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Cervical cancer screening for survivors diagnosed with cancer before age 25

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Abstract

Purpose

The study aims to better understand Pap test utilization for cancer survivors diagnosed before age 25 in British Columbia (BC), Canada.

Methods

A population-based cross-sectional data linkage study that included 1285 5-year female cancer survivors diagnosed with cancer before age 25 and 12,185 randomly selected and birth-year-matched BC female residents. Pap participation rates in 2008–2010, both uncorrected and corrected for hysterectomy status, were compared between two groups. Adjusted prevalence ratios (PRadj) were calculated to examine (1) associations between factors and Pap rates in each group and (2) interactions between factors and groups, using log-binomial regression models.

Results

Overall Pap rates, both uncorrected and corrected, were higher for survivors (71.8%; 72.9%) than population (69%; 69.7%). Pap rates were 4.8–5.1 and 17.8–22.4% higher for survivors aged 30–39 and 50–59 respectively. Significantly higher Pap test utilization was associated with previous Pap tests (PRadj = 1.83, 95%CI = 1.76–1.89) and previous cervical procedures (1.20, 95%CI = 1.15–1.25). Hysterectomy rates were doubled for survivors (7.4%) than population (3.7%). This did not affect Pap participation rate comparisons between two groups. In both groups, 51.6–70% of females with hysterectomies still received Pap tests.

Conclusion

Survivors’ Pap test utilization was significantly higher than population, but lower than the Canadian benchmark of 90%. Hysterectomy correction does not affect this observation. Cervical cancer screening is suboptimal for survivors. Females with prior hysterectomies might have received unnecessary Pap tests.

Implications for Cancer Survivors

Survivors without prior hysterectomies should continue to undergo Pap tests recommended by provincial guidelines, to optimize their health.

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Abbreviations

ALL:

Acute lymphocytic leukemia

AYA:

Adolescent and Young Adult

BC:

British Columbia

BCCA:

British Columbia Cancer Agency

BCCH:

British Columbia Children’s Hospital

CAYACS:

Childhood, adolescent and young adult cancer survivor

CCSP:

Cervical Cancer Screening Program

CCSS:

Childhood Cancer Survivor Study

CI:

Confidence interval

CNS:

Central nervous system

ICCC:

International Classification of Childhood Cancer

MSP:

Medical Service Plan

Pap:

Papanicolaou

PHNs:

Personal Health Numbers

PRs:

Prevalence ratios

PORs:

Prevalence odds ratios

SAS:

Statistical analysis system

SES:

Socio-economic status

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

UBC:

University of British Columbia

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Acknowledgements

The authors gratefully acknowledge the BC Cancer Registry, BC Cancer Agency, Cervical Cancer Screening Program of BC Cancer Agency, BC Ministry of Health Services, and the BC Children’s Hospital, who approved access and use of the data, facilitated by Population Data BC. All inferences, opinions, and conclusions drawn in this publication are those of the authors and do not reflect the opinions or policies of the Data Steward(s). The first author, Dr. Olivia L. Tseng, was financially supported by the Clinician Scholarship through the Department of Family Practice of University of British Columbia.

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Authors and Affiliations

  1. Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada

    Olivia L. Tseng, John J. Spinelli & Mary L. McBride

  2. Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada

    Olivia L. Tseng & Martin Dawes

  3. Department of Statistics, Simon Fraser University, Burnaby, British Columbia, Canada

    John J. Spinelli

  4. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada

    John J. Spinelli & Mary L. McBride

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  1. Olivia L. Tseng
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Correspondence to Olivia L. Tseng.

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Funding

This study was funded by the Canadian Cancer Society (CCS) Research Institute and CCS BC and Yukon Division, Program Project Grant (PPG #19000, 19804).

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Tseng, O.L., Spinelli, J.J., Dawes, M. et al. Cervical cancer screening for survivors diagnosed with cancer before age 25. J Cancer Surviv 11, 410–419 (2017). https://doi.org/10.1007/s11764-017-0598-z

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