Lifetime Cervical Cancer Screening and Social Determinants of Health in the Canadian Longitudinal Study on Aging

Objectives: In Canada, cervical cancer rates remain well above the World Health Organization target, despite screening and vaccination programs. Modeling reveals that those who have never undergone screening represent one of the highest risk populations. The Canadian Longitudinal Study on Aging (CLSA) prospectively collected health outcomes on >50,000 individuals. The authors sought to identify the prevalence of Canadian female participants having never undergone cervical cancer screening and the association with social determinants of health. Methods: The authors performed a cross-sectional analysis from CLSA data. The main outcome was self-report of ever having undergone a Pap smear. Regression analyses evaluated the association between demographic or social determinants of health and self-reported lifetime cervical cancer screening. Results: The population-based sample comprised 22,910 participants aged 45-85, of whom 99.8% had available information on cervical cancer screening (n = 22,720). The prevalence of never having undergone a Pap smear was 14.1%; weighted prevalence, 11.8% (95% CI = 11.0-12.6). The following factors were associated with never having undergone screening: older age((10-year)) (OR = 1.5, 95% CI = 1.4-1.6), lower education((low vs. high)) (OR = 1.5, 95% CI = 1.2-1.9), lower household income((low vs. high)) (OR = 1.7, 95% CI = 1.3-2.3), having a religious affiliation (OR = 1.3, 95% CI = 1.1-1.5), and never being married/lived in common law (OR = 1.5, 95% CI = 1.2-1.9). Notably, not having a family physician was also associated (OR = 2.3, 95% CI = 1.6-3.3). However, among participants who never underwent a Pap smear, 97% reported having a family physician. Conclusions: This analysis highlights inequities in cervical cancer screening in the Canadian context. These insights are critical in informing a more equitable approach to implementing human papillomavirus (HPV)-based screening.