Cervical cancer screening among women with comorbidities: A cross-sectional examination of disparities from the Behavioral Risk Factor Surveillance System.

Background. In 2020, the American Cancer Society projected that 13,800 women would be diagnosed and nearly 4,300 would die from cervical cancer (CC). Human papillomavirus (HPV) infection is the leading cause of CC development. Implementation of prophylactic HPV vaccination and screening via Papanicolaou smear has reduced CC rates up to 80% over the last five decades, yet, disparities in screening usage continue to exist. Current research suggests adherence to CC screening is inversely related to patient body mass index, however, no study has assessed the impact of other comorbidities on screening use. Thus, our objective was to analyze screening rates among women with diabetes mellitus, hypertension, cardiovascular disease, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, depression, or skin cancer compared to healthy women.

Methods. We combined the 2018 and 2019 Behavioral Risk Factor Surveillance System datasets and then constructed multivariate logistic regression models to determine the adjusted risk ratios (ARR) of persons receiving CC with and without comorbidities as well as in those with multiple comorbidities (1, 2-4, 5+) compared to zero. Confidence intervals were reported at 95%.

Results. Our study found that individuals who were obese (ARR: 0.96; CI: 0.95-0.98), had diabetes (ARR: 0.98; CI: 0.96-0.99), COPD (ARR: 0.92; CI: 0.90-0.94), arthritis (ARR: 0.96; CI: 0.95-0.97), depression (ARR: 0.97; CI: 0.95-0.98), or chronic kidney disease diagnoses (ARR: 0.94; CI: 0.91-0.98) were less likely to be screened, controlling for age, race, healthcare coverage, and education. Women with 2-4 or 5 or more diagnoses were significantly less likely to receive screening compared to those with zero diagnoses.

Conclusion. Women diagnosed with comorbidities including obesity, diabetes mellitus, COPD; arthritis; depression; and kidney disease were less likely to complete CC screenings. Additionally, the number of comorbidities was inversely related to completing screenings. These findings suggest physicians and patients are not following evidence-based guidelines regarding cervical cancer screening schedules in patients with comorbidities. Further efforts are warranted to reduce the disparities in cervical cancer screening among women with comorbidities.