Cervical cancer screening among women ≥70 years of age in the United States-A referral problem or patient choice.
OBJECTIVE
Clinical guidelines recommend that women with a history of adequate screening and not otherwise at high risk may discontinue cervical cancer screening after 65 years of age. However, screening remains common among US women over 65 years old. This study was conducted to examine whether overutilization was attributable to provider's recommendation or patient choice.


METHODS
This cross-sectional study used data from 1752 female participants (70+ years) from the 2013 National Health Interview Survey (NHIS). We quantitatively assessed the proportions of provider-recommended and patient self-initiated Pap smears.


RESULTS
Among female respondents, 40.8% had a Pap smear within the past 3 years, 19.4% had a Pap smear in the last year, and 39.7% reported receiving a recommendation for a Pap smear from their provider in the past year. Among women who received a recommendation to obtain a Pap smear, 39.8% did so within the past 12 months compared to 5.9% of women who did not receive a recommendation (adjusted odds ratio 10.5, 95% confidence interval 7.39-15.0). About 70% of women who visited an obstetrician/gynecologist and reported receiving a recommendation to have a Pap smear did so in the past year, while 32.3% of women who visited an obstetrician/gynecologist but did not receive a recommendation obtained one.


CONCLUSIONS
Pap smears were common among women ≥70 years of age. Health care providers may need additional education on current guidelines regarding indications for Pap smears in this age group to help reduce screening of patients who may not benefit.
Department of Obstetrics & Gynecology, and Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, United States.
Fangjian
F
Guo
Department of Obstetrics & Gynecology, and Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, United States.
Jacqueline M
JM
Hirth
Department of Obstetrics & Gynecology, and Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, United States. Electronic address: abberens@utmb.edu.
Abbey B
AB
Berenson
D000368:Aged; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*
Cancer screening; Cervical cancer; Overutilization of health services; Pap smear