Trend of Population Coverage, Frequency and Volume of Pap Tests: An Attempt To Estimate the Extent of Unnecessary Pap Tests in the Era of HPV-Testing
Isam Eltoum, Janie Roberson. University of Alabama at Birmingham, Birmingham, AL; University of Alabama at Birmingham, Birmingham
Background: Screening for cervical cancer has changed remarkably. We and others have predicted a decrease in Pap test volume regardless of demographic change. In this report, we assessed those predictions by: 1) determining the changes in population coverage and trends in the frequency and volume of Pap tests 2) estimating volume of unnecessary Pap tests and 3) assessing the correlates associated with unnecessary Pap tests.
Design: This is a secondary data analysis of the NHIS for 2000, 2005, 2008 and 2010. It focused on questions related to ever having a Pap test, number of Pap tests in 6 years, having an abnormal Pap test, hysterectomy status, socio-demographic factors, health status and extent of access to health care. We used the Census Bureau to estimate the population of women eligible for screening. After multiple imputations, we used logistic regression SAS MI-analysis to determine the correlates associated with unnecessary Pap tests.
Results: Beween 2000 and 2010, the population of women eligible for screening increased by 12%, 108 to 121 million,while the national Pap test volume remained the same, 66 .4 million, 95% C.I. 64.7-67.9 million, vs. 66.0 million, 95% C.I. 63.9-66.2 million. Coverage with Pap test in the preceding year was significantly higher in 2000 at 66%, 95% C.I. 65.1-66.6%, compared to 2010, 55.5%, 95% C.I. 54.4-56.6%, while coverage in the preceding 3 years remained the same, 84% in 2000 compared to 79.4% in 2010. Within the group of women age >20 who had normal Pap tests, a significantly higher percent received an annual Pap test in 2000, 56.1%, C.I. 54.9-57.3%, compared to 2010, 52.8%, 95% C.I. 51.5-54.2%. The volume of unnecessary Pap tests was not different in 2000, 21.0 million, 95% C.I. 20.3-21.7 million, compared to 22.4 million, 95% C.I. 21.5-23.4 million, in 2010. A Factors that were significantly associated with having unnecessary Pap tests included having health insurance coverage, odd ratio (OR) 1.5, 95% C.I. 1.2-1.9, number of mammograms, OR 3.7,95% C.I. 3.1-4.3, having visited an ob/gyn clinic, OR 3.9, 95% C.I. 3.4-4.7, having a doctor recommending Pap test, OR 1.2,95%, C.I. 1.01-1.3 and being married, OR 1.36, 95% C.I. 1.1-1.7.
Conclusions: Although Pap test volume has decreased compared to demographic changes, still one third of this volume is performed unnecessarily, in women who have frequent and easy access to healthcare. Physician and patient education is needed to reduce unnecessary Pap tests.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 38, Tuesday Morning