National Trends and Disparities in Cervical Cancer Screening among Commercially Insured Women, 2001-2010

Background: Previous surveys reported declining cervical cancer screening rates from 2000 to 2010, but trends by key demographic and age groups are less clear. Methods: We examined 3-year Papanicolaou (Pap) test rates among 4.2 million women enrolled in a large national health plan during 2001 to 2010. We calculated and plotted adjusted 3-year rates stratified by age and key neighborhood-level socioeconomic characteristics including poverty level and race/ethnicity (white, black, Hispanic, and mixed ethnicity neighborhood). We fitted trends in 2001–2010 screening rates and socioeconomic disparities as annual percentage changes (APC) using joinpoint analysis. Results: Women ages 21 to 29 years had estimated 3-year Pap testing rates of 81.3% to 81.4% over the decade. Estimated disparities by low–high poverty level were 3.1% and 2.0% in 2001–2003 and 2008–2010, respectively, a nonsignificant decline. Initial white–black disparities were 4.0% and declined significantly from 2005–2007 to 2008–2010 to 2.8% at an APC of −0.65% ( P = 0.021). White–Hispanic disparities declined from 4.3% to 0.8% over the decade, a −0.50% APC ( P = 0.024). Among women ages 30 to 64 years, estimated 3-year Pap testing rates trended down from 76.1% to 71.8% over the decade [−0.94% APC ( P < 0.001) until 2005–2007]. This pattern was similar among women from most categories of poverty and race/ethnicity. Conclusions: Among commercially insured women ages 21 to 29 years, 3-year Pap testing rates remained stable at 81% over the decade; disparities were small and improved for Hispanic women to a greater degree than for black women. Among women ages 30 to 64 years, 3-year Pap testing rates declined from 2001 to 2010. Impact: Cervical cancer screening should be promoted to achieve Healthy People 2020 goals. Cancer Epidemiol Biomarkers Prev; 23(11); 2366–73. ©2014 AACR .