This is part 1 of our 3 part series on cervical cancer. Click here for part 2. Check back in December for part 3.
Approximately 1 in 5 veterans who undergo a cervical cancer screening test receive an abnormal result, according to a recent study published in Preventive Medicine Reports.
Takeaways
- Approximately 1 in 5 veterans who undergo cervical cancer screening tests receive an abnormal result, including cervical dysplasia and high-risk HPV infection, which can lead to surveillance testing and invasive treatments.
- Female US veterans have an estimated 3 times greater risk of abnormal cervical cancer screening results compared to non-veterans, although these differences might be influenced by varying screening behaviors and data sources.
- A recent study compared cervical cancer screening results between veterans and non-veterans using data from the National Health Interview Survey (NHIS) and found that veterans had a 1.46 times higher odds of abnormal results.
- Veterans had a 15.3% predicted probability of an abnormal cervical cancer screening result in the past 3 years, while non-veterans had a 13.1% probability after adjusting for demographic and health factors.
- The elevated rates of abnormal results among veterans suggest a need for further research on innovative models of care delivery to address the disparities in cervical cancer screening outcomes in this population.
Abnormal cervical cancer screening results include cervical dysplasia and high-risk human papillomavirus (HPV) infection. These conditions are associated with increased cervical cancer risk, and a test with these results often lead to surveillance testing and potentially invasive treatments.
Increased rates of cervical cancer risk factors have been reported among female US Veterans compared to non-veterans, with estimates finding the risk of an abnormal cervical cancer screening result 3 times greater among veterans. However, these differences may be caused by different screening behaviors and data sources.
To compare cervical cancer screening results between veterans and non-veterans in a recent, shared data source, investigators conducted a population-based cross-sectional household survey. Data was obtained from the 2010 and 2015 Cancer Screening Supplement and 2010, 2015, and 2018 Household, Family, and Sample Adult files.
Self-reported abnormal Pap or HPV test result within the previous 3 years was recorded as the primary outcome of the analysis, with veteran status as the main predictor. Participants with hysterectomy were excluded from the main model but included in a sensitivity analysis.
Covariates included race and ethnicity, age, income, marital status, geographic region, health care utilization, sexual orientation, insurance, Veterans Health Administration coverage, HPV vaccine receipt, smoking, and time since last screening test.
There were 380 veterans and 25,102 non-veterans included in the analysis, aged a mean 43 years. Veterans were more often Black and less often Hispanic than non-veterans.
Veterans were also more likely to live in the South, not be married, have attended college, have public insurance, attend over 10 outpatient visits per year, be gay or lesbian, and be a current or former smoker, among other attributes.An abnormal cervical cancer screening result was reported in 19% of veterans and 13.7% of non-veterans.
Compared to non-veterans, veterans had an odds ratio of 1.46 for an abnormal result. Other factors associated with increased odds of an abnormal result include being unmarried, Black race, having public insurance, being uninsured, and smoking.
When adjusting for demographic and health factors, veterans had a 15.3% predicted probability of an abnormal cervical cancer screening results in the past 3 years vs 13.1% for non-veterans. These results indicated elevated rates of abnormal results among veterans, leading investigators to recommend further research on innovative models of care delivery.
Reference
Danan ER, Than C, Chawla N, Hoggatt KJ, Yano EM. Abnormal cervical cancer screening results among US Veteran and non-Veteran participants in the National Health Interview Survey (NHIS). Preventive Medicine Reports. 2023;36. doi:10.1016/j.pmedr.2023.102472
