Obstetrics/GynecologyORIGINAL ARTICLE

Cervical cancer screening among women with comorbidities: a cross-sectional examination of disparities from the behavioral risk factor surveillance system

Jordyn Austin, BS; Paul Delgado, ScM; Ashton Gatewood, MPH; Mackenzie Enmeier, BS; Brooke Frantz, MD; Benjamin Greiner, DO, MPH; and Micah Hartwell, PhD
Notes and Affiliations
Notes and Affiliations

Received: February 7, 2021

Accepted: January 31, 2022

Published: March 14, 2022

  • Jordyn Austin, BS, 

    College of Osteopathic Medicine at the Cherokee Nation, Office of Medical Student Research, Oklahoma State University, Tahlequah, OK, USA

  • Paul Delgado, ScM, 

    Center for Health Sciences, Office of Medical Student Research, Oklahoma State University, Tulsa, OK, USA

  • Ashton Gatewood, MPH, 

    College of Osteopathic Medicine at the Cherokee Nation, Office of Medical Student Research, Oklahoma State University, Tahlequah, OK, USA

  • Mackenzie Enmeier, BS, 

    College of Osteopathic Medicine at the Cherokee Nation, Office of Medical Student Research, Oklahoma State University, Tahlequah, OK, USA

  • Brooke Frantz, MD, 

    OU College of Medicine, Department of Women’s Health at Oklahoma City Indian Clinic, Oklahoma City, OK, USA

  • Benjamin Greiner, DO, MPH, 

    Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA

  • Micah Hartwell, PhD, 

    Center for Health Sciences, Department of Psychiatry and Behavioral Sciences, Oklahoma State University, Tulsa, OK, USA

Abstract

Context: Implementation of guideline-based Papanicolaou (Pap) smear screening, human papillomavirus (HPV) testing, and HPV vaccination has reduced cervical cancer (CC) rates up to 80%, yet prevention disparities continue to exist.

Objectives: This study aims to analyze whether CC screening rates differ among women with comorbidities—body mass index (BMI) ≥30 kg/m2, diabetes mellitus, hypertension, cardiovascular disease, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, depression, or skin cancer—compared to women without these comorbidities.

Methods: Combined 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) datasets were evaluated utilizing multivariate logistic regression models to determine the adjusted odds ratios (AORs) of persons having completed CC screening without comorbidities compared to those with individual diagnoses, as well as in those with multiple comorbidities (1, 2–4, 5+). Confidence intervals (CIs) were reported at 95%.

Results: Among the 127,057 individuals meeting inclusion criteria, 78.3% (n = 83,242; n = 27,875,328) met CC screening guidelines. Multivariable regression showed that women who had a BMI ≥30 kg/m2 were significantly less likely to have completed a CC screening (AOR: 0.90; CI: 0.83–0.97) as were those with COPD (AOR: 0.77; CI: 0.67–0.87) and kidney disease (AOR: 0.81; CI: 0.67–0.99). Conversely, women with skin cancer were significantly more likely to report CC screening (AOR: 1.22; CI: 1.05–1.43). We found no significant differences in CC screening completion rates by diagnosis of diabetes, hypertension, cardiovascular disease, arthritis, or depression nor between women lacking comorbidities compared to women with multiple comorbidities.

Conclusions: Women with BMI ≥30 kg/m2, COPD, and kidney disease were less likely to complete CC screening, whereas women with skin cancer were more likely to complete CC screening. Additionally, diabetes mellitus, hypertension, cardiovascular disease, arthritis, and depression diagnoses did not significantly impact rates of CC screening. Physicians should be aware of the deviations in CC screening completion among patients with diagnoses to know when there may be an increased need for Pap tests and pelvic examinations. CC screening is critical to reduce mortality through early detection and prevention measures.

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