Cervical cancer; screening; Pap test; disparities; Arkansas


Community Health and Preventive Medicine | Epidemiology | Preventive Medicine | Women's Health


Introduction: Cervical cancer preys on women without access to preventative screening. Any woman who has developed an invasive case of cervical cancer should be regarded as a failure of screening. Disparities in access to screening, triage, and treatment fuel an uneven distribution in the burden of cervical cancer within the United States; weighing unusually heavy on the Southern States like Arkansas. The purpose of this study was to evaluate demographic and behavioral risk factors for cervical cancer and identify potential barriers which may influence the likelihood of complying with current Pap test recommendations on a state level, in Arkansas, and also a national scale, in the United States.

Materials and Methods: National data from the 2014 Behavioral Risk Factor Survey System (BRFSS) was used to collect demographic characteristics and behavioral risk factors among females aged 18 and above in Arkansas and the United States. BFRSS data included a total of 1,587 women in Arkansas and 162,222 in the United States who were aged 18 and above and eligible to receive Pap tests. Women with a medical history of hysterectomy that included the removal of the cervix were excluded from analysis because they are not considered to be medically eligible to receive Pap tests.

Results: Socioeconomic status, age, race, and health insurance were significantly associated with likelihood to comply with current screening recommendations among women in both Arkansas and the United States. Arkansan women who had less than a 12-year education (Odds Ratio (OR) = 1.41, 95% Confidence Interval (CI) = 1.04, 1.64) and were without health insurance (OR = 3.56, 95% CI = 1.66, 7.66) were more likely to be non-compliant with Pap testing, which is similar to the finding on the national level. The prevalence of Pap test compliance was significantly lower among women in Arkansas when compared to US average in every sociodemographic sector.

Discussion: According to US Census data collected in 2013, Arkansas had the highest cervical cancer incidence of 10.6 per 100,000 person-years, while the national average was 7.7 per 100,000 person-years. Therefore, future population-based cervical cancer interventions in Arkansas should target the promotion of Pap test compliance among the most vulnerable subpopulations (i.e., low socioeconomic status, minority, medically under or uninsured). Organized screening interventions might include offering free or reduced cost Pap testing in both urban and rural locations.