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Complete Health Indicator Report of Cervical Cancer Screening (Pap)

Definition

The proportion of women 18 years or older who reported having a Pap test in the last three years.

Numerator

The proportion of women 18 years or older who reported having a Pap test in the last three years.

Denominator

The total number of female survey respondents aged 18 or older excluding those who responded "don't know" or "refused" to the numerator question.

Data Interpretation Issues

To reduce bias and more accurately represent population data, the BRFSS has changed survey methodology. In 2010, it began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. More details about these changes can be found at: [http://health.utah.gov/opha/publications/brfss/Raking/Raking%20impact%202011.pdf].

Why Is This Important?

Cervical cancer is one of the most curable cancers if detected early through routine screening. Almost all cases of cervical cancer are caused by infection with high-risk types of the human papillomavirus (HPV). The HPV vaccine protects against the HPV types that most often cause cervical cancer. Women who have had an HPV vaccine still need to have routine Pap smears because the vaccine does not fully protect against all the strains of the virus and other risk factors that can cause cervical cancer. HPV is transmitted through sexual contact. Any woman who is sexually active is at risk for developing cervical cancer. Other risk factors include giving birth to many children, having sexual relations at an early age, having multiple sex partners or partners with many other partners, cigarette smoking, and use of oral contraceptives. The U.S. Preventive Services Task Force recommends cervical cancer screening (Pap smear) every 3 years for women 21 to 65 years old. For women 30 to 65 years old, Pap smears may be conducted every 5 years in conjunction with human papillomavirus (HPV) testing.

Healthy People Objective C-15:

Increase the proportion of women who receive a cervical cancer screening based on the most recent guidelines
U.S. Target: 93.0 percent
State Target: currently being revised

How Are We Doing?

Between 1991 and 2010, the percentage of Utah women aged 18 or older who reported receiving a Pap test within the last three years decreased from 88.2 percent to 74.0 percent (old methodology, age-adjusted rates). To reduce bias and more accurately represent population data, the Behavioral Risk Factor Surveillance Survey (BRFSS) has changed survey methodology in 2010. It began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. Based on this methodology, Utah's 2014 rate was 69.5 percent (age-adjusted rate). All additional indicator views are based on the new methodology. For combined years 2012 and 2014, Utah County, TriCounty, and San Juan local health districts reported significantly lower cervical cancer screening rates (65.3 percent, 62.0 percent, and 51.2 percent respectively) when compared to the state (69.8 percent). After dividing the health districts into Utah Small Areas, the prevalence of Pap tests for combined years 2012 and 2014 ranged from a high of 84.4 percent in Woods Cross/North Salt Lake to a low of 56.2 percent in Provo (North)/BYU. There were no significant differences in cervical cancer screening rates in 2014 among Hispanic and non-Hispanic ethnic groups. In 2014, and when looking at the highest level of education completed for women 25+, college graduates were significantly more likely to have received a Pap test than those that did receive a college degree (college graduate, 77.0 percent; some post high school, 74.1 percent; high school graduate, 67.8 percent; below high school, 67.5 percent). Also in 2014, women in households with lower annual incomes were significantly less likely to have had a Pap test within the past 3 years (58.6 percent for incomes less than $25,000; 69.9 percent for incomes of $25,000-$49,999; 71.6 percent for incomes of $50,000-$74,999; and 76.3 percent for annual incomes of $75,000 or more). For women of screening age in 2014, younger women ages 18-34 reported significantly lower rates (66.2 percent) when compared to older women (ages 35-49, 80.4 percent; ages 50-64, 76.5 percent).

How Do We Compare With the U.S.?

Nationally, the percentage of women aged 18 or older who reported receiving a Pap test in the past three years decreased from 88.6 percent in 1989 to 80.6 percent in 2010. Since then, and with the new BRFSS methods, national Pap test screening rates have continued to decline (83.0 percent in 2010 and 74.9 percent in 2014). Utah screening rates are also on a downward trend and have consistently been lower than national rates in the past decade. Using the new BRFSS methodology, 69.5 percent of Utah women aged 18 or older reported receiving a Pap test in 2014.

What Is Being Done?

The Utah Cancer Control Program (UCCP) provides free to low cost Pap tests and pelvic exams to women who meet age and income guidelines. Eligible women with abnormal screening exams are offered diagnostic evaluation by participating providers. In addition, the UCCP provides education about the need for early detection and the availability of screening services, collects outcome data, and disseminates information about cervical cancer. The Utah Department of Health also initiated the Utah Cancer Action Network (UCAN), a statewide partnership whose goal is to reduce the burden of cancer. The mission of the UCAN is to lower cancer incidence and mortality in Utah through collaborative efforts directed toward cancer prevention and control. As a result of this planning process, objectives and strategies have been developed by community partners regarding the early detection of cervical, testicular, prostate, skin, breast, and colorectal cancers as well as the promotion of physical activity, healthy eating habits, and smoking cessation.

Available Services

The Utah Cancer Control Program (UCCP) provides free and low cost Pap tests and pelvic exams to women who meet age and income guidelines. Eligible women with abnormal screening exams are offered diagnostic evaluation by participating providers. As of July 1, 2001, the UCCP is able to refer Utah women in need of treatment for cervical cancers and precancerous lesions to Medicaid for full benefits. The women must meet all requirements as outlined in the National Breast and Cervical Cancer Treatment Act. In addition, the Utah Immunization Vaccines for Children (VFC) program provides low cost HPV vaccines to females ages 9 to 18 who meet income guidelines.

Health Program Information

In 1976, the Utah Department of Health received a cervical cancer grant from the National Cancer Institute. In 1980, the Utah Department of Health began providing clinical breast exams and Pap tests on a sliding fee scale. In 1993, state funding was appropriated for mammography. In that same year, the Utah Cancer Control Program (UCCP) first received a capacity building grant from the Centers for Disease Control and Prevention to conduct breast and cervical cancer screening in Utah. A comprehensive grant was awarded to the program in 1994 to continue breast and cervical cancer screening. Since 1994, the UCCP and partners, including local health departments, mammography facilities, pathology laboratories, and private providers, have worked together to ensure the appropriate and timely provision of clinical services. The UCCP continues to receive funding from the CDC for breast and cervical cancer screening. Additionally, the UCCP receives funding to implement comprehensive cancer control strategies that were identified by the Utah Cancer Action Network (UCAN) statewide partnership.


Related Indicators

Relevant Population Characteristics

Economically disadvantaged persons are significantly less likely to get a Pap test. Women are also more likely to receive screening tests as their level of education increases.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

As part of the Affordable Care Act, women can receive free preventive services such as Pap smears.

Related Health Care System Factors Indicators:


Risk Factors

Any woman who is sexually active is at risk for developing cervical cancer. Other risk factors include having sexual relations at an early age, having multiple sex partners or a partner with many other partners, having a weakened immune system, not getting the HPV vaccine, and cigarette smoking.

Related Risk Factors Indicators:


Health Status Outcomes

Cervical cancer is one of the most preventable types of cancer with the use of the HPV vaccine. It is also highly treatable when caught early through screening tests.

Related Health Status Outcomes Indicators:




Graphical Data Views

Pap Test Within the Past Three Years, Utah and U.S., 1991-2000, 2002, 2004, 2006, 2008, 2010, 2012, and 2014

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confidence limits

BRFSS Utah vs. U.S.YearAge-adjusted Percentage of Women 18+Lower LimitUpper Limit
Record Count: 36
UT Old Methodology199188.2%85.2%90.7%
UT Old Methodology199281.1%77.3%84.3%
UT Old Methodology199379.4%75.4%82.8%
UT Old Methodology199482.5%78.9%85.5%
UT Old Methodology199580.0%76.6%83.0%
UT Old Methodology199680.1%77.2%82.8%
UT Old Methodology199778.2%74.7%81.4%
UT Old Methodology199877.8%74.3%81.1%
UT Old Methodology199980.4%77.2%83.2%
UT Old Methodology200081.8%78.5%84.7%
UT Old Methodology200280.7%77.8%83.2%
UT Old Methodology200479.0%76.8%81.1%
UT Old Methodology200675.1%72.6%77.4%
UT Old Methodology200874.1%71.7%76.4%
UT Old Methodology201074.0%72.2%75.6%
US Old Methodology199188.6%88.1%89.1%
US Old Methodology199282.1%81.5%82.3%
US Old Methodology199383.0%82.4%83.5%
US Old Methodology199482.8%82.2%83.3%
US Old Methodology199582.8%82.2%83.4%
US Old Methodology199683.3%82.8%83.8%
US Old Methodology199783.6%83.2%84.2%
US Old Methodology199883.5%83.1%84.0%
US Old Methodology199984.6%84.1%85.0%
US Old Methodology200085.2%84.7%85.6%
US Old Methodology200285.6%85.2%86.0%
US Old Methodology200484.8%84.5%85.2%
US Old Methodology200683.5%83.1%83.9%
US Old Methodology200882.2%81.9%82.6%
US Old Methodology201080.6%80.2%80.9%
UT New Methodology201074.2%72.7%75.7%
UT New Methodology201270.2%68.7%71.6%
UT New Methodology201469.5%68.1%70.9%
US New Methodology201083.0%82.0%84.0%
US New Methodology201277.4%77.0%77.8%
US New Methodology201474.9%74.5%75.3%

Data Notes

Age-adjusted to the 2000 standard population. UT/US Old Methodology: Previous BRFSS methodology used "post-stratification" which was used to weight data by age, gender, and local health district (LHD). UT New Methodology: To reduce bias and more accurately represent population data, the BRFSS has changed survey methodology. It began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. With raking, education, race/ethnicity, marital status, home ownership/renter, and telephone source are included in the weighting procedure.

Data Sources

  • Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health
  • U.S. Data: Behavioral Risk Factor Surveillance System (BRFSS), Division of Behavioral Surveillance, CDC Office of Surveillance, Epidemiology, and Laboratory Services


Pap Test Within the Past Three Years by Local Health District, Utah, 2012 and 2014

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confidence limits

Local Health DistrictAge-adjusted Percentage of Women Aged 18+Lower LimitUpper Limit
Record Count: 14
Bear River69.8%65.7%73.6%
Central64.4%58.7%69.8%
Davis County72.7%69.7%75.6%
Salt Lake County72.0%70.2%73.7%
San Juan51.2%40.5%61.7%
Southeast68.2%62.4%73.5%
Southwest69.8%65.3%74.0%
Summit77.2%70.1%83.0%
Tooele74.5%68.7%79.6%
TriCounty62.0%56.1%67.5%
Utah County65.3%62.7%67.8%
Wasatch73.8%67.2%79.4%
Weber-Morgan71.7%68.1%75.1%
State of Utah69.8%68.8%70.9%

Data Notes

Age-adjusted to U.S. 2000 population. Prior to 2015 San Juan County was part of the Southeast Local Health District. In 2015 the San Juan County Local Health District was formed. Data reported are for all years using the current boundaries.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Pap Test Within the Past Three Years by Utah Small Area, 2012 and 2014

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confidence limits

Utah Small AreasAge-adjusted Percentage of Women Aged 18+Lower LimitUpper Limit
Record Count: 64
Brigham City64.1%53.6%73.5%
Box Elder Co (Other)73.4%61.6%82.6%
Logan68.4%62.3%74.0%
Cache Co (Oth)/Rich Co (All)67.2%60.4%73.3%
Ben Lomond70.4%62.5%77.3%
Morgan Co (All)/Weber Co (E)72.0%65.4%77.8%
Ogden (Downtown)73.4%63.0%81.6%
South Ogden65.1%56.1%73.2%
Roy/Hooper77.5%68.7%84.4%
Riverdale74.6%63.4%83.3%
Clearfield/Hill AFB72.1%64.7%78.4%
Layton71.3%65.0%76.9%
Syracuse/Kaysville70.3%64.4%75.7%
Farmington/Centerville76.7%66.6%84.5%
Woods Cross/North Salt Lake84.4%75.1%90.7%
Bountiful68.7%60.4%76.0%
SLC (Rose Park)59.8%49.0%69.7%
SLC (Avenues)74.9%62.6%84.2%
SLC (Foothill/U of U)79.5%72.0%85.4%
Magna65.0%52.5%75.8%
SLC (Glendale)80.0%70.5%86.9%
West Valley (West)74.2%67.4%79.9%
West Valley (East) V274.0%64.0%82.1%
SLC (Downtown)70.3%62.1%77.4%
South Salt Lake60.9%48.8%71.9%
Millcreek73.1%67.5%78.1%
Holladay74.6%66.5%81.3%
Cottonwood68.2%60.8%74.7%
Kearns V268.8%59.9%76.5%
Taylorsville (E)/Murray (W)71.9%64.0%78.7%
Taylorsville (West)62.8%53.5%71.1%
Murray72.4%65.3%78.6%
Midvale67.7%57.5%76.5%
West Jordan (NE) V274.8%65.4%82.3%
West Jordan (SE)65.4%55.8%73.9%
West Jordan (W)/Copperton77.5%69.5%83.9%
South Jordan71.8%64.8%77.9%
Sandy (Center)74.6%68.3%80.1%
Sandy (NE)70.0%61.1%77.6%
Sandy (SE)74.9%66.5%81.8%
Riverton/Draper77.1%70.7%82.5%
Tooele Co74.5%68.7%79.6%
Lehi/Cedar Valley67.4%58.2%75.5%
American Fork/Alpine62.9%55.0%70.1%
Pleasant Grove/Lindon73.7%66.2%80.0%
Orem (North)72.8%61.8%81.6%
Orem (West)73.6%65.6%80.3%
Orem (East)66.2%54.3%76.3%
Provo (North)/BYU56.2%48.0%64.0%
Provo (South)66.1%57.5%73.7%
Springville/Spanish Fork64.8%58.8%70.3%
Utah Co (South)65.2%55.0%74.3%
Summit Co77.2%70.1%83.0%
Wasatch Co73.8%67.2%79.4%
TriCounty LHD62.0%56.1%67.5%
Juab/Millard/Sanpete Co64.1%57.4%70.2%
Sevier/Piute/Wayne Co66.5%56.2%75.5%
Carbon/Emery Co65.7%59.4%71.6%
Grand/San Juan Co59.6%49.3%69.1%
St George73.4%65.7%79.9%
Washington Co (Other)72.0%64.7%78.4%
Cedar City68.4%58.9%76.6%
Southwest LHD (Other)64.0%50.4%75.7%
State69.8%68.8%70.9%

Data Notes

Age-adjusted to U.S. 2000 standard population. Maps, methods, and changes to Utah Small Areas may be found on IBIS at the following URL: [http://ibis.health.utah.gov/resource/Help.html].

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Pap Smear in the Past Three Years by Ethnicity, Utah, 2014

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confidence limits

Hispanic EthnicityAge-adjusted Percentage of Women 18+Lower LimitUpper Limit
Record Count: 3
Hispanic71.2%65.2%76.6%
Non-Hispanic69.6%68.1%71.1%
All Utahns69.5%68.1%70.9%

Data Notes

Age-adjusted to the U.S. 2000 standard population.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Pap Smear in the Past Three Years by Race, Utah, 2014

::chart - missing::
confidence limits

RaceAge-adjusted Percentage of Women Age 18+Lower LimitUpper Limit
Record Count: 6
American Indian/Native Alaskan66.8%51.8%79.0%
Asian67.4%55.5%77.5%
Black65.7%46.7%80.7%
Pacific Islander48.3%28.7%68.5%
White71.7%70.1%73.2%
All Races69.5%68.1%70.9%

Data Notes

Age-adjusted to the U.S. 2000 standard population based on 3 age groups: 18-34, 35-49, and 50+.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Pap Test Within the Past Three Years by Education, Utah, 2014

::chart - missing::
confidence limits

Education LevelAge-adjusted Percentage of Women 25+Lower LimitUpper Limit
Record Count: 4
Less Than High School67.5%60.6%73.7%
H.S. Grad or G.E.D.67.8%64.7%70.7%
Some Post High School74.1%71.6%76.5%
College Graduate77.0%74.7%79.1%

Data Notes

Age-adjusted to the 2000 standard population.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Pap Test Within the Past Three Years by Income, Utah, 2014

::chart - missing::
confidence limits

Income CategoryAge-adjusted Percentage of Women 18+Lower LimitUpper Limit
Record Count: 5
<$25,00058.6%54.8%62.3%
$25,000-$49,99969.9%66.5%73.1%
$50,000-$74,99971.6%67.8%75.0%
$75,000+76.3%73.1%79.3%
Total69.5%68.1%70.9%

Data Notes

Age-adjusted to the 2000 standard population.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health


Pap Test Within the Past Three Years by Age, Utah, 2014

::chart - missing::
confidence limits

Age GroupPercentage of Women Aged 18+Lower LimitUpper LimitNote
Record Count: 4
18-3466.2%63.2%69.0%
35-4980.4%78.0%82.6%
50-6476.5%73.4%79.4%
65+48.8%44.6%53.1%^

Data Notes

^The U.S. Preventive Services Task Force recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise high risk for cervical cancer.

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

References and Community Resources

Utah Cancer Control Program @ [http://www.cancerutah.org] [[br]] Utah Cancer Action Network @ [http://www.ucan.cc] [[br]] National Cancer Institute @ [http://www.cancer.gov] [[br]] American Cancer Society @ [http://www.cancer.org] [[br]] Huntsman Cancer Institute @ [http://www.huntsmancancer.org] [[br]] Centers for Disease Control and Prevention @ [http://www.cdc.gov] [[br]] American Society of Clinical Oncology @ [http://www.asco.org]

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

Page Content Updated On 11/26/2016, Published on 02/13/2017
The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sat, 19 August 2017 5:18:37 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Fri, 26 May 2017 10:19:43 MDT