Are cervical cancer screening rates different for women with schizophrenia? A Manitoba population-based study

Context: Barriers to cervical cancer screening (Pap tests) may exist for women experiencing schizophrenia. Design: This study analyzed healthcare records of all women in the province of Manitoba, Canada to: (a) compare cervical cancer screening rates of women with and without schizophrenia; and (b) determine factors associated with screening uptake. Setting: This study took place in Manitoba, Canada, utilizing anonymized universal administrative data in the Population Health Research Data Repository at the Manitoba Centre for Health Policy. Participants: All females aged 18-69 living in Manitoba December 31, 2002, excluding those diagnosed with invasive or in situ cervical cancer in the study period or previous 5 years. Main outcome: To determine factors associated with Papanicolaou (Pap) test uptake (1+ Pap test in 3 years, 2001/02-2003/04), logistic regression modeling included: diagnosis of schizophrenia, age, region, average household income, continuity of care (COC), presence of major physical comorbidity. Good COC was defined as at least 50% of ambulatory physician visits from the same general/family practitioner within two years. Results: Women with schizophrenia (n = 3220) were less likely to have a Pap test (58.8% vs. 67.8%, p<.0001) compared to all other women (n = 335 294). In the logistic regression, a diagnosis of schizophrenia (aOR = 0.70,95% CI 0.65-0.75); aged 50+, and living in a low-income area or the North decreased likelihood; good continuity of care (aOR 1.88, 95% CI 1.85-1.91) and greater physical comorbidity (1.21, 95% CI 1.04-1.41) increased likelihood. Conclusion: Women with schizophrenia are less likely to receive appropriate cervical cancer screening. Since good continuity of care by primary care physicians may mitigate this, psychiatrists should consider assisting in ensuring screening uptake. (C) 2009 Elsevier B.V. All rights reserved.