Regular Pap Smear Research Articles

Access and Attitudinal Factors Related to Breast and Cervical Cancer Rescreening: Why are Latinas Still Underscreened?

To identify access, attitudes, and health practices of Latina women undergoing regular mammography and Pap smear screening, 977 Latinas aged 40 to 74, residing in four California cities, answered a telephone interview. Forty-one percent of women had regular mammography, and 73% had regular Pap smear screening. Cancer screening maintenance was associated with having health insurance, a regular place of care, and fewer fatalistic attitudes about cancer. Regular mammography and Pap smear screening were also associated with ever being married, attending church, and having taken hormone replacement therapy. Being older than 50, residing in the United States a long time, and having had a hysterectomy predicted mammography maintenance. Pap smear screening maintenance was negatively associated with poverty, old age, and negative attitudes toward physicians. There are structural and attitudinal barriers to regular cancer screening among Latinas. Interventions that increase access to care and address women's attitudes about cancer are needed.

A Cervical Cancer CD-ROM Intervention for College-Age Women: Lessons Learned from Development and Formative Evaluation

Despite the decline of incidence rates of cervical cancer over the past 50 years, data suggest an increase of precervical cancer among college women. This increase may be the result of the high prevalence of the Human Papillomavirus (HPV) among this population. To increase cervical cancer prevention behaviors, we developed a computer-based intervention targeting women ages 18 to 24. Through the use of story scripts, role models, and demonstrations (both animated and videotaped procedures), women learn the importance of regular Pap smear screenings, personal risks for developing cervical cancer, the meaning of and dealing with abnormal Pap smears, communication with health care providers, and sexual practices that impact the transmission of HPV. Results from the formative evaluation support the viability of CD-ROM interventions in health education and emphasize the importance of addressing women’s cognitive and affective perceptions surrounding cancer, sexual health, and gynecological exams. Lessons learned from the development process are presented.

Preventive healthcare use, smoking, and alcohol use among Rhode Island women experiencing intimate partner violence.

Intimate partner violence (IPV) poses major health threats to women, including increased risk for several chronic health conditions. The impact of IPV on use of preventive health services is not well understood. Although several studies indicate that female victims of IPV have higher rates of alcohol abuse, this has not been replicated in population-based studies. The association of IPV with smoking has not been a major research focus. The purpose of this study was to examine the association between physical and psychological IPV in the past 12 months and preventive healthcare use, smoking, and alcohol use among women. Data on 1643 women aged 18-54 from the 1999 Rhode Island Behavioral Risk Factor Surveillance System were analyzed. Logistic regression, controlling for age, race, marital status, education, insurance status, and functional disability, was used to model the associations of IPV with (1) checkups, (2) clinical breast examinations (CBEs), (3) Pap smear screening, (4) cigarette smoking, and (5) high-risk alcohol use. Prevalence of physical IPV was 4.1%. The prevalence of psychological IPV, in the absence of physical IPV was 4.5%. Physical IPV was associated with receiving regular Pap smears odds ratio ([OR] = 2.39, 95% confidence interval [CI] 1.01-5.70), current smoking (OR = 2.07, 95% CI 1.03-4.18), and high-risk alcohol use (OR = 4.85, 95% CI 2.02-11.60). Psychological IPV was associated with high-risk alcohol use (OR = 3.22, 95% CI 1.46-7.09). Women experiencing IPV regularly access preventive healthcare, providing healthcare providers with opportunities to assess and counsel women for IPV in addition to smoking and high-risk alcohol use.

Improving Adherence to Regular Pap Smear Screening Among Asian Women: A Population-Based Study in Singapore

Improving Adherence to Regular Pap Smear Screening Among Asian Women: A Population-Based Study in Singapore

Improving Adherence to Regular Pap Smear Screening Among Asian Women: A Population-Based Study in Singapore

Improving Adherence to Regular Pap Smear Screening Among Asian Women: A Population-Based Study in Singapore

Vitamin/calcium supplement use in Taiwan: findings from the 1994 National Health Interview Survey.

This study aimed to provide the prevalence of vitamin/calcium supplement use and, to explore the gender differences in and the correlates of supplement use. Data came from the 1994 National Health Interview Survey of 3,814 households; and 7,019 respondents (3,561 females and 3,458 males) aged 25 years old and older were included in the analysis. Supplement users were defined as individuals who reported taking any supplements at least once a week. Associations between supplement use and its correlates were examined by using chi-square analysis and logistic regression. The results indicated that 22.2% of females and 12.7% of males used vitamin supplement, and 10.2% of females and 3.7% of males took calcium supplement. The adjusted sex odds ratio was 2.8 (95% CI = 2.4-3.2) for vitamin supplement use and 3.8 (95% CI = 3.0-4.7) for calcium supplement use when sociodemographic and health variables were controlled. Increased likelihood on the use of vitamin/calcium supplement was associated with sociodemographic characteristics (females, over 45 years old, more educated) and health behaviors (more regular exercise and check on blood pressure). Additionally, females who received regular Pap smear or with no chronic disease tended to take more vitamin supplement and females who perceived themselves with a poor health condition were more likely to use calcium supplement than others.

Colpocytology in a preventive gynecological ambulatory service

evaluate the results of Pap smear in women attended at a gynecology preventive ambulatory (University of São Paulo Medical School Clinical Hospital). 6821 women were submitted to a medical interview, clinical and gynecologic exam. Cervical and vaginal cytology (Pap smear) were analyzed according to the Papanicolaou method and classification. All women were grouped according to their age into three categories:under 40 years old, between 41 and 60 years and over 60 years. most of them, and mainly the younger ones, had been submitted to a previous Pap smear in a period shorter than 1 year (44.2%). The majority of women recognized the usefulness of the exam and knew its interval; the group that best knew its importance and interval was the one with ages between 41 and 60 years, while most women over 60 years did not know both its importance and interval. Cytological material was considered insufficient for analysis in 15,1% and inadequate in 1.1%, and for those with adequate material results were classes I (21.7%), II (59.9%), III (2.0%), IV (0.1%) and V (0.1%). Distribution of cervical intraepithelial neoplasia (CIN) were similar in the three groups. The main microbiologic findings was Gardnerella sp. (8,6%) and Human papillomavirus (HPV) incidence was significantly lower among women over 60 years. Cytological diagnoses of neoplastic modifications were performed in 2,2% and Gardnerella sp. was the most prevalent microbiologic agent. Distribution of HPV showed a decrease with age. Older women had lower knowledge on the importance of regular Pap smear examination.

Risk for anogenital cancer and other cancer among women hospitalized with gonorrhea.

We investigated the relationship between infections with Neisseria gonorrhoeae and anogenital and other cancers. Nationwide and population based register linkage study utilizing prospectively notified information. The observed numbers of cancers among the women were compared with those expected on the basis of national incidence rates. In a cohort of 4440 women hospitalized for gonorrhea we observed a total of 227 cases of cervical intraepithelial neoplasia grade III (CIN III), with 103 expected (standardized incidence ratio (SIR), 2.2; 95% confidence interval (CI), 1.9-2.5). No significantly increased risk for other anogenital cancers or cancer at other sites was seen. These results support the view that the observed association between gonorrheal infection and subsequent cervical preneoplasia is due mainly to surveillance bias. However, our results also indicate that women hospitalized with a N. gonorrhoeae infection will benefit from the compliance with the regular Pap smear screening programs.

Risk for anogenital cancer and other cancer among women hospitalized with gonorrhea

Background. We investigated the relationship between infections with Neisseria gonorrhoeae and anogenital and other cancers. Methods. Nationwide and population based register linkage study utilizing prospectively notified information. The observed numbers of cancers among the women were compared with those expected on the basis of national incidence rates. Results. In a cohort of 4440 women hospitalized for gonorrhea we observed a total of 227 cases of cervical intraepithelial neoplasia grade III (CIN III), with 103 expected (standardized incidence ratio (SIR), 2.2; 95% confidence interval (CI), 1.9–2.5). No significantly increased risk for other anogenital cancers or cancer at other sites was seen. Conclusions. These results support the view that the observed association between gonorrheal infection and subsequent cervical preneoplasia is due mainly to surveillance bias. However, our results also indicate that women hospitalized with a N. gonorrhoeae infection will benefit from the compliance with the regular Pap smear screening programs.

Health beliefs and Pap smears among Thai women in Brisbane, Australia.

Although a number of studies have assessed the use of Pap smear among Thai women in Thailand, little is known about factors influencing the use of this cervical cancer screening among potentially high risk Thai migrant women. We related health belief model (HBM) factors and sociodemographic variables to the use of Pap smears among migrant Thai women in Brisbane, Australia. A cross-sectional study was conducted in Brisbane, Queensland, Australia. A snowball sampling method was used to recruit 145 women. Thirty-nine percent reported regular Pap smears. Summary HBM index and self-efficacy index were positively associated with Pap smears. Barriers to screening were negatively associated. The HBM appears to be a useful framework for planning cervical cancer prevention. Strategies that reduce barriers to the screening and increase the confidence of women and their self-efficacy are likely to increase their participation.

Diagnosis of trichomoniasis by polymerase chain reaction.

The clinical usefulness of polymerase chain reaction (PCR) for the diagnosis of trichomoniasis was evaluated in comparison with other conventional tests. PCR was used for specific detection of Trichomonas vaginalis by primers based on the repetitive sequence cloned from T. vaginalis (TV-E650). Between June 1996 and August 1997, 426 patients visited the department of obstetrics and gynecology, Hanyang University Kuri Hospital and were examined for trichomoniasis using wet mount examination, Papanicolaou (Pap) smear, culture and PCR. One hundred and seventy-seven patients (group A) visited with the symptoms of vaginal discharge and 249 patients (group B) visited for regular cervical Pap smear with no vaginal symptoms. From group A (n = 177), 3 infections (2.0%) were detected by wet mount, 6 infections (3.3%) by Pap smear and culture, and 17 infections (10.4%) by PCR. From group B (n = 249), 4 patients (1.6%) were found to have T. vaginalis by culture and 6 infections (2.4%) were detected by PCR. Therefore, in both groups, PCR for T. vaginalis showed a higher detection rate compared with conventional wet mount, Pap smear or culture. The detection by PCR was specific for T. vaginalis since no amplification was detected with DNAs from other protozoa and Candida albicans. The sensitivity and specificity of PCR were 100%. This method could detect T. vaginalis in vaginal discharge at a concentration as low as 1 cell per PCR mixture. These results indicate that PCR could be used as a specific and sensitive diagnostic tool for human trichomoniasis.

Factors Influencing College Women's Gynecological Screening Behaviors and Intentions

Sexually transmitted human papilloma virus (HPV) is highly prevalent among adolescent and young adult women, and is causally associated with cervical cancer. Although the effectiveness of early detection of cervical cancer through Papanicolaou (Pap) screening and early treatment have resulted in a decrease in mortality from cervical cancer, many women do not have regular Pap smears. Information about the gynecological screening behaviors of adolescent and young adult women, who are at risk for HPV, is limited. In this study we examined 400 college women's attitudes, intentions, behavior, knowledge, and self efficacy regarding gynecological screening and Pap smears, as well as resources that might increase the likelihood of their engaging in gynecological screening behavior. Self efficacy and resources made the greatest contributions to the predictions of exam behavior.

A Qualitative, theory-based study of adolescent girls’ knowledge and attitudes about pap smears and compliance with follow-up

Background Little is known about predictors of compliance with recommended follow-up for normal or abnonnal Pap smears among adolescents. The objectives of this study were to explore qualitatively adolescent knowledge and attitudes about Pap smears, and to identify which constructs of three behavioraJ theories - the Health Belief Model. Social Cognitive Theory, and the Transtheoretical Model of Change - may be relevant to understanding attitudes about Pap smears and predicting adolescent compliance with Pap smear follow-up. Methods A focus group of nine adolescents with a history of abnormal Pap smears was used to develop a behavioral theory-based interview guide. The guide was then used to conduct in-depth individual interviews with 15 adolescents. Of the 15,5 had a normal Pap smear, 5 had an abnormal Pap smear and had complied with a colposcopy referral, and 5 had an abnormal Pap smear but had not complied with a colposcopy referral. The interviews were audiotaped, transcribed, and analyzed for relevant themes by three investigators. Consensus on themes was reached after independent coding. Results Mean age of the interview participants was 18.7 years (SD 1.9). 53% were black, nonhispanic and 13% hispanic. Overall knowledge about Pap smears was poor: 73% could not derine any aspect of a Pap smear, and 80% could not distinguish between a pelvic examination and a Pap smear. 60% thought that most of their peers received regular Pap smears. Major themes that emerged in terms of perceived benefits of Pap smears were prevention and early diagnosis, mentioned 17 times in 15 interviews. Other themes included trealment of STDs. peace of mind, and validation of the initial result. 53% of participants perceived high susceptibility to cancer after an abnormal Pap smear. 73% of participants reponed that they would seek intormation from their primary physician after an abnormal Pap smear; other information sources included clinics, gynecologists, school nurses, libraries and relatives. Major barriers to obtaining Pap smears included pain/discomfon (87%) and embarrassment (67%). Other barriers included fear of finding a problem. denial, prior negative experiences, lack of knowledge, fear of the unknown problematic relationship with doctor and peers’ advice. Teengenerated strategies to overcome barriers included in-depth, understandable education (by provider or through written materials), a trusting, personal, consistent relationship with a provider, and a gentle examination. Reponed strategies to enhance appointment-making and appointment-keep109 included phone and written reminders and expanded hours. Conclusions In this population of primarily minority adolescents. knowledge about Pap smears was poor. Selected constructs of three behavioral theories were useful in classifying themes and identifying novel themes related to adolescent attitudes about Pap smears and compliance with follow-up. Adolescents repon physicians as the primary source of information about Pap smears. Major perceived benefits to Pap smears were prevention and early diagnosis. Half of adolescents perceived themselves to be at high risk for cervical cancer after an abnormal Pap smear. Major barriers to obtaining Pap smears were pain and embarrnssment. Strategies to overcome barriers and enhance appointment keeping included education. a trusting. consistent relationship with a provider, and phone or written reminders.

Acculturation and Pap smear screening practices among college-aged Vietnamese women in the United States.

The purposes of this study were both to gather information on the prevalence of Pap smear screening among college-aged Vietnamese women and to identify predictive factors that influence Vietnamese women to engage in early cervical cancer detection behavior. This study also examines the role of acculturation in explaining cervical cancer screening behavior. Data were collected through mail and telephone surveys. Of those respondents (n = 207), approximately one-third (36.8%) reported having had a Pap smear. More than one-third (39.3%) of sexually active respondents reported never having had a Pap smear. Acculturated women were more likely to be sexually active and to be obtaining regular Pap smears. In the logistic regression model, marital status, sexual activity, and a belief that only married women should have a Pap smear were important predictors of prior reported Pap smear experience. These study findings suggest that less-acculturated women appear to have the belief that cervical cancer screening is more important for married women than for unmarried women, regardless of their sexual activity. The existence of such misconceptions underscores the importance of offering culturally relevant cancer education that addresses related misconceptions.

Risk of Sexual Abuse Among Adolescents with Cervical Dysplasia

<h3>Background</h3> Adolescents with cervical dysplasia are known to be at risk for other STDs; many have initiated intercourse at a young age. This study was undertaken to assess the risk of a history of sexual abuse/vaginal or rectal penetration in this population. <h3>Methods</h3> One hundred twenty-two adolescents (ages 12–21) were seen in a hospital-based adolescent dysplasia clinic for evaluation of abnonnal Pap smears and genital condylomata from September 1991 until September 1993. As part of an initial screening intake evaluation, demographic data and infonnation about past sexual experiences, STDs, contraceptive use, and general health was obtained. These adolescents clinic were asked if they had ever been sexually abused. In particular, the question was worded: "Have you ever been forced to have sex when you didn't want to?" <h3>Results</h3> The mean age was 16.8; 70% were African American, 45% were Medicaid/25% self pay. Thirty-two percent of adolescent dysplasia patients reported a past history of forced vaginal or rectal penile penetration. This percentage does NOT include adolescents who reported fondling. The mean age of initiation of sexual intercourse was 13.9 years. Dysplasia patients reported a mean of 3.6 sexual partners, with six girls reporting 7 or more partners. A history of STDs other than genital warts/dysplasia was reported by 66% of dysplasia patients. <h3>Conclusions</h3> Adolescent females with cervical dysplasia represent a high risk population. They are at high risk for having experienced other STDs as well as past sexual abuse. Adolescents with a history of cervical dysplasia should be questioned about past experiences of sexual abuse. Conversely, patients with a history of sexual abuse should have regular Pap smears perfonned. Sexual abuse during or prior to adolescence is potentially a risk marker/factor for sexual behaviors which put an adolescent at risk for cervical dysplasia and other STDs.

Using the health belief model to examine and predict college women's cervical cancer screening beliefs and behavior

The high prevalence of human papillomavirus (HPV) among adolescent and young adult women and the causal association between certain types of HPV and cervical cancer make regular gynecological screening and Pap smear testing essential health practices for young women. In this study, we used the constructs of the Health Belief Model (HBM) to examine the gynecological screening beliefs and behaviors of a sample of 400 college women. Although the constructs of the model were able to explain only 15% of the variance in screening behavior and 11% of screening intentions, the use of the HBM framework resulted in important information regarding the participants' beliefs.

Cervical Cancer Screening: American College of Preventive Medicine Practice Policy Statement

Many Korean-American women (KAW) are unaware of the importance of regular cancer screening. This research estimates rates and examines predictors of regular cervical cancer screening among KAW.Face-to-face surveys were conducted with 459 KAW residing in Maryland. Study participants were recruited through Korean churches and senior housing.Thirty-nine percent of women had regular Pap smears. Regular Pap smear rates varied with age, with women 65 years and older least likely to have regular Pap smears. In multiple logistic regression, the strongest correlate of regular Pap smear was knowledge of guidelines. Physician recommendation, having health insurance, and having friends or family members receiving Pap smears were also important facilitators. Spoken English proficiency interacted with education for an outcome; women with a low level of education and low English proficiency had lower rates of Pap smears than those who had a high level of education and high proficiency. The most frequently given reason for lack of a regular Pap smear was a belief that screening was unnecessary if a woman had no symptoms of cervical cancer.Strategies for education on screening guidelines, along with physician referrals, should be implemented. Culturally appropriate educational programs about cervical cancer screening should be developed for less educated and less acculturated immigrant women.

Menopause and healthy aging: a pilot project

Twenty-three women drawn from a culturally diverse community participated in a pilot health promotion project on menopause and healthy aging. The participants offered information about their usual information sources, menopausal experiences and health promotional practices. Their comments suggest that mid-aged women are frustrated by the lack of accurate and up-to-date information available to them, many found that their concerns about menopause were trivialised by their medical practitioners, most did not practice breast self-examination or have regular Pap smears, and some voiced concerns about the accessibility and affordability of appropriate health care. For some women, common medical therapies did not appear to control the symptoms they attributed to menopause. They expressed a desire to be active in health promotion and wanted to be more involved in the decision making process when consulting health care professionals. Suggestions for improving the quality of health promotion programs include the development of peer support groups and professional partnerships aimed at meeting the education, information and support needs of aging women.

SCREENING AND EARLY DIAGNOSIS OF GYNECOLOGIC CANCERS

Gynecologic malignancies remain an important health concern for women. The primary care practitioner plays a valuable role in performing regular Pap smears and pelvic examinations. Although routine screening for asymptomatic women for ovarian and endometrial cancer cannot be recommended at this time, vaginal ultrasound is a valuable tool for the evaluation of postmenopausal bleeding and ovarian masses.

Patterns of Pap Smear Screening in Women Diagnosed with Invasive Cervical Cancer

ABSTRACT The purpose of this study was to gather data about the extent and nature of the observation that many women with invasive cervical cancer were reporting a history of regular Pap smears. A ...