Provincial variation and associated factors in adherence to cervical cancer screening in Canada: Evidence from the Canadian Partnership for Tomorrow's Health.

ObjectivesCervical cancer screening programs reduce cervical cancer mortality; however, screening engagement is not equally distributed across populations, and evidence on factors contributing to variation remains limited.MethodsUsing data from the Canadian Partnership for Tomorrow's Health (CanPath) across five regional cohorts (BC Generations Project, Alberta's Tomorrow Project, Ontario Health Study, CARTaGENE, and Atlantic Partnership for Tomorrow's Health Study (Atlantic PATH), we assessed self-reported engagement in Pap test cervical cancer screening among participants recruited between 2008 and 2016. Self-reported Pap (Papanicolaou) screening status was categorized as "never" or "ever." Ever screening was further classified as "recent" (≤3 years) or "past" (>3 years). Multivariable logistic regression models assessed associations with screening status while adjusting for potential confounders.ResultsA total of 166,804 individuals met the inclusion criteria. Across cohorts, 162,592 (97.5%) and 4212 (2.5%) reported ever and never undergoing cervical cancer screening, respectively. Among those with a screening history, 135,823 (83.5%) were recently screened, ranging from 78% in CARTaGENE to 85% in Atlantic PATH. Nonwhite ethnicity, lower household income, single or never-married status, low physical activity, poorer self-perceived health, and ≥24 months since the last medical checkup were associated with never or past screening. Current smoking, younger age, and reproductive and hormonal factors showed differential associations between never versus ever screened individuals and past versus recent screening.ConclusionThe national target of 80% cervical cancer screening adherence was exceeded in most regions. Persistent socioeconomic and health-related disparities highlight the need for targeted interventions. Differences between factors associated with screening initiation and maintenance warrant further investigation.