Cervical cancer screening for survivors diagnosed with cancer before age 25

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 (PR_adj) 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 (PR_adj = 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.

Keywords: Cancer follow-up care; Cervical cancer screening; Childhood cancers; Pap test; Survivorship research.