Sociodemographic factors associated with cervical cancer screening coverage and follow-up of high grade abnormal results in a population-based cohort

INTRODUCTION: A cervical cytology based screening program is effective if there is regular screening of the 'at risk' population and close follow-up of those labeled abnormal. METHODS: This is a population cohort study of women between 20-69 year old who were eligible in Ontario from 2008-2010. We used administrative data to evaluate the rates of cervical cancer screening and follow-up of high grade Pap tests. Variation in cervical cytology coverage and follow-up of high grade abnormal results are associated with age, area level income and health region. Multivariate logistic regression was used to identify independent factors associated with screening and followup. RESULTS: 3.7million women were eligible for screening of which 72% had a Pap smear in the prior 3years. These rates varied by age, income and region (p<0.0001). Women residing in the lowest income neighborhoods were half as likely to be screened (p<0.0001). 83% of those with an high grade intraepithelial lesion Pap test result had follow-up with colposcopy or treatment within 6months and this varied by year, age, income and region (p<0.0001). CONCLUSIONS: Despite universal health coverage, cervical cancer screening rates are suboptimal with older and low income women being at greatest risk. Follow-up among women with high grade abnormal tests is mediocre at 3months and acceptable at 6months. Novel models of cervical cancer screening program implementation are needed to address these inadequacies.