Reasons for Screening Test Use Among Cervical Cancer Survivors
Screening tests can help prevent cervical cancer or find it early, when treatment works best. Many women don’t think they can get cervical cancer. But any woman who has a cervix can get cervical cancer.
Screening tests can help prevent cervical cancer, but many women haven’t been screened as recommended. CDC scientists wanted to find out why many women don’t get the cervical cancer screening tests they need. With this information, public health agencies can help more women get screened.
The study tried to answer these questions—
- Did women who were diagnosed with cervical cancer get screened during the 5 years before their diagnosis? (Screening tests are recommended at least every 5 years.) Why or why not?
- Did women with an abnormal screening test result go back to the doctor for follow-up care? Why or why not?
- Why did the women go to the doctor? Was it for a routine checkup or because they had symptoms?
Gathering Information in Three Ways
The registries faced a major challenge in gathering this information: many of the women contacted refused to participate in the study. Each registry found solutions to overcome the problems they faced.
CDC’s Case Investigation of Cervical Cancer (CICC) Study took a unique approach to looking at women’s cervical cancer screening history. The scientists gathered information in three ways—
- First, they asked the cancer registries in three states (Michigan, New Jersey, and Louisiana) for information about women who were 21 years old or older and diagnosed with cervical cancer from 2014 through 2016.
- Then they mailed a survey to these women. The survey asked when they were screened for cervical cancer (if ever), and why they did or didn’t get screened. The survey also asked what their household income was, whether they had health insurance, and what their race and ethnicity were.
- They asked the women for permission to see their medical records. If the women agreed, specialists at each cancer registry collected medical record data for five years before they were diagnosed with cervical cancer.
Later on (between September 2018 and January 2019), the same survey was offered to women in Cervivor,external icon a social network of cervical cancer survivors. Only women who were 21 years old or older and had been diagnosed with cervical cancer were asked to complete the survey.
Characteristics of Women Who Were Not Screened Compared to Women Who Were Screened
Of the 376 cervical cancer survivors in the CICC Study, 60% (228) had not been screened.
- 51% of unscreened women and 31% of screened women had household incomes of less than $30,000 per year.
- 39% of unscreened women and 26% of screened women were of races and ethnicities other than non-Hispanic White.
- 34% of unscreened women and 15% of screened women didn’t have health insurance.
- 33% of unscreened women and 17% of screened women had a tubal ligation, a form of permanent birth control in which a woman’s fallopian tubes are cut or blocked to prevent pregnancy.
Women who had not been screened were more likely to be older when their cancer was found. Also, their cancer was more often found at a later stage, when it’s harder to treat.
- 21% of unscreened women and 45% of screened women were younger than 40 when their cancer was found.
- 35% of unscreened women and 18% of screened women were 55 or older when their cancer was found.
- The cervical cancer was found in the earliest stage (stage 1), before it had spread to other parts of the body, in 43% of unscreened women and 64% of screened women.
Reasons for Screening Test Use
A survey was sent to two groups of women—
- A survey was mailed to cervical cancer survivors found through cancer registries in Michigan, New Jersey, and Louisiana; 480 women completed the survey.
- An online survey was offered to women in Cervivor,external icon a social network of cervical cancer survivors; 148 women completed the survey.
Women found through the social network were younger, had higher household incomes, had better access to health care, and were more likely to be non-Hispanic White than women found through the cancer registries. In spite of these differences, women in both groups had the same reasons for getting—or not getting—screened for cervical cancer.
Why Women Didn’t Get Screened
The top reason for not being screened was the same for women in both groups: they didn’t think they would get cervical cancer.
Other common reasons included—
- They didn’t have a family history of cervical cancer.
- They didn’t have a regular health care provider.
- They didn’t have health insurance.
- They were busy and didn’t have time.
- They didn’t have a family history of cancer.
- The screening test cost too much.
- They thought screening tests were only for women who had symptoms.
- They didn’t know what a cervical cancer screening test was for.
- They forgot.
Why Women Did Get Screened
Women in both groups shared the same reasons for getting screened. The most common reasons included—
- They wanted to take care of their bodies.
- They understood the importance of screening tests.
- They got screening tests with their annual exams.
- Health insurance paid for all or part of the cost of their screening tests.
Why Women Didn’t Follow-Up on Abnormal Test Results as Recommended
The survey asked women if they had received an abnormal result on a cervical cancer screening test. If so, did they go back to the doctor for follow-up care? Why or why not?
Women in both groups who didn’t return for follow-up care had the same reasons—
- They didn’t know that an abnormal test could mean they had cervical cancer.
- They were scared to hear what an abnormal test result meant.
- They didn’t have health insurance, or their health insurance wouldn’t pay for follow-up care.
- They were busy and didn’t have time.
How to Help More Women Get Screened
The top reasons why women do or don’t get screened relate to what they know about cervical cancer risk and screening tests, and whether they have health insurance to pay for screening. This information can guide programs that try to increase cervical cancer screening.
Educate Women About Cervical Cancer and the Importance of Screening
The top reason why women don’t get screened is because they don’t think they will get cervical cancer, but all women who have a cervix are at risk. CDC’s Inside Knowledge About Gynecologic Cancer educational campaign raises awareness about cervical and other gynecologic cancers. One of the campaign’s key messages is, “Getting screened regularly can help prevent cervical cancer or help find it early, when it is easiest to treat.” Campaign materials are offered free of charge for wide distribution.
Also, doctors should take every opportunity to encourage women to get screened, especially those who have had a tubal ligation. This study found that women who had a tubal ligation were about half as likely to be screened as women who hadn’t. Women who don’t need to go to a doctor to get birth control may not talk to any doctor about cervical cancer screening.
Lower the Cost of Screening
Like similar studies, this study found that screened women had higher incomes and were more likely to have health insurance than unscreened women. CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) funds states, territories, and tribal organizations to help women who have low incomes and are uninsured get cervical cancer screening, diagnostic testing, and referral to treatment.
Also, state and local public health organizations can encourage women to get screened through state Medicaid programs, community health centers, and community-based groups.
Help Women with Abnormal Test Results Get the Care They Need
This study found that more than one-third of women with abnormal test results did not get the right follow-up care. Doctors can explain to their patients why prompt follow-up care is important. Helping to cover the costs may increase timely follow-up.
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Bernard VB, Jackson JE, Greek A, Senkomago V, Huh WK, Thomas CC, Richardson LR. A population study of screening history and diagnostic outcomes of women with invasive cervical cancer.external icon Cancer Medicine 2021;10:4127–4137.
Senkomago V, Greek A, Jackson JE, Thomas CC, Richardson LC, Benard V. Learning from cervical cancer survivors: an examination of barriers and facilitators to cervical cancer screening among women in the United States.external icon Journal of Primary Care & Community Health 2021;12: 1–10.