Predictors of timely diagnostic follow-up after an abnormal Pap test among Hispanic women seeking care in El Paso, Texas

Thelma Carrillo,Zuber D Mulla,Michele Follen,Michael E Scheurer,Christina G Bracamontes,Jane R Montealegre

doi:10.1186/s12905-020-01161-9

Abstract

BackgroundDiagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer. The purpose of this study is to describe patient characteristics associated with timely receipt of a diagnostic colposcopy after an abnormal Pap test among Hispanic women in El Paso, a Texas-Mexico border city.MethodsWe conducted a retrospective chart review of Hispanic patients seen at an academic colposcopy clinic following an abnormal Pap test. An optimal diagnostic interval to colposcopy was based on a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) quality indicator and was defined as receipt of colposcopy within 90 days or less from the date of an abnormal Pap test. Risk ratios (RR) were calculated by building a generalized linear model fit using a Poisson distribution, log link, and robust variance.ResultsOverall, 177 of the 270 women (65.6%) received follow-up within an optimal diagnostic interval. After adjusting for other variables in the model, women who were 30 years of age or older were 32% more likely to have an optimal interval than younger women (adjusted RR = 1.32, P < 0.01). High school graduates were less likely than more educated women to have an optimal interval (adjusted RR = 0.68, P < 0.01). Participation in the NBCCEDP was not associated with receipt of follow-up within an optimal diagnostic interval.ConclusionsCompared with women with greater educational attainment, high school graduates were less likely to receive follow-up within an optimal diagnostic interval, as were younger (< 30 years) women compared with older women. Participation in the NBCCEDP was not associated with receipt of care within an optimal diagnostic interval.

Highlights

Diagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer
Cervical cancer incidence and mortality are highest among minority women, among African-American and Hispanic women [3], with respective incidence and mortality rates of 9.0 and 4.0 per 100,000 among African Americans and 9.5 and 2.5 per 100,000 among Hispanic women compared with 7.1 and 2.1 per 100,000 among non-Hispanic Whites [2, 4, 5]
We examine the characteristics of predominantly low-income Hispanic women living along the Texas-Mexico border who received timely followup diagnostic care after receiving their abnormal Pap smear results

Summary

Introduction

Diagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer. Cervical cancer incidence and mortality are highest among minority women, among African-American and Hispanic women [3], with respective incidence and mortality rates of 9.0 and 4.0 per 100,000 among African Americans and 9.5 and 2.5 per 100,000 among Hispanic women compared with 7.1 and 2.1 per 100,000 among non-Hispanic Whites [2, 4, 5]. The cervical cancer mortality rates among women along the Texas-Mexico border are reported to be even higher than for women living in non-border counties in Texas. In the years 2002–2006, Hispanic women along the Texas-Mexico border had a cervical cancer mortality rate of 4.6 per 100,000 compared with 2.5 per 100,000 in non-Hispanic White women living in non-border counties [6]. Women along the border are less likely to report a recent Pap test compared with women in non-border counties in Texas, 61.7% vs. 75.7% [7] and are substantially less likely to have health insurance, 52.6% vs. 73.7% [7]

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