Physical Activity and Cervical Cancer Testing Among American Indian Women


  • This study was supported by grants from Native People for Cancer Control, a Community Networks Program sponsored by the National Cancer Institute (grant 1U01CA114642 to D. Buchwald), and the Education and Research Toward Health study sponsored by the National Cancer Institute (grant 1R01CA89139 to J. Henderson). Dr. Henderson reports a minor financial relationship (less than $10,000) with the Centers for Disease Control and Prevention through his membership on the Breast and Cervical Cancer Early Detection Program National Advisory Council. The authors thank our participating tribal communities, the many American Indians who generously gave their time and energy to participate in the survey, and the many staff and colleagues who worked on the study. We also thank Raymond Harris, PhD, for his thoughtful editing of successive drafts of this manuscript. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official view of the National Cancer Institute. The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the IHS. For further information, contact: Dedra Buchwald, MD, General Internal Medicine, Harborview Medical Center, Box 359780, 325 Ninth Avenue, Seattle, WA 98104; e-mail


Purpose: Studies have shown that women who engage in high levels of physical activity have higher rates of cancer screening, including Papanicalaou (Pap) tests. Because American Indian (AI) women are at high risk for cervical cancer morbidity and mortality, we examined Pap screening prevalence and assessed whether physical activity was associated with screening adherence among AI women from 2 culturally distinct regions in the Northern Plains and the Southwest.

Methods: A total of 1,979 AI women at least 18 years of age participating in a cross-sectional cohort study reported whether they received a Pap test within the previous 3 years. Physical activity level was expressed as total metabolic equivalent (MET) scores and grouped into quartiles. We used binary logistic regression to model the association of Pap testing and MET quartile, adjusting for demographic and health factors.

Findings: Overall, 60% of women received a Pap test within the previous 3 years. After controlling for covariates, increased physical activity was associated with higher odds of Pap screening (OR = 1.1 per increase in MET quartile; 95% CI = 1.1, 1.2).

Conclusions: This is the first study to examine physical activity patterns and receipt of cancer screening in AIs. While recent Pap testing was more common among physically active AI women, prevalence was still quite low in all subgroups. Efforts are needed to increase awareness of the importance of cervical cancer screening among AI women.