Pap smear utilization in Canada: estimates after adjusting the eligible population for hysterectomy status

The 1994 National Population Health Survey (NPHS) confirmed that the trend in Pap smear utilization has not changed in the past 10 years; 15% of Canadian women reported never having had a Pap smear and an additional 15% reported not having had one within 3 years prior to the survey. Most of these underserved women can be characterized as disadvantaged. The overall prevalence of hysterectomy in Canada in 1994 was 16.3%, and prevalence increased sharply to 30% between ages 35 and 55 years. Hysterectomy rates vary according to sociodemographic factors, with women of lower income and education indicating a higher proportion of hysterectomies. We adjusted the female population from the NPHS, by removing the estimated proportion of women reporting hysterectomy, to reveal the true population at risk of developing cervical cancer. Absolute prevalence of Pap smear utilization increased (7 - 25%); the relative improvement was much higher. Adjusting the eligible population could enable screening programs to better estimate the size of their underserved population.