Recent Pap Smear Research Articles

Adherence to Cervical Cancer Screening Guidelines for U.S. Women Aged 25–64: Data from the 2005 Health Information National Trends Survey (HINTS)

Although it is widely accepted that Papanicolaou (Pap) screening can reduce cervical cancer mortality, many women still do not maintain regular cervical cancer screenings. To describe the prevalence of cervical cancer screening and the demographic, behavioral, psychological, and cancer-related knowledge factors associated with adherence to U.S. Preventive Services Task Force (USPSTF) cervical cancer screening guidelines among women in the United States. Data for women aged 25-64 were obtained from the National Cancer Institute's (NCI) 2005 Health Information National Trends Survey (HINTS). Women were considered adherent to screening guidelines if they had two consecutive, on-schedule screenings and planned to have another within the next 3 years. The sample comprised 2070 women. Ninety-eight percent of women reported ever having a Pap smear, 90% reported having had a recent Pap smear (within 3 years), and 84% were adherent to USPSTF screening guidelines. Maintaining regular cervical cancer screening was significantly associated with having health insurance, normal body mass index (BMI), smoking status (nonsmoker), mood (absence of a mood disturbance), and being knowledgeable about cervical cancer screening and human papillomavirus (HPV) infection. Based on the observation that women who were current smokers, obese, or experiencing a substantial degree of psychological distress were significantly less likely to adhere to recommended screening guidelines, we suggest that healthcare providers pay particular attention to the screening needs of these more vulnerable women.

The Association Between Individual Time Preferences and Health Maintenance Habits

Encouraging healthy behaviors, including disease screening, exercise, and tobacco avoidance, has been a significant focus of clinical attention in recent decades. Little is known about the association between individual preferences with respect to time play and preventive health care use and healthy lifestyles. To determine whether rates of these health behaviors are associated with latent time preferences. Interval regression analysis was used to impute individual level discount rates. The difference in means for the rates of health behaviors were assessed for high vs. low to moderate discounting groups using one-factor probit models. The 2004 wave of the Health and Retirement Survey included in a time preferences module (1,039 respondents aged 24 to 65 years). Rates of recent mammograms, breast exams, Pap smears, prostate exams, cholesterol testing, flu shots, and dental visits, and non-smoking status. Respondents in the upper 20th percentile of the distribution have an average imputed annual discount rate of 0.335 (33.5%). High discount rate status is found to have a negative marginal association on the probability that respondents had recent mammogram use (-15.1%; P = 0.001), Pap smear use (-8.3%; P = 0.049), prostate examination use (-20.4%; P =0.003), dental visits (-24.8%; P = 0.001), cholesterol testing (-12.4%; P = 0.001), flu shot usage (-11.1%; P = 0.005), rates of vigorous exercise (-15.1%; P = 0.001), nonsmoking status (-10.4%; P= 0.001), and undertook all measured health habits (-7%; P = 0.001). Differences in underlying preferences for the present over the future may be a substantial barrier for people's propensity to adopt healthy lifestyles.

Cervical cancer control research in Vietnamese American communities.

Census data show that the U.S. Vietnamese population now exceeds 1,250,000. Cervical cancer among Vietnamese American women has been identified as an important health disparity. Available data indicate the cervical cancer disparity may be due to low Papanicolaou (Pap) testing rates rather than variations in human papillomavirus infection rates and/or types. The cervical cancer incidence rates among Vietnamese and non-Latina White women in California during 2000 to 2002 were 14.0 and 7.3 per 100,000, respectively. Only 70% of Vietnamese women who participated in the 2003 California Health Interview Survey reported a recent Pap smear compared with 84% of non-Latina White women. Higher levels of cervical cancer screening participation among Vietnamese women are strongly associated with current/previous marriage, having a usual source of care/doctor, and previous physician recommendation. Vietnamese language media campaigns and lay health worker intervention programs have been effective in increasing Pap smear use in Vietnamese American communities. Cervical cancer control programs for Vietnamese women should address knowledge deficits, enable women who are without a usual source of care to find a primary care doctor, and improve patient-provider communication by encouraging health-care providers to recommend Pap testing as well as by empowering women to ask for testing.

Social Networks and Cancer Screening in Four U.S. Hispanic Groups

Am J Prev Med 2000;19:47–52 The purpose of the study was to determine the relationship between a woman's social integration and her likelihood of recalling having had a Pap smear. The population consisted of 2,383 women over the age of 40 drawn from a consortium of public health organization in California, Texas, New York, and Florida. A telephone survey was conducted among Mexican, Central American, Puerto Rican, and Cuban women using measures of language acculturation and social integration (church attendance, number of close relatives/friends). Social integration was positively linked to the likelihood of having had a recent Pap smear more than to mammography. The link was not significant for Puerto Rican women or for mammography. The likelihood of a recent Pap smear ranged from 45% among Mexican-American women with low levels of social integration to 75% among Cuban-American women with high levels of social integration. Comment: Cervical cancer rates are high among Hispanic women. Many outreach efforts involve recruitment to screening through social networks. This study suggests that improved outreach may depend on strategies to reach women who are not tightly integrated into their communities. It also identifies differences among Hispanic populations, suggesting that it may not be possible to generalize a single approach to improving cancer screening to all Hispanic communities. (LSM)

Pap smear screening history of women with squamous cell carcinoma and adenocarcinoma of the cervix

Since the introduction of the Pap smear screening, the incidence of squamous cell carcinoma (SCC) has decreased significantly, but the incidence of adenocarcinoma (AC) relative to SCC has increased. To compare the Pap smear history of patients with AC and SCC of the cervix. Patients for the study were identified from the database of Queensland Centre for Gynaecological Cancer. Patients with AC and SCC were matched for age at diagnosis and International Federation of Gynecology and Obstetrics stage. The final population included 188 matched pairs, being 376 patients in total. Data were collected upon the histological type of cancer, result of the most recent Pap smear, date and result of the Pap smear prior to the most recent Pap smear and symptoms. Chi-squared tests and Fisher's exact test were used to compare the two patient groups for several variables. Patients with AC had significantly more false-negative results on their most recent Pap smear (P<0.0001) than patients with SCC. The incidence of symptoms such as bleeding and/or vaginal discharge was comparable in patients with AC and SCC. The time between the most recent Pap smear and the diagnosis of cervical cancer was significantly shorter for patients with AC (P=0.01). Patients with AC had Pap smears more regularly than those with SCC, and their most recent Pap smear was significantly more likely to be normal. Thus, Pap smear prior to a diagnosis of AC is more likely than SCC false-negative and therefore not indicative of cervical cancer.

Knowledge about Cervical Cancer Risk Factors, Traditional Health Beliefs, and Pap Testing Among Vietnamese American Women

The objective of this paper was to examine knowledge about cervical cancer risk factors and traditional health beliefs in relation to Papanicolaou (Pap) testing among Vietnamese women. A population-based survey was conducted in Seattle (n<352, response rate=82%) during 2002. The proportions of women who knew that older age, not getting regular Pap tests, and Vietnamese ethnicity are associated with an elevated cervical cancer risk were only 53%, 62%, and 23%, respectively. The majority (87%) incorrectly believed poor women's hygiene is a risk factor for cervical cancer. Approximately two-thirds (68%) of the women had received a Pap test during the preceding three years. Knowing that lack of Pap testing increases the risk of cervical cancer was strongly associated (p<0.001) with recent Pap smear receipt. Our results confirm that Vietnamese women have lower levels of cervical cancer screening than non-Latina white women. Intervention programs addressing Pap testing in Vietnamese communities should recognize women's traditional beliefs while encouraging them to adopt biomedical preventive measures into their daily lives.

Minority adult survivors of childhood cancer: a comparison of long-term outcomes, health care utilization, and health-related behaviors from the childhood cancer survivor study.

To determine the influence of race/ethnicity on outcomes in the Childhood Cancer Survivor Study (CCSS). Of CCSS adult survivors in the United States, 443 (4.9%) were black, 503 (5.6%) were Hispanic and 7,821 (86.6%) were white. Mean age at interview, 26.9 years (range, 18 to 48 years); mean follow-up, 17.2 years (range, 8.7 to 28.4 years). Late mortality, second malignancy (SMN) rates, health care utilization, and health status and behaviors were assessed for blacks and Hispanics and compared with white survivors. Late mortality rate (6.5%) and 15-year cumulative incidence of SMN (3.5%) were similar across racial/ethnic groups. Minority survivors were more likely to have lower socioeconomic status (SES); final models were adjusted for income, education, and health insurance. Although overall health status was similar, black survivors were less likely to report adverse mental health (females: odds ratio [OR], 0.6; 95% CI, 0.4 to 0.9; males: OR, 0.5; 95% CI, 0.3 to 0.8). Differences in health care utilization and behaviors noted: Hispanic survivors were more likely to report a cancer center visit (females: OR, 1.5; 95% CI, 1.1 to 2.0; males: OR, 1.7; 95% CI, 1.2 to 2.3); black females were more likely (OR, 1.6; 95% CI, 1.1 to 2.4), and Hispanic females less likely to have a recent Pap smear (OR, 0.7; 95% CI, 0.5 to 1.0); black and Hispanic survivors were less likely to report smoking; black survivors were less likely to report problem drinking. Adjusted for SES, adverse outcomes in CCSS were not associated with minority status. Importantly, black survivors reported less risky behaviors and better preventive practices. Hispanic survivors had equitable access to cancer related care.

Impact of U.S. Citizenship status on cancer screening among immigrant women

We evaluated the relationship between U.S. citizenship status and the receipt of Pap smears and mammograms among immigrant women in California. Cross-sectional study using data from the 2001 California Health Interview Survey. Noninstitutionalized, civilian women, aged 18 years and older living in California. We analyzed data from the 2001 California Health Interview Survey and used logistic regression models to adjust for sociodemographic factors and for access and utilization of health services. After adjusting we found that U.S. citizen immigrants were significantly more likely to report receiving a Pap smear ever (adjusted prevalence ratio [aPR], 1.05; 95% confidence interval [CI], 1.01 to 1.08), a recent Pap smear (aPR, 1.07; 95% CI, 1.03 to 1.11), a mammogram ever (aPR, 1.17; 95% CI, 1.12 to 1.21), and a recent mammogram (aPR, 1.38; 95% CI, 1.26 to 1.49) as compared to immigrants who are not U.S. citizens. Also associated with receiving cancer screening were income, having a usual source of care, and having health insurance. Hispanic women were more likely to receive Pap smears as compared to whites and Asians. Not being a U.S. citizen is a barrier to receiving cervical and breast cancer screening. Additional research is needed to explore causal factors for differences in cancer screening rates between citizens and noncitizens.

Acculturation and cancer screening among latinas: Results From the National Health Interview Survey

Although early detection of breast and cervical cancer is one of the most effective means of assuring timely treatment and survival, the cultural hypothesis proposes that traditional norms, values, and beliefs deter Latinas from being screened. We assessed whether acculturation is associated with Latinas' receipt of a recent mammogram, clinical breast examination (CBE), and Papanicolaou (Pap) test, and the contribution of acculturation to screening after adjusting for sociodemographic variables. We used data from the Health Promotion and Disease Prevention Supplement of the 1991 National Health Interview Survey. The sample for analyses of Pap test utilization included 1,370 Latinas age 18 and over, and for mammography and CBE, 525 Latina women age 40 and over. Acculturation was associated with a higher likelihood of having had a recent mammogram, but this effect was not significant when controlling for sociodemographic factors. In both adjusted and unadjusted analyses, acculturation did not predict recent Pap smears. Acculturation was associated with greater likelihood of recent CBE, controlling for sociodemographic factors. The association between acculturation and cancer screening is inconsistent. Theoretical models are needed to explain the mechanisms involved in the association (or lack thereof) between acculturation and screening.

Pap testing among Vietnamese women: health care system and physician factors.

Cervical cancer occurs more frequently among Vietnamese Americans than women of any other race/ethnicity. In addition, previous studies in California have documented low Papanicolaou (Pap) testing rates in Vietnamese communities. This study focused on health care system factors and physician characteristics associated with recent cervical cancer screening among Vietnamese women. A population-based survey was conducted in Seattle during 2002. In-person interviews were conducted by bilingual, bicultural female survey workers. The survey response rate was 82% and 518 women were included in the analysis. Seventy-four percent of the respondents reported having been screened for cervical cancer on at least one occasion, and 64% reported a Pap smear within the previous 2 years. Women with a regular doctor were more likely to have been recently screened than those without a regular doctor (OR = 2.33, 95% CI = 1.45-3.74). Among those with a regular doctor, having a male physician, receiving care at a private doctor's office (rather than a community, hospital, or multi-specialty clinic), and concern about the cost of health care were independently associated with lower screening rates. Physician ethnicity was not associated with recent Pap smear receipt. The findings support targeted interventions for Vietnamese women without a regular physician and private doctors' offices that serve Vietnamese Americans. The availability of low cost screening services should be publicized in Vietnamese communities.

Pap smear use in California: are we closing the racial/ethnic gap?

Background Minority women continue to be disproportionately affected by cervical cancer. Minority population groups at high risk for cervical cancer may be failing to fully comply with screening recommendations. The use of Pap smears among women in California was evaluated to identify ethnic groups at higher risk for noncompliance with cervical cancer screening. Methods Cross-sectional analysis of 2001 California Health Interview Survey data. Logistic regression was used to assess the independent contribution of race/ethnicity to the use of Pap smears. Results Hispanic (aPR = 1.03, 95%CI 1.02–1.05) and Black (aPR = 1.03, 95% CI 1.001–1.06) women are more likely to report a Pap smear in the past 3 years as compared to White women. Asians were the least likely to report cervical cancer screening despite a more favorable sociodemographic profile. Screening rates varied among Hispanic or Asian subgroups; Mexicans, Vietnamese, Chinese, and South Asians are particularly underserved. Conclusions In contrast to the country as a whole, Hispanic women in California are more likely to report a recent Pap smear as compared to White women. However, racial/ethnic disparities in Pap smear use persist; Asian women are the least likely to report cervical cancer screening as compared to any other group.

Comparison of endoscopic procedures for colorectal cancer screening in women with mammography and Pap smear

Background This study compared the experiences of women who underwent endoscopic screening for colorectal cancer vs. their experiences with breast and cervical cancer screening by mammography and Pap smear, respectively. Methods Women who had either flexible sigmoidoscopy or colonoscopy as a screening procedure for colorectal cancer were asked to return a questionnaire by mail. In the questionnaire, they were asked about the procedure they had just undergone and to compare it with recent mammograms and Pap smears. Flexible sigmoidoscopy was performed without sedating the patient; colonoscopy was performed with the patient under deep sedation (midazolam, fentanyl, and propofol administered by an anesthesiologist). Results Responses were obtained from 258 women (88%). Of these, 152 had colonoscopy and 106 had flexible sigmoidoscopy. A total of 72% of respondents found colonoscopy to be a comfortable test. Only 26% found flexible sigmoidoscopy uncomfortable, which was similar to mammography and Pap smear, at 22%. In terms of the test considered to be the most embarrassing, the highest response rate (38%) was for the Pap smear. Most women had no preference as to the gender of the endoscopist, but 46% preferred a woman doctor for a Pap smear ( p < 0.001). Preparation was regarded as the worst part of the colonoscopy procedure; for flexible sigmoidoscopy, the procedure itself and the preparation were equivalent. Conclusions Women found flexible sigmoidoscopy or colonoscopy comfortable and less embarrassing than a Pap smear or a mammography. There was no preference with respect to the gender of the physician who performed the colorectal screening procedures, unlike the Pap smear. Most respondents would have the procedure again and would recommend it to others.

Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age.

Older women whose life expectancy is less than 5 years are unlikely to benefit from screening mammography or Papanicolaou (Pap) smears. Since life expectancy is better predicted by health status than by age alone, guidelines recommend considering an older woman's general health when making screening decisions. To determine whether screening mammography and Pap smears are targeted to healthy older women and are avoided in women with limited life expectancies. Cross-sectional population-based study. California. 4792 women 70 years of age or older who participated in the California Health Interview Survey between November 2000 and October 2001. Predictor variables included age and health status. Health status was measured by using the Medical Outcomes Study 12-item Short Form Physical Summary Scale. The main outcome was self-reported receipt of screening mammography within the previous 2 years and a screening Pap smear within 3 years. Seventy-eight percent of women reported recent screening mammography, and 77% reported a recent Pap smear. Screening rates decreased with advancing age. However, within each age group, the percentage of women reporting screening did not significantly decrease with worsening health status (P > 0.1 for all comparisons). More than half of women 80 years of age or older in the worst health quartile reported recent screening, representing approximately 81,000 mammograms and 35,000 Pap smears. This study relied on self-report, and the interview response rate was 63.7%. Rates of recent screening mammography and Pap smears are high among older women in California. Although screening rates drop with advancing age, women in poor health do not avoid screening. Screening should be better targeted to healthy older women and should be avoided in women with limited life expectancies for whom risks of screening outweigh potential benefits.

Impact of English language proficiency on receipt of pap smears among Hispanics.

Our aim was to assess the impact of English language proficiency on Pap smear use among Hispanics. We performed a cross-sectional study using 2000 National Health Interview Survey data and included 2,331 Hispanic women, age >/=18 without a hysterectomy. After adjusting for sociodemographic and access factors, highly proficient English speakers were more likely to report a Pap smear in the past 3 years as compared to low proficient (adjusted prevalence ratio, 1.16; 95% confidence interval, 1.08 to 1.22). Also associated with Pap smear use were income, usual source of care, and health insurance. Our finding suggests that low English language proficiency is a barrier to receiving recent Pap smears among Hispanics.

Community-based Cultural Predictors of Pap Smear Screening in Nova Scotia

Pap smear screening is effective in reducing the incidence of cervical cancer. However, some subgroups of women are less likely to be screened than others. Since Canadian provincial health databases do not contain data fields identifying ethnicity or language, analyses employing these variables are typically not available. This paper overcomes this problem by using community- rather than person-based measures. Associations with having had a recent Pap smear are reported by community income, language, ethnic group, and urban/rural status, as well as the woman's age. The provincial Health Card Number and Cytology Registries were linked to ascertain the screening status of women in mainland Nova Scotia and Cape Breton. Postal codes were linked to census enumeration areas and then to Statistics Canada census data to create community-based cultural measures for each woman. Women in mainland Nova Scotia were more likely to have had a recent Pap smear (Odds Ratio (OR)=1.36; 95% Confidence Interval (CI):1.33-1.39). Women living in low income (OR=1.19; CI:1.15-1.22), Aboriginal (OR=1.60; CI:1.46-1.76), mixed Black (OR=1.25; CI:1.19-1.30) and rural (OR=1.09; CI:1.07-1.11) communities and who were older were less likely to have had a recent Pap smear. These findings were not unexpected. In the United States and elsewhere, associations between Pap screening status and women with low income, rural residence, Aboriginal and Black heritage have been reported using person-based methods. Our findings demonstrate a method of providing measures of ethnicity and language that should be considered for use in Canadian studies of service utilization, disease status, and well-being.

Pap Smear Use in a Population of Older Mexican-American Women

ABSTRACT Background: Hispanic women and older women (age ≥ 50 years) in general have been identified as populations of women who often underutilize Papanicolaou (Pap) smears. Objective: To report the rates of cervical cancer screening in a group of older Mexican American women and to identify the correlates of having a Pap smear in the past three years. Data Source: The Mammography Use by Older Mexican-American Women Survey, a stratified area probability sample of 452 women ages 50–74 from three southeast Texas counties. Self-report data was collected with in-person interviews from 1997 to 1999. Results: We found that 93.1% of the women reported at least one Pap smear in their lifetime and that 64.1% reported a Pap smear in the past three years. Odds of reporting a recent Pap smear was lower for older women (OR 0.51, 95% CI 0.32–0.82) and those below the poverty line (OR 0.52, 95% CI 0.33–0.82). The odds were higher for women who had a regular doctor for female care (OR 6.49, 95% CI 2.96–14.23) or a regular clinic or hospital source for female care (OR 5.50, 95% CI 2.55–11.89). Among these older Mexican-American women, cultural factors (language of interview, acculturation, fatalism) did not have a significant effect on screening use. Conclusion: Recent Pap smear use (64.1%) falls well below the year 2010 goal of 90%. Efforts need to be made to overcome barriers to Pap smear utilization for these women, such as providing access to female medical care.

Changes in mucosal immunity of the adolescent genital tract throughout the menstrual cycle

BACKGROUND: Females may be most susceptible to STDs during menses and the follicular phase of the menstrual cycle. Research in adults has shown that genital tract immunity is most suppressed as unopposed estrogen peaks at ovulation; adolescents may be more responsive to estrogen, resulting in greater local immunosuppression and higher risk of STD. Study objectives were to (1) characterize mucosal immunity of the adolescent genital tract during the cycle and (2) determine if adolescents have more suppressed immunoglobulin (Ig) levels in the follicular phase than adults.METHODS: Girls age 15-17 years were eligible if they were ≥ 2 years post-menarche, had regular cycles, had had sex, and had a recent normal Pap smear. Daily from cycle day 9 until ovulation, then every other day until menses, cervical secretions for IgA, IgG, and cytokines were collected via Weck-cel sponge and serum for luteinizing hormone (LH), estradiol (E), and progesterone was obtained. To control for individual differences in cycle length and time of ovulation, each visit was converted to relative day (RD) to ovulation. From adult data, representative RDs for each cycle phase were identified: RD −4 (follicular), RD 0 (ovulation), RD +8 (luteal). Igs and cytokines were compared among the phases using the Friedman matched samples test. Spearman correlation coefficients (ρ) were used to correlate E levels with Ig and cytokine levels for each phase. Curves were fitted to the data using locally weighted regression (loess) smoothing. Rates of change in IgA and IgG were determined by the slope (β) from linear regressions for the follicular and luteal phases. Mean βs were compared with historical data on 13 adults, using t tests.RESULTS: Three girls (mean age 16.8 years) completed 49 visits (13-23 each). Mean IgA levels varied from 455 μg/mL (RD −4) to 140 μg/mL (RD 0) to 863 μg/mL (RD +8) (p = 0.05), as did mean levels of interleukin (IL)-6 (1756 to 262 to 6200 pg/mL, p = 0.05) and IL-8 (34 to 4 to 59 ng/mL, p = 0.05). Mean IgG levels followed a similar pattern, although the differences were not significant. Loess curves showed that IgA, IgG, IL-2, and IL-8 reached their lowest levels within 1 day of ovulation. In the follicular phase, E levels were negatively correlated with IgA (ρ = −0.62, p = 0.008), IL-2 (ρ = −0.52, p = 0.04), and IL-10 (ρ = −0.70, p = 0.002). Compared with adults, adolescents had a greater drop in IgG in the follicular phase (mean β −953 vs. −269 μg/mL/day, p = 0.045), but a similar rate of rise in IgG in the luteal phase (mean β + 118 vs. +100 μg/mL/day, p = 0.252). Rates of change in IgA did not differ between adolescents and adults for either phase.CONCLUSIONS: Cervical Ig and cytokine levels vary during the menstrual cycle in adolescents, reaching their nadir at ovulation. Adolescents have a steeper decline in follicular IgG than adults, suggesting that adolescents are more immunosuppressed when exposed to unopposed estrogen. Replicating and expanding these findings with a larger sample will be important to develop effective immunoprotection against STDs for this vulnerable population.

Pap Smear Screening among Urban Southwestern American Indian Women

Background. American Indian women have among the highest incidence and mortality rates of cervix cancer in the United States. The incidence of cancer of the cervix among American Indians is 19.5/100,000 versus 7.8/100,000 in U.S. whites, and comparison by geographic region/tribe indicates that the rate is four to six times higher in some tribes. Papanicolaou cytological testing (Pap smear) permits the detection of cervical lesions before they become cancerous, effectively reducing the incidence of cervical cancer by 75–90%. The American Cancer Society recommends a Pap smear every year beginning at age 18 years or when sexually active, and more frequent screening in high-risk populations.Methods. A random household cross-sectional survey was conducted in Phoenix, Arizona, to assess cervical cancer screening rates among 519 adult urban American Indian women. Logistic regression was used to identify predictors of Pap smear use.Results. Three-quarters (76.1%) of urban women American Indian surveyed received a Pap smear within the past 3 years, but only 49.5% received a Pap smear within the last year. Women over age 50 years were significantly less likely to have received a recent Pap smear in comparison to younger women.Conclusions. The results of this study indicate that limited access to health care and lack of knowledge about the procedure were important barriers to Pap smear use. Improving cervix cancer screening participation rates is an important step in reducing the disease burden in this high-risk population.

Compliance with Mammography Guidelines: Physician Recommendation and Patient Adherence

Background.Guidelines recommend that women ages 50–75 years receive screening mammography every 1–2 years. We related receipt of physician recommendations for mammography and patient adherence to such recommendations to several patient characteristics.Methods.We retrospectively reviewed medical records of 1,111 women ages 50–75 attending three clinics in an urban university medical center. We ascertained overall compliance with mammography guidelines and two components of compliance: receipt of a physician recommendation and adherence to a recommendation. Outcome measures were the proportion of patients demonstrating each type of compliance and adjusted odds ratios, according to several patient-related characteristics.Results.Overall, 66% of women received a recommendation. Of women receiving a documented recommendation, 75% adhered. Factors showing significant positive associations with receiving a recommendation included being a patient in the general internal medicine clinic, having private insurance, visiting the clinic more often, and having a recent Pap smear. Patient adherence was positively associated with private insurance and Pap smear history, negatively associated with internal medicine, and not associated with visit frequency.Conclusions.Patient factors influencing physician mammography recommendations may be different from those associated with patient adherence, except for having private health insurance, which was a predictor of both.

Missed Opportunities for Cervical Cancer Screening of HMO Members Developing Invasive Cervical Cancer (ICC)

Objective.To identify potential missed opportunities and to suggest interventions for cervical cancer screening in members of a prepaid health plan by examining the membership histories and medical records of women who had no Pap smear performed in the 3 years prior to the diagnosis of ICC.Methods.Medical records of all 642 members of a prepaid health plan developing ICC during the period from 1988 to 1994 were reviewed and details of patient interaction with the health care system were abstracted. Assessment of screening history and history of clinic visits was limited to the period 36 months prior to diagnosis, but excluded the last 6 months prior to diagnosis, so as to avoid including smears or visits which were part of the evaluation that led to the recognition of ICC.Results.Of women developing ICC, 384/642 (60%) had not had a smear in the period from 36 months to 6 months preceding the diagnosis. Of these 384 unscreened women, 241 (63%) had been insured by our HMO for at least 30 of the 36 months prior to diagnosis. Contact with the medical system in one of the primary care outpatient clinics was documented in 180/241 (75%) of these long-standing members during the specified period. Considering only Internal Medicine and Family Practice clinic visits, 169/241 (70%) had been seen at least once and 101/241 (42%) had been seen 3 or more times.Conclusion.Most long-standing HMO members developing ICC without benefit of recent Pap smear screening were seen in primary care outpatient clinics in the 3 years preceding their diagnosis.