacy underwent Pap-smears as compared to those with limited health literacy (59% vs 34%, p &lt; 0.0001). Patients with fewer liver births were also more likely to use Pap-smears (2 or less: 44% vs 3 or more: 34%, p = 0.0003). Patients without a PCP had Pap -smears at rate similar to those with a PCP (37% vs 41%, p = 0.10). The type of PCP, however, did appear to make a difference as those who had a GYN were significantly more likely to have Pap-smears as compared to those who had an internist or family practitioner (65% vs 23% and 42%, p &lt; 0.0001). Patients less than 21 years or older than 65 years underwent screening infrequently (11% and 11% vs. 41% (age 21-65 years), p &lt; 0.0001). Race, ethnicity, language, and insurance status did not affect use of Pap-smears.

Conclusions: Overall use of pap smears was suboptimal in this underinsured population. Patients with a Gynecologist as their PCP appeared more likely to have Pap-smears. Health literacy assessment can help identify patients at increased risk for underutilization of this important screening tool. Tailored interventions to target populations with limited health literacy should be considered to increase use of Pap-smears Providers do appear to be adjusting their practice in accordance with changes in national guidelines as few patients under age 21 and above age 65 underwent Pap-smears.

Citation Format: Ian Komenaka, Meredith Heberer, Jesse Nodora, Chiu-Hsieh Hsu, Marcia Bouton, Sonal Gandhi, Maria Elena Martinez. Factors which affect cervical cancer screening in an underinsured safety net population. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B83. doi:10.1158/1538-7755.DISP13-B83