Top

Published in:

01-07-2010 | Original paper

Meeting the cervical cancer screening needs of underserved women: The National Breast and Cervical Cancer Early Detection Program, 2004–2006

Authors: Florence K. L. Tangka, Brett O’Hara, James G. Gardner, Joanna Turner, Janet Royalty, Kate Shaw, Susan Sabatino, Ingrid J. Hall, Ralph J. Coates

Published in: Cancer Causes & Control | Issue 7/2010

Abstract

Objective

To examine the extent to which the only national organized screening program in the US, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), has helped to meet the cervical cancer screening needs of underserved women.

Methods

Low-income, uninsured women 18–64 years of age are eligible for free cervical cancer screening services through NBCCEDP. We used data from the US Census Bureau to estimate the number of eligible women, based on insurance status and income. The estimates were adjusted for hysterectomy status using the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. We used administrative data from NBCCEDP to obtain the number of women receiving NBCCEDP-funded Papanicolaou (Pap) tests. We then calculated the percentage of NBCCEDP-eligible women who received free cervical cancer screening through NBCCEDP. We also used the NHIS to calculate the percentage of NBCCEDP-eligible women screened nationally and the percentage unscreened.

Results

In 2004–2006, nearly 9% (775,312 of 8.9 million) of NBCCEDP-eligible women, received NBCCEDP-funded Pap test. Rates varied substantially by age groups, race, and ethnicity. NBCCEDP-eligible women 40–64 years of age had a higher screening rate (22.6%) than eligible women 18–39 years of age (2.3%). Non-Hispanic women had a higher screening rate (9.3%) than Hispanic women (7.3%). Among non-Hispanics, the screening rate was highest among American Indian and Alaska Native (AIAN) women (36.1%) and lowest among women of different race combinations (4.6%), The percentage of eligible women screened in each state ranged from 2.0 to 38.4%.

Conclusions

Although NBCCEDP provided cervical cancer screening services to 775,312 low-income, uninsured women, this number represented a small percentage of those eligible. In 2005, more than 34% of NBCCEDP-eligible women (3.1 million women) did not receive recommended Pap tests from either NBCCEDP or other sources.

US Cancer Statistics Working Group (2009) United States cancer statistics: 1999–2005 incidence and mortality web-based report. US Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, Atlanta. Available at: http://www.cdc.gov/uscs

US Preventive Services Task Force (2003) Screening for cervical cancer. In: Guide to preventive clinical services. 3rd ed. Periodic updates. AHRQ Publications Clearinghouse, Rockville (MD) [cited 2008 Sep 29]. Publication No. APPIP02-0001. Available from: http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm

Benard VB, Eheman CR, Lawson HW, Blackman DK, Anderson C, Helsel W (2004) Cervical screening in the National Breast and Cervical Cancer Early Detection Program, 1995–2001. Obstet Gynecol 103(3):564–571PubMed

Swan J, Breen N, Graubard BI et al. (2010) Trends in cancer screening practices in the United States: 1992–2005 National Health Interview Surveys. Cancer (Forthcoming, Summer 2010)

US Department of Health and Human Services (2006) Healthy people 2010 progress review [cited 2008 Sep 29]. Available from: http://www.cdc.gov/nchs/about/otheract/hpdata2010/focusareas/fa03-cancer2.htm

Tsui J, Saraiya M, Thompson T, Dey A, Richardson L (2007) Cervical cancer among foreign-born women by birthplace and duration in the United States. J Womens Health 16(10):1447–1457CrossRef

Tangka FK, Dalaker J, Chattopadhyay SK et al (2006) Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002–2003 (United States). Cancer Causes Control 17(9):1145–1154CrossRefPubMed

Ryerson AB, Benard VB, Major AC (2005) National Breast and Cervical Cancer Early Detection Program: 1991–2002 national report. US Department of Health and Human Services, Atlanta [cited 2008 Sep 29]. Available from: http://www.cdc.gov/cancer/nbccedp/bccpdfs/national_report.pdf

Chattopadhyay SK, Hall HI, Wolf RB, Custer WS (1999) Sources of health insurance in the US: analysis of state-level data and implications for public health programs. J Public Health Manag Pract 5:35–46PubMed

10.

US Department of Health and Human Services (2003) Healthy people 2010, 2nd edn. US Government Printing Office, Washington, DC

11.

Swan J, Breen N, Coates RJ, Rimer BK, Lee NC (2003) Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer 97(6):1528–1540CrossRefPubMed

12.

Blackman DK, Bennett EM, Miller DS (1999) Trends in self-reported use of mammograms (1989–1997) and Papanicolaou tests (1991–1997)—Behavioral Risk Factor Surveillance System. MMWR CDC Surveill Summ 48(6):1–22

13.

DeNavas-Walt C, Proctor BD, Smith J (2007) Income, poverty, and health insurance coverage in the United States: 2006. US Census Bureau current population reports, P60-231. US Government Printing Office, Washington, DC

14.

National Center for Health Statistics (2006) Data file documentation, National Health Interview Survey, 2005 (Machine-readable data file and documentation). US Department of Health and Human Services, Hyattsville, MD. Located at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2005/srvydesc.pdf. Accessed: December 30, 2009

15.

Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion (2008) Behavioral risk factor surveillance system. [cited 2008 Sep 29]. Available from: http://www.cdc.gov/brfss/index.htm

16.

US Census Bureau (2006) Source and accuracy of estimates for income, poverty, and health insurance coverage in the United States. [cited 2008 Sep 29]. Available from: http://www.census.gov/hhes/www/p60_233sa.pdf

17.

Merrill RM (2008) Hysterectomy Surveillance in the United States, 1997 through 2005. Med Sci Monit 14(1):CR24–CR31PubMed

18.

NBCCEDP Program Guidance Manual, Policies and Procedures, August 2007

19.

United States Government Accountability Office (2009) Report to Congressional Requesters. MEDICAID. Source of Screening Affect Women’s Eligibility for Coverage of Breast and Cervical Cancer Treatment in Some States. GAO-09-384

20.

Song L, Fletcher R (1998) Breast cancer rescreening in low-income women. Am J Prev Med 15(2):128–133CrossRefPubMed

21.

Coughlin SS, Breslau ES, Thompson T, Benard VB (2005) Physician recommendation for papanicolaou testing among U.S. women, 2000. Cancer Epidemiol Biomarkers Prev 14(5):1143–1148CrossRefPubMed

22.

Ingrid J, Hall1 C, Ashani T, Danielle B, Ngozi NK (2010) Developing a community-based intervention to increase breast cancer screening and early detection among low-income, African-American women. [cited 2010 Jan 13]. Available from: http://intl-preventionportal.aacrjournals.org/misc/07Disparities_Poster_Session_B.pdf

23.

Centers for Disease Control and Prevention (2010) National Breast and Cervical Cancer Early Detection Program. Screening Program Data. [cited 2010 Jan 4]. Available from: http://www.cdc.gov/cancer/nbccedp/data/

24.

Centers for Disease Control and Prevention (2010) National Breast and Cervical Cancer Early Detection Program. [cited 2010 Jan 13]. Available from: http://www.cdc.gov/cancer/nbccedp/about.htm

25.

Ringel J, Klerman J (2005) Today or last year? How do interviewees answer the CPS health insurance questions? RAND Corporation Working Paper No 288. RAND Corporation Publications Department, Santa Monica, California

26.

Ochner MH, Salvail FR, Ford ES, Ajani U (2008) Obesity and self-reported general health, Hawaii BRFSS: are polynesians at higher risk? Obesity 16(4):923–926CrossRefPubMed

27.

Centers for Disease Control and Prevention (2010) Publications and information products. [cited 2010 Jan 27]. Available from: http://www.cdc.gov/nchs/nhis/releases.htm

28.

Cohen RA, Makuc DM (2008) State, regional, and national estimates of health insurance coverage for people under 65 years of age: National Health Interview Survey, 2004–2006. National health statistics reports; no1. National Center for Health Statistics, Hyattsville, MD. [cited 2010 Jan 27]. Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr001.pdf

29.

Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG (2007) Hysterectomy rates in the United States, 2003. Obstet Gynecol 110(5):1091–1095PubMed

Title: Meeting the cervical cancer screening needs of underserved women: The National Breast and Cervical Cancer Early Detection Program, 2004–2006
Authors: Florence K. L. Tangka
Brett O’Hara
James G. Gardner
Joanna Turner
Janet Royalty
Kate Shaw
Susan Sabatino
Ingrid J. Hall
Ralph J. Coates
Publication date: 01-07-2010
Publisher: Springer Netherlands
Published in: Cancer Causes & Control / Issue 7/2010
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI: https://doi.org/10.1007/s10552-010-9536-3

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2010

Family history and lung cancer risk: international multicentre case–control study in Eastern and Central Europe and meta-analyses

Case–control study of lifetime total physical activity and endometrial cancer risk

Racial differences in PSA screening interval and stage at diagnosis

Head injury, diagnostic X-rays, and risk of medulloblastoma and primitive neuroectodermal tumor: a Children’s Oncology Group study

Intake of fiber and nuts during adolescence and incidence of proliferative benign breast disease

Cancer risk in DES daughters

Keynote webinar | Spotlight on antibody–drug conjugates in cancer