Women's Behaviors Toward Mammogram and Pap Test: Opportunities to Increase Cervical Cancer Screening Participation Rates among Older Women

Screening rates for cervical cancer remain moderate among women over 50 years of age. Because cervical and breast screening interventions can be linked, evaluating screening factors relating to both is important. This study evaluates factors associated with breast and cervical screening participation in women aged 52 to 69. A cross-sectional study was used to describe characteristics associated with screening behaviors of 1,173,456 eligible women in Ontario, Canada. Overdue for screening was defined as more than 2.5 years from last mammogram or more than 3.5 years from last Pap test. Factors that might influence uptake of mammogram or Pap test were included as covariates in a multivariable multinomial logistic regression model. Overall, 52.4% of eligible women were up-to-date for both, 21.3% were overdue for both, 14.4% were overdue for Pap test but were up-to-date with mammogram, and 11.9% were overdue for mammogram but were up-to-date with Pap test. There was an opposite effect of age on likelihood of being overdue for Pap test only versus mammogram only. Women aged 67 to 69 compared with those 52 to 54 were more likely to be overdue for Pap test only (adjusted odds ratio, 2.3; 95% confidence interval, 2.3–2.4) and less likely to be overdue for mammogram only (adjusted odds ratio, 0.5; 95% confidence interval, 0.5–0.6). A greater proportion of women rostered to a female physician versus a male physician were up-to-date for both (63.7% vs. 51.5%). Comparing screening patterns may provide physician- and patient-directed strategies to increase cervical screening participation by recruiting women who are overdue for Pap test but undergoing breast cancer screening.