Breast and cervical cancer screening in Virginia: The impact of insurance coverage and the Every Woman’s Life screening program
Kamila Somyaji
Advisor: Christopher M.G. Buttery, MD
Preceptor: Resa Jones, Ph.D., MPH
Background: Screening for breast and cervical cancers is important because early detection increases cancer survival. Since 1991, the U.S. government has helped finance a national early detection program for breast and cervical cancer among uninsured low-income women, known in Virginia (VA) as Every Woman's Life (EWL).
Objectives: This study aims to determine whether there are differences in the prevalence of breast and cervical cancer screening based on insurance coverage and evaluate the ability of EWL to effectively reach its target population.
Methods: Cross-sectional data from the 2005 Behavioral Risk Factor Surveillance System survey were analyzed. Using population weights, descriptive statistics were generated and multiple regression was performed to assess the association between insurance coverage and screening prevalence among VA women 40 to 64 years of age (n=1,627). Adjusted screening prevalence by health district was also calculated. EWL client (n=4,959) and provider data from the VA Department of Health was obtained to create screening density maps with Geographic Information Systems.
Results: After adjustment, women with insurance were significantly more likely to have a mammogram within the last two years compared to those without insurance (78% vs. 50%, p<0.0001) and a pap smear in the last three years (89% vs. 66%, p<0.0001). Breast cancer screening per recommendations was lowest for Three Rivers Health District (52%) whereas cervical cancer screening per recommendations was lowest for the Cumberland Plateau Health District (56%). Several health districts did not contain adequate numbers of EWL screening and/or diagnostic provider sites.
Conclusion: The results of this study will be used to assist EWL in recruitment of additional screening and/or diagnostic sites in underserved areas of Virginia.
