Breast and cervical cancer screening of American Indian women in Montana and Wyoming

Background: American Indian (AI) women in the Northern Plains states (IA, IL, IN, MI, MN, MT, ND, NE, SD, WI, WY) have among the highest incidence and mortality rates of breast and cervical cancer in the United States. Current surveys may not accurately estimate screening utilization in some states.

Purpose: Determine the prevalence of breast and cervical cancer screening and factors associated with being screened among AI women receiving care from the IHS in Montana and Wyoming .

Methods: An age- and service unit-stratified random sample resulted in 1,292 AI women attending a reservation health facility at least once during the study period (Jan. 1, 2004 to Dec. 31, 2006). Women with a previous hysterectomy or mastectomy were excluded from the analysis.

Results: Over all service units, 34% of women received at least one Papanicolaou test, and 36% of women over age 45 received at least one mammogram during the study period. Women without a pap during the study period were significantly older (51. 2 v. 43.5, p < 0.0001). The likelihood of receiving cervical and breast cancer screening was associated with the facility (p = 0.026 and 0.0002, respectively) and facility type, but only for breast cancer screening (p=0.3170 and p = 0.0002, respectively).

Discussion: This study identifies lower rates of screening than previously believed. Factors associated with not being screened include age (cervical cancer), facility type (breast cancer) and service unit (breast and cervical cancer). Improvement in screening is needed to bring AI women up to national averages.