Cervical cancer screening of underserved women in the United States: results from the National Breast and Cervical Cancer Early Detection Program, 1997–2012

Abstract

ObjectiveThe National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screens to low-income, uninsured, and underinsured women. We describe the number and proportion of women eligible for cervical cancer screening services and the proportion of eligible women screened over the period 1997–2012.MethodsLow-income, uninsured, and underinsured women aged 18–64 years who have not had a hysterectomy are eligible for cervical cancer screening through the NBCCEDP. We estimated the number of low-income, uninsured women using data from the US Census Bureau. We adjusted our estimates for hysterectomy status using the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. We used data from the NBCCEDP to describe the number of women receiving NBCCEDP-funded screening and calculated the proportion of eligible women who received screening through the NBCCEDP at the national level (by age group, race/ethnicity) and at the state level by age group. We used the Medical Expenditure Panel Survey to estimate the proportion of NBCCEDP-eligible women who were screened outside the NBCCEDP and the proportion that are not screened. ResultsWe estimate that in 2010–2012, 705,970 women aged 18–64 years, 6.5 % (705,970 of 9.8 million) of the eligible population, received NBCCEDP-funded Pap tests. We estimate that 60.2 % of eligible women aged 18–64 years were screened outside the NBCCEDP and 33.3 % were not screened. The NBCCEDP provided 623,603 screens to women aged 40–64 years, an estimated 16.5 % of the eligible population, and 83,660 screens to women aged 18–39 years, representing an estimated 1.2 % of the eligible population. The estimated proportions of eligible women screened in each state ranged from 1.5 to 32.7 % and 5 % to 73.2 % among the 18–64 and 40–64 years age groups, respectively. Changes in the proportion of eligible women screened over the study period were nonsignificant.ConclusionsAlthough the program provided cervical screening to over 700,000 women between 2010 and 2012, it served a small percent of those eligible. The proportion of women screened varied substantially across age groups, racial/ethnic groups, and states. Many low-income, uninsured women are not being screened.

Explaining variation across grantees in breast and cervical cancer screening proportions in the NBCCEDP

“…We used data on the number of women eligible and number of women screened to calculate the proportion of eligible women screened through the NBCCEDP. The complete methods for calculating the screening proportions are described elsewhere [5, 6]. …”

“…First, the number of women in the specified age range and the fraction of this population that was eligible for the NBCCEDP were identified from the same data used to calculate the screening proportions [5, 6]. Second, the percentage of the population residing in urban areas was estimated using data from the Current Population Survey [11].…”

“…Women aged 18–64 receive cervical cancer screening (the age of eligibility was increased to 21 years in 2012 to align with updated clinical recommendations), and women aged 40–64 receive breast cancer screening [2–4]. About 11 % of US women were eligible for NBCCEDP cervical cancer screening and about 10 % for breast cancer screening [5, 6]. Since 1991, the NBCCEDP-funded programs in the states, District of Colombia (DC), territories, and tribes have screened more than 4.6 million women, provided more than 11.6 million breast and cervical cancer screening examinations, and diagnosed more than 64,718 breast cancers, 3,576 invasive cervical cancers, and 167,169 premalignant cervical lesions, of which 40 % were high grade (http://www.cdc.gov/cancer/nbccedp/about.htm).…”

“…Based on NBCCEDP data from selected years during the period from 2010 to 2012, it is estimated that the NBCCEDP screened on average 10.6 % of eligible women for breast cancer and 6.5 % of those eligible for cervical cancer using federal funds [5, 6]. In addition, there was substantial variation across grantees, with screening proportions for NBCCEDP-funded services varying from 1.6 to 52.8 % for breast cancer and 1.5 to 32.7 % for cervical cancer.…”

Breast cancer screening of underserved women in the USA: results from the National Breast and Cervical Cancer Early Detection Program, 1998–2012

“…Most women older than 64 have coverage for screening through Medicare. (Estimates of program reach for cervical cancer screening are reported elsewhere in this monograph—Tangka et al [7]. ) Although women aged 40–64 are eligible for breast cancer screening, NBCCEDP performance standards state that at least 75 % of federally funded mammograms be provided to the priority population of women aged 50 and older.…”