Smoking and cancer screening for women ages 42-75: associations in the 1990-1994 National Health Interview Surveys

Background: Previous studies have found an association between current smoking and lower rates of mammography and Pap testing. The objective of this study was to investigate the association of smoking status with breast and cervical cancer screening across the 1990-1994 National Health Interview Surveys (NHIS). The NHIS provides a consistent set of independent and dependent variables across several surveys, with data collected by a similar in-person interview methodology from year to year. This report employs more databases than have been used in other analyses that have examined associations between smoking and cancer screening.

Methods: Data were from the health promotion and cancer control supplements to the 1990-1994 NHIS. The target population was women ages 42-75. Associations were examined between smoking status (never, former, <1 pack/day, >/=1 pack/day) and three screening indicators: ever had a mammogram, mammogram in the past 2 years, and Pap test in the past 3 years. Sample sizes ranged from about 3,000 to over 10,800 depending on the respective NHIS survey and dependent variable. Data analyses were conducted by bivariate and multiple logistic regression.

Results: Women who smoked >/=1 pack of cigarettes per day were significantly less likely to have had mammography screening in all NHIS surveys, compared to women who never smoked. Adjusted odds ratios were 0.63 to 0.74 for ever had a mammogram, and 0.56 to 0.66 for mammography in the past 2 years. Women who smoked >/=1 pack per day also had lower Pap test rates than women who never smoked in 1992-1994 (adjusted odds ratios of 0.51-0.71). Results for lighter smokers were not as consistent. Former smokers often had significantly higher screening rates than never smokers.

Conclusions: Research still needs to identify reasons for lower screening among women who smoke. Factors to explore include the social networks of smokers and broader health behavior patterns. Clinicians should consider heavier smoking as a marker for risk of not obtaining screening and make assessment of screening status a priority at each visit.