Factors Important in Promoting Cervical Cancer Screening among Canadian Women: Findings from the 1996–97 National Population Health Survey (NPHS)

Abstract

Approximately 1,450 new cases and 430 deaths from cervical cancer were estimated to occur among Canadian women during 2000, resulting in an estimated incidence rate of 8.4 per 100,000 women. 1 Observed declines in cervical cancer incidence and mortality rates in previous years are largely attributed to the widespread adoption of Pap screening. 1 Current Canadian guidelines recommend women receive annual Pap tests once sexually active or at age 18 with a reduction in screening frequency to every three years after two normal smears to the age of 69, in the presence of an organized screening program. 2,3 Currently, there are no comprehensive screening programs in Canada, although several provinces have programs with several of the required elements. [4][5][6] Although cervical cancer is almost completely preventable through regular screening, Pap tests remain underused by some women. Studies consistently show that among new cases, a relatively high proportion of women report no or poor participation in a Pap screening program. 7,8 As the early stages of cervical cancer (non-invasive) are asymptomatic, routine screening can result in better prognosis for the patient. 9,10 If cervical cancer is detected when symp-toms are apparent, the five-year survival rate is only 10%, but with early detection exceeds 90%. 2 Research has illustrated the relative importance of several sociodemographic, health and lifestyle factors to Pap screening among North American women. [11][12][13][14][15][16] Significant predictors of under-utilization include older age, lower education, non-English language, ethnic background, single marital status and poor preventive health behaviours.This study examines the consistency of findings regarding sociodemographic, health and lifestyle factors that promote appropriate cervical cancer screening among different age groups of Canadian women in the 1996-97 National Population Health Survey (NPHS). Questions regarding reasons for not obtaining a Pap test were added to this survey cycle; thus, a secondary objective was to examine the relative importance of personal and system barriers to Pap test participation among this sample. METHODSThe NPHS is an ongoing survey conducted by Statistics Canada involving the collection of cross-sectional and longitudinal data on the health of Canadians. Data from the second cycle (1996-97) of the household component, obtained primarily through telephone interviews, were used to examine the relation of sociodemographic, health and lifestyle factors to Pap test participation in a representative sample of the non-institutionalized population.Of the 36,667 female respondents aged 18+ years, 34,832 consented to share their

Inconsistent self-reported mammography history: Findings from the National Population Health Survey longitudinal cohort

“…Our analyses of factors associated with inconsistent ever/never responses indicate that women reporting ever having had a mammogram at baseline but never use at follow-up exhibited many of the sociodemographic and health behaviour characteristics (e.g., lower income, outside age groups targeted for screening, non-users of Pap screening and hormone replacement therapy) commonly observed among non-participants in mammography screening in previous studies [31-38]. Such findings provide support for the assumption that the 1994–95 response of ever use is more likely erroneous.…”

“…Additional factors (e.g. being born in an Asian country) previously associated with non-use of mammography [31,33] also showed a positive association with providing an inconsistent response; however, small numbers resulted in high variability once clustering and stratification were taken into account and precluded further analysis of this variable.…”

Social Network Effects of Nonlifesaving Early-Stage Breast Cancer Detection on Mammography Rates

“…As noted earlier, one of our goals in designing the survey was to determine which factors were most important in influencing individuals’ decisions to be screened. We used logistic regression analysis of data collected in our survey to test whether the following individual-level factors, identified in earlier studies, were associated with the likelihood of future screening in our study population: physician recommendation, 20–22 insurance status, 21,23–25 past screening behavior, 22 age, 21,26 race, 26,27 education, 26 and income. 26,27 Furthermore, we tested whether learning about an early- or late-stage breast cancer diagnosis in a woman who had or had not been regularly screened within the past year affected a respondent’s future likelihood of being screened.…”

Participation and retention in the breast cancer screening program in New Brunswick Canada

“…Studies identified demographic (Zapka et al, 1989), geographical (Lerman et al, 1990), socio-economic factors (Zapka et al, 1989, Katz and Hofer, 1994, Maxwell et al, 2001) and psychological factors (Zapka et al, 1989, Lerman et al, 1990) contributing to variation in participation in breast cancer screening. For example, less education, minority ethnicities, etc.…”

“…Many previous studies relied on self-reported data (Zapka et al, 1989, Lerman et al, 1990, Katz and Hofer, 1994, Maxwell et al, 2001, McDonald and Sherman, 2010, Tang et al, 2000) and examined initial rescreening only (Song and Fletcher, 1998, Barr et al, 2001, Bobo et al, 2004, Calvocoressi et al, 2005, Fox et al, 2004) or first and second follow-up (Rauscher et al, 2005, Bancej et al, 2005) only, without considering initial screening or retention over a longer period of time. Some existing studies have used administrative data on individuals participating in screening programs to study compliance with guidelines (Kiran et al, 2014, Corkum et al, 2014, Vigod et al, 2011) but use of Canadian administrative data has been limited (Bancej et al, 2005).…”