Recent Pap tests among Canadian women: is depression a barrier to cervical cancer screening?

Previous studies have shown that depression is associated with both lower use of preventive cancer screening programs and lower probability of cancer survival. Given the increasing incidence of depression among Canadian women, this study sought to determine if recent Pap testing varies by the presence of depression.

This population-based study used cross-sectional, self-reported data from the Canadian Community Health Survey (CCHS) Cycle 3.1 (2005) to estimate the association between depression and recent Pap testing within the previous 3 years among 2351 Canadian women without hysterectomy aged 18-69 years.

After adjustment for confounders, depressed women had nonsignificantly increased odds of a recent Pap test (OR 1.08, 95% CI 0.95, 1.29); however, age was an important effect modifier of this relationship. Young depressed women (18-29 and 30-39 years) were significantly more likely to report a recent Pap test (AOR 1.78, 95% CI 1.37, 2.31, and AOR 1.47, 95% CI 1.00, 2.15, respectively), whereas middle-aged depressed women (40-49 and 50-59 years) were significantly less likely to report a recent Pap test (AOR 0.76, 95% CI 0.58, 0.98, and AOR 0.68, 95% CI 0.50, 0.93, respectively) compared with their nondepressed counterparts. No significant relationship was detected for the oldest age group (60-69 years).

To our knowledge, these results are the first to demonstrate an interaction effect of age on the association between depression and recent Pap testing. Longitudinal studies should be conducted to explore the role of age as an effect modifier of this relationship and to inform policy and programming aimed at improving rates of cervical cancer screening across all age groups.