Cervical Cancer Prevention Among Veterans: What Is the Impact of Military Sexual Trauma, PTSD, and Women’s Health Primary Care Providers on Screening and Prevention?

Abstract

Women veterans are more likely to receive cervical cancer screening than their civilian peers. Among veterans, those with mental health conditions are less likely to receive timely screening as compared to veterans without mental health conditions. The current study aimed to investigate whether a history of military sexual trauma, with or without concurrent PTSD disorder, and care from a provider with advanced training in women’s health (WH-PCP) altered the likelihood of cervical cancer screening among veterans. We conducted crosssectional analysis using a cohort of 89,249 women veterans, aged 21 through 64 years, who received outpatient care at any VHA medical center between FY13 and FY16. We used multivariable logistic regressions to examine variation in screening rates. The current study found that cervical cancer screening rate was higher among women assigned to WH-PCP (69.5% vs 61.2%). In the multivariable model with adjustment for patient characteristics and provider assignment, women veterans were more likely to receive cervical cancer screenings if they had a history of MST (OR = 1.14, p < 0.001), did not have a diagnosis of PTSD (OR = 1.06, p < 0.05), and were assigned to WH-PCP (OR = 1.48, p < 0.001). A statistically significant interaction effect was detected between MST and WH-PCP (p < 0.05). Veterans with a history of MST assigned to a WH-PCP were more likely to receive a screening than veterans with a history of MST not assigned to a WH-PCP. There is a complex relationship between MST and provider status, indicating a need to understand barriers and facilitators to cancer screenings.