Washington, D.C. – Although morbidity and mortality attributable to cervical cancer has decreased significantly over the past several decades, uninsured or underinsured women may be less likely to receive sufficient preventive Pap screening.

Pap testing has led to significant advances in the prevention, detection, and treatment of cervical cancer.

To determine whether demographic characteristics influence Pap utilization, Mary E.  Springston, PA-C, and student colleagues from Le Moyne College in Syracuse, N.Y., designed a cross-sectional study at two clinics in central New York that provide free health care to uninsured and underinsured patients.

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The results were presented at a poster session at the American Academy of Physician Assistants IMPACT 2013 meeting.

A total of 69 women aged 21 years and older completed an anonymous survey that asked questions about demographics, Pap testing utilization, knowledge about human papillomavirus and awareness of clinics offering Pap testing. Women with a history of cervical cancer or total hysterectomy were not included in the study.

A high proportion of participants reported having received a Pap smear — 88.5% — data indicated. Furthermore, 68.1% had received their last Pap test within the guidelines recommended by the American College of Obstetricians and Gynecologists (ACOG) and United States Preventive Task Force (USPTF) guidelines, and 72.5% reported routine testing.

Nearly 90% of the survey participants knew that Pap testing should be completed within three-year intervals, as stated in the current guidelines.

Other important findings indicate:

  • Nonwhite women were more than nine times more likely to be compliant with the guidelines
  • Women that reported being knowledgeable about HPV were significantly more likely to have a history of Pap screening
  • Older women had a lower awareness of local clinics that provide free or low-cost HPV testing
  • Women who were knowledgeable about free and low-cost clinics were significantly more likely to have a history of Pap testing.

“[M]ost women presenting to clinics that offer free health care to the uninsured or underinsured believe that they should have a Pap test within the recommended [three]-year guideline and are obtaining proper cervical cancer screening within this time frame,” researchers wrote.

However, survey results also suggest that a discrepancy exists between many women’s awareness of the guidelines and their utilization of proper screening.

Factors that influence the utilization of cervical cancer screening in this population include race, income, education, awareness of HPV, knowledge of HPV screening and knowledge of local clinics.

“While our data show that cervical cancer screening is being utilized a relatively high rate, greater effort needs to be focused toward targeting impoverished populations and educating them about HPV and proper screening in order to prevent development and improve early detection of cervical cancer in the future,” the researchers wrote.


  1. Gaffney E et al. Poster Session. “Utilization of Cervical Cancer Screening Among Uninsured and Underinsured Females in Syracuse, New York.” Presented at: American Academy of Physician Assistants IMPACT 2013 Meeting. May 25-29, 2013. Washington, DC