Reduced age-wise disparity in estimated cervical cancer screening participation rates after applying hysterectomy correction: a population-based cross-sectional study.

introductionCervical cancer screening participation rates (CCSPR) are often underestimated when women who have undergone total hysterectomy for benign reasons remain in the screening-eligible population. This study aimed to improve the accuracy of Alberta’s CCSPR by excluding these individuals and to assess disparities in participation across sub-populations.

methodsWe conducted a retrospective cross-sectional study using provincial administrative health data. Women aged 25–66 years were included, and those with a documented total hysterectomy for benign indications were excluded from the screening-eligible population. We stratified the population into two age strata (25–49 and 50–66) while estimating screening participation rate by zone of residence, migration status, and ethnicity. We conducted multivariable modified poisson regression to estimate hysterectomy corrected prevalence ratios for being uptodate with cervical cancer screening.

findingsA total of 1,324,927 women aged 25–66 year at index date were included in the analysis. Correction for hysterectomy increased CCSPR by 3% point among women aged 25–66 years (uncorrected: 57.3%, corrected 60.4%). Upon correction, age for peak participation shifted from 30–39 years to 40–59 years. After hysterectomy correction, those aged 25–29 years and 60–66 years showed lower screening participation compared to those aged 30–59 years. North Zone continued to show lower participation even after correction for hysterectomy (55.2%) compared to Edmonton (62.9%) and Calgary (61.8%) in the 25-49-year age group. Inter-provincial migrants (55.8%) and international migrants (58.8%) had lower screening participation than non-immigrants (67.0%). Similarly, the Asian population (57.6%) and the Black population (60.2%) showed a lower screening participation compared to the White (62.0%) and the Hispanic population (63.1%). Multivariable modified Poisson regression analysis confirmed significantly lower likelihood of up-to-date screening among the youngest (25–29) and the oldest (60–66) age groups, residents of the North zone, and immigrants particularly those identifying as Asian or Black.

conclusionApplying hysterectomy correction increased Alberta’s estimates for screening participation. The uncorrected cervical cancer screening participation rate shows a declining trend by increased age (after 30–39), but this trend is no longer apparent after hysterectomy correction. Future interventions and patient education need to consider other key factors (zone of residence, migration status, ethnicity) including age to design targeted interventions.