title: Does patient health and hysterectomy status influence cervical cancer screening in older women?
abstract: BACKGROUND
  Decisions to screen older patients for cancer are complicated by the fact that aging populations are heterogeneous with respect to life expectancy.
  
  
  OBJECTIVE
  To examine national trends in the association between cervical cancer screening and age, health and hysterectomy status.
  
  
  METHODS
  Cross-sectional data from the 1993, 1998, 2000, and 2005 National Health Interview Surveys (NHIS) were used to examine trends in screening for women age 35-64 and 65+ years of age. We investigated whether health is associated with Pap testing among older women using the 2005 NHIS (N = 3,073). We excluded women with a history of cervical cancer or who had their last Pap because of a problem.
  
  
  METHODS
  The dependent variable was having a Pap test within the past 3 years. Independent variables included three measures of respondent health (the Charlson comorbidity index (CCI), general health status and having a chronic disability), hysterectomy status and sociodemographic factors.
  
  
  RESULTS
  NHIS data showed a consistent pattern of lower Pap use among older women (65+) compared to younger women regardless of hysterectomy status. Screening also was lower among older women who reported being in fair/poor health, having a chronic disability, or a higher CCI score (4+). Multivariate models showed that over 50% of older women reporting poor health status or a chronic disability and 47% with a hysterectomy still had a recent Pap.
  
  
  CONCLUSIONS
  Though age, health and hysterectomy status appear to influence Pap test use, current national data suggest that there still may be overutilization and inappropriate screening of older women.
authors.affiliation: Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD 20892-2027, USA. meissneh@od.nih.gov
authors.forename: Helen I
authors.initials: HI
authors.lastname: Meissner
authors.forename: Jasmin A
authors.initials: JA
authors.lastname: Tiro
authors.forename: David
authors.initials: D
authors.lastname: Haggstrom
authors.forename: Grace
authors.initials: G
authors.lastname: Lu-Yao
authors.forename: Nancy
authors.initials: N
authors.lastname: Breen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007044:Hysterectomy / Q000523:psychology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D014626:Vaginal Smears / Q000523:psychology*
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