This retrospective matched cohort study used a large US insurance database (2010–Q1 2022) to compare rates of routine gynecologic exams, Pap tests, and mammograms in adult women with cerebral palsy (CP; n=138,277) versus age-matched women without CP (n=553,102), across five-year age intervals from 20–69 years.
Women with CP were far less likely to receive every type of preventive screening: gynecologic exams (31.8% vs. 79.8%), Pap tests (23.4% vs. 54.1%), and mammograms (44.9% vs. 72.3%; all p<0.001). On multivariable analysis, CP independently predicted lower odds of gynecologic exams (OR 0.15), Pap tests (OR 0.26), and mammograms (OR 0.39; all p<0.001).
- Insurance claims data cannot confirm whether screenings were offered but declined, or never offered — limiting insight into root causes. - Study does not capture uninsured women, potentially underrepresenting the most vulnerable. - CP severity and functional status are not captured in ICD codes, so dose-response relationships cannot be assessed.
Clinicians should proactively offer and facilitate gynecologic screenings for women with CP, who receive these services at dramatically lower rates despite equal need. Addressing access barriers — such as positioning accommodations and care coordination — may be a high-yield starting point.
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