Abstract B106: Cervical cancer screening modalities by state, 2016
Authors: Sauer Ann Goding , Jemal Ahmedin , Fedewa Stacey A. 
Published: August 2020

Abstract
Introduction: The Papanicolaou (Pap) test has long been a recommended cervical cancer screening modality. However, for women age 30-65 years, recommendations of the American Cancer Society and the US Preventive Services Task Force (USPSTF) now include testing for human papillomavirus (HPV) in conjunction with Pap test every five years (co-testing) or Pap testing alone. Additionally, draft USPSTF recommendations issued in 2017 include primary HPV testing for women 30-65 years. HPV co-testing is the preferred cervical cancer screening method in this age group because abnormalities are less likely to be missed. It is unknown how test modality varies by geography and insurance status, but such information could be useful for cancer control efforts. We examined prevalence estimates of cervical cancer screening modality among women age 30-65 years by state and insurance status.
Methods: Nonpregnant female respondents age 30-65 years with intact uteri and complete information on HPV and Pap testing (n=83,715) were selected from 2016 Behavioral Risk Factor Surveillance System data. Cervical cancer screening modality was categorized as co-testing (HPV and Pap testing in the past five years), HPV testing alone (in the past 5 years), and Pap testing alone (in the past 3 years), among those recently screened. SAS-callable SUDAAN was used to generate weighted, age-adjusted prevalence estimates.
Results: The prevalence of recent cervical cancer screening ranged from 79.9% in Idaho to 92.4% in Massachusetts (median=87.4%). Among those who were recently screened, Pap testing (range: 49.7%-73.3%; median=62.0%) was more common than co-testing (range: 26.1%-48.9%; median=37.4%) or HPV testing alone (&lt;2%). Although modality varied widely by state, in the District of Columbia (DC), Maine, and New York the prevalence of co-testing approached that of Pap testing where 48.9%, 45.9%, 44.2% were co-tested and 49.7%, 53.8%, and 54.6% had Pap testing alone, respectively. Generally, the prevalence of co-testing was lower in Southern and Midwestern states compared to states in other regions. The prevalence of recent screening was about 18% higher among the insured (median=89.1%) compared to the uninsured (median=71.2%). Among both the insured (median=61.5%) and uninsured (median=65.1%) Pap testing was the most common modality, but co-testing was more common in the insured (median=38.1%) than uninsured (median=34.9%).
Discussion: In 2016, most women had recently been screened for cervical cancer; however, utilization was notably lower among the uninsured than the insured. Among those who had been recently screened, the prevalence of Pap testing was higher than co-testing in all states, but was most similar in DC, Maine, and New York. Pap testing was even more common than co-testing among the uninsured compared to the insured. Efforts to educate women and their providers on the benefits of HPV co-testing may be needed.
Citation Format: Ann Goding Sauer, Ahmedin Jemal, Stacey A. Fedewa. Cervical cancer screening modalities by state, 2016 [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B106.