Analyzing factors associated with completion of guideline-adherent cervical cancer screening in a county safety-net clinic

Cervical cancer remains a leading cause of cancer-related death in women globally. Nearly all cervical cancers are caused by human papillomavirus (HPV) infection. Significant disparities in cervical cancer screening and mortality exist. To better understand factors affecting timely completion of cervical cancer screening among patients attending safety-net clinics in Harris County, Texas, we evaluated characteristics associated with overdue screening. A retrospective chart review was conducted to examine a 3-month period for patients with Pap smear results and for patients with alerts for incomplete Pap smears. Most Pap smears were collected at well-woman (50%) or prenatal (11%) visits. Overdue Pap smear testing differed significantly by ethnicity, preferred language, index appointment type, pregnancy status at index appointment, diabetes status, last HbA1c values, and BMI. In unadjusted logistic regression analyses, patients from Hispanic/Latina backgrounds and those who did not speak English as their primary language had lower odds of being overdue in our patient sample. Patients attending annual/well-woman visits were less likely to be overdue. Patients with pre-diabetes had lower odds of being overdue compared to patients diagnosed with diabetes. Non-pregnant patients had higher odds of being overdue. When adjusting for all potential confounders, patients attending annual/well-woman visits were much less likely to be overdue compared to those with other appointment types (aOR 0.02, CI 0.001-0.25) and non-pregnant patients were much more likely to be overdue than pregnant patients (aOR 14.46, CI 5.36-39.01). Results of this evaluation will be used to develop targeted interventions to increase guideline-adherent cervical cancer screening.