Meeting the Cervical Cancer Screening Needs of Underserved Women: The Performance of the National Breast and Cervical Cancer Early Detection Program in 2004-2006

Background: Cervical cancer screening rates are low among low income, uninsured and underinsured women. To these women gain access to Papanicolaou (Pap) tests, the U.S. Congress passed an Act of 1990, authorizing the CDC to establish the National Breast and Cervical Cancer Early Detection Program (Program). It provides services in all states, DC, 4 territories, and 13 tribal organizations.

Objective: To examine the extent to which the Program meets the cervical cancer screening needs of this underserved population.

Methods: We estimated the number of Program-eligible women using U.S. Census Bureau data. The estimates were adjusted for hysterectomy status using the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. We obtained the number of women receiving Program-funded Pap tests from the Program, and calculated the percentage of eligible women screened.

Results: In 2004-2006, of all U.S. women aged 18-64, approximately 8.9 million (9.5%) had not had a hysterectomy, had no health insurance and had a family income below 250% of the federal poverty level, meeting Program eligibility criteria. Of these women, 8.7% received a Program-funded Pap test. Rates varied substantially by age groups, race and ethnicity. The percentage of eligible women screened in each state ranged from 2.0% to 38.4%.

Conclusions: Although the Program provided cervical cancer screening services to over 750 thousand low-income, uninsured women, it served a small percentage of those eligible. In 2005 more than 3.1 million low-income, uninsured women aged 18-64 did not receive recommended Pap tests from either the Program or other sources.