Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.
Cancer Causes Control. 2022 Oct;33(10):1305-1312. doi: 10.1007/s10552-022-01615-5. Epub 2022 Aug 10.
Women with diabetes have lower survival rates after a cervical cancer diagnosis compared to women without diabetes. Pap smears and human papilloma virus (HPV) testing are highly effective screening tests for cervical cancer, therefore, it is important to know the prevalence of guideline-concordant screening among women with diabetes and understand if their predictors of screening differ. The purpose of this analysis was to assess guideline-concordant cervical cancer screening and predictors by diabetes status.
We used the 2019 National Health Interview Survey data, limited to women aged 21-65 years without a previous diagnosis of cancer, a hysterectomy, or diagnosed with diabetes in the year prior to the survey. We considered the Pap and HPV tests together and concordance as being tested within the past 3 years as part of a routine exam. We calculated weighted, adjusted prevalence, and prevalence ratios (PRs) of screening concordance comparing women with diabetes to those without.
The unadjusted prevalence of concordant screening was 66.5% for women with diabetes compared to 73.3% for women without diabetes (PR = 0.91 95% CI 0.84-0.98). In the fully adjusted model adjusting for factors known to be associated with diabetes and access to healthcare, the association was attenuated and no longer statistically significant (PR = 0.96 95% CI 0.89-1.04).
Cervical cancer screening concordance was lower in women with diabetes compared to those without overall but the deficit appears to be due primarily to underlying differences in sociodemographic characteristics and access to healthcare and not diabetes independently.
与无糖尿病的女性相比，患有糖尿病的女性在宫颈癌诊断后生存率较低。巴氏涂片检查和人乳头瘤病毒（HPV）检测是宫颈癌的高度有效筛查试验，因此，了解糖尿病女性中符合指南的筛查率并了解其筛查预测因素很重要。本分析的目的是评估按糖尿病状况评估符合指南的宫颈癌筛查和预测因素。
我们使用了 2019 年全国健康访谈调查数据，仅限于年龄在 21-65 岁之间、无先前癌症诊断、子宫切除术或在调查前一年被诊断患有糖尿病的女性。我们将巴氏涂片检查和 HPV 检查一起考虑，并将在过去 3 年内作为常规检查进行的检查视为一致。我们计算了调整后的加权筛查一致性的患病率和患病率比（PR），将患有糖尿病的女性与无糖尿病的女性进行比较。
未经调整的糖尿病女性符合筛查标准的患病率为 66.5%，而无糖尿病女性为 73.3%（PR=0.91，95%CI 0.84-0.98）。在完全调整模型中，根据已知与糖尿病和获得医疗保健相关的因素进行调整后，这种关联减弱且不再具有统计学意义（PR=0.96，95%CI 0.89-1.04）。
总体而言，患有糖尿病的女性宫颈癌筛查的一致性低于无糖尿病的女性，但这一缺陷似乎主要是由于社会人口统计学特征和获得医疗保健方面的差异，而不是糖尿病本身造成的。
