Background: Participation in cervical cancer screening (CCS) is overall high in Germany. However, little information is available on women remaining unscreened over several years, how they differ from participants and to which extent these non-participants could be reached via the health care system to be informed about CCS.
Objectives: To quantify the proportion of women not participating in CCS over 10 years, to compare them to participants regarding educational level, health indicators, and lifestyle/behavioral factors, and to determine contacts with the health care system among non-participants.
Methods: Using health claims data (~20% of the German population), we included women aged 20-65 years in 2012 with continuous observation from 2010-2021 to obtain baseline (2010-2011) and follow-up (2012-2021) information. 10-year participation in CCS was determined from 2012-2021 (ever/never). Participants and non-participants were described at baseline regarding education and health indicators (e.g., antihypertensive treatment, use of antidepressants, smoking). Non-participants were further described regarding contacts with physicians (by specialty) and utilization of other preventive offers (e.g., general health check-up, screening) during follow-up. Analyses were stratified by age in 2012 (20-34, 35-49, and 50-65 years).
Results: Overall, 3,382,939 women were included. The proportions of women not participating in CCS from 2012-2021 were 4.7% (20-34 years), 10.2% (35-49 years) and 21.4% (50-65 years). The differences in these proportions between those with higher vs. lower education were 1.4% (20-34 years: 3.8% vs. 5.2%) 2.8% (35-49 years: 8.2% vs. 11.0%) and 3.9% (50-65 years: 17.2% vs. 21.1%). Regarding health indicators at baseline, the differences between participants and non-participants were ≤2 percentage points in all age groups. Among CCS non-participants, 15.2% (20-34 years), 49.0% (35-49 years) and 67.0% (50-65 years) utilized at least one other screening offer for which they were eligible during follow-up. Most often, this was the general health check-up (31.3%, 58.7% and 71.2%, respectively). Of all CCS non-participants, ≥95% had at least one contact to a general physician and 18-27% had at least one contact to a gynecologist during follow-up (i.e., without having been screened).
Conclusions: Long-term non-participants in CCS seem to otherwise engage with the health care system and might thus be reachable using existing structures. The general health check-up could be an opportunity to discuss CCS with women. Raising awareness regarding the possible benefits of CCS could be considered among women aged 50-65 in particular since one in five women in this group did not participate in CCS for at least ten years.