Regular Pap Tests Research Articles

A case–control study of the protective benefit of cervical screening against invasive cervical cancer in NSW women

To examine the effects of different Pap screening patterns in preventing invasive cervical cancer among women in New South Wales, Australia. A total of 877 women aged 20-69 years diagnosed with invasive cervical cancer during 2000-2003 were matched with 2,614 controls by month and year of birth. Screening behavior patterns in 4 years preceding the time of cancer diagnosis in the cases were classified into none (no Pap test in the 4 years), 'irregular' (1 of the 4 years with Pap test(s)), and 'regular' (2 or more of the 4 years with a Pap test), and compared with those in the matched non-cases over the same period. Conditional logistic regression modeling was used to estimate the relative risk, approximated by the odds ratio, of invasive cervical cancer for regular and irregular cervical screening compared with no screening in the previous 4 years, before and after controlling for potential confounders including the first recorded Pap test result in the preceding 6-year reference period. Compared with no screening, irregular Pap screening in the 4 years preceding the cancer diagnosis is estimated to reduce the risk of invasive cervical cancer by about 85% (RR = 0.15, 95% CI: 0.120-0.19); regular Pap screening reduces the risk by about 96% (RR = 0.04, 95% CI: 0.03-0.05). After adjusting for the index Pap test result, the relative risks for invasive cervical cancer were 0.19 (95% CI: 0.13-0.27) for irregular screening and 0.07 (95% CI: 0.04-0.10) for regular Pap screening. Regular and irregular Pap tests among women aged 20-69 years were highly effective in preventing invasive cancer. At-risk women with no Pap test history should be encouraged to undergo a Pap test every 2 years, but any Pap screening over a 4-year period remains highly protective against future invasive cervical cancer.

Applying the transtheoretical model to cervical cancer screening in Vietnamese‐American women

Low levels of Papanicolaou (Pap) screening participation in Vietnamese-American women remain a significant public health problem. The transtheoretical model (TTM) suggests that individuals adopting Pap smear behaviour move through a series of stages of readiness to change. Determining a woman's level of readiness for regular Pap testing and identifying the screening behaviour that an individual already performs is important in the development of successful intervention programmes that address the specific needs of Vietnamese-American women in different stages. To describe Pap smear screening behaviours of Vietnamese-American women, and to examine whether constructs (stages of change, self-efficacy and perceived benefits/barriers) from the TTM are applicable to Vietnamese-American women relative to Pap testing. A descriptive, cross-sectional design with snowball sampling was used to recruit participants. A total of 80 Vietnamese-American women completed the self-administered questionnaire. Most respondents (62.5%) reported previous Pap testing and only 46.3% receiving regular Pap testing. Compared with those in the pre-contemplation stage of the TTM, participants in maintenance reported significantly less self-efficacy (F (3, 73) = 4.85, P = 0.00), a lower level of perceived barriers (F (3, 75) = 5.99, P = 0.00) and a higher level of perceived benefits (F (3, 76) = 3.91, P = 0.01) relative to Pap smear. The results support some of the assumptions of the TTM but raise questions about the predicted relationships between stages of change and self-efficacy. Continued research is needed to identify the most effective theory-based interventions for evidence-based nursing practice in this population.

What Do Women in the U.S. Know about Human Papillomavirus and Cervical Cancer?

Women need to understand the link between human papillomavirus (HPV) and cervical cancer in order to make appropriate, evidence-based choices among existing prevention strategies (Pap test, HPV DNA test, and HPV vaccine). Assessment of the public's knowledge in nationally representative samples is a high priority for cervical cancer control. To assess factors associated with U.S. women's awareness of HPV and knowledge about its link to cervical cancer. Analyzed cross-sectional data from women ages 18 to 75 years old responding to the 2005 Health Information National Trends Survey (n = 3,076). Among the 40% of women who had ever heard about HPV, <50% knew it caused cervical cancer; knowledge that HPV was sexually transmitted and caused abnormal Pap tests was higher (64% and 79%, respectively). Factors associated with having heard about HPV included: younger age, being non-Hispanic White, higher educational attainment, exposure to multiple health information sources, trusting health information, regular Pap tests, awareness of changes in cervical cancer screening guidelines, and having tested positive for HPV. Accurate knowledge of the HPV-cervical cancer link was associated with abnormal Pap and positive HPV test results. Awareness about HPV among U.S. women is low. Having heard about HPV did not ensure accurate knowledge. Strategies for communicating accurate information about HPV transmission, prevention, and detection as well as risk and treatment of cervical cancer are needed.

The utility of a health risk assessment in providing care for a rural free clinic population

BackgroundFree clinics are an important part of our country's health safety net, serving a working poor uninsured population. With limited resources and heavily dependent upon volunteer health care providers, these clinics have historically focused on stopgap, band-aid solutions to the population's health problems. Embracing a new paradigm, free clinics are now prioritizing resources for disease prevention and health promotion.MethodsWe initiated a Healthy Friday Clinic project in a rural, southwest Virginia free clinic. The clinic operated every Friday and was open to all people eligible for care in the free clinic. Each participant completed a 43 question Health Risk Appraisal which was used to calculate current risk age (age as determined by current lifestyle choices), optimal risk age (age with optimal lifestyle choices) and potential risk years gained (current risk age - optimal risk age) as well as a ranked listing of modifiable risk factors.ResultsThe total sum of potential risk years gained in the free clinic population of 186 subjects was 371.4. Frequency distributions on potential risk years gained by each of the eleven modifiable risk factors revealed the following, in order of impact: quitting smoking could result in a total of 173.5 risk years gained; reducing alcohol consumption, 64.2 years gained; reducing blood pressure, 50.8 years gained; increasing seatbelt use, 38.2 years gained; weight reduction, 24.7 years gained; having regular mammograms, 6.8 years gained; reducing cholesterol levels, 5.8 years gained; reducing frequency of speeding while driving, 3.5 years gained; having regular pap tests, 2.3 years gained; improving HDL levels, 0.9 years gained; and reducing use of smokeless tobacco, 0.8 years gained. Each person received an individualized letter explaining his evaluation along with resources for making changes.DiscussionHealth risk assessments play a role in changing health beliefs and behaviors by providing subjects with individualized feedback on how their lifestyle choices impact their health and well-being. Summed data from health risk appraisals can also be a useful tool in determining the allocation of limited health resources. Whether health risk assessments impact health outcomes directly needs to be studied.

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.

Factors Associated with PAP Testing in Adolescents in Northern Nova Scotia

To determine relationships of socio-economic factors and contraceptive behaviours with PAP testing in sexually active women aged 15-19 who had received physician services in northern Nova Scotia in the previous year.A cross-sectional survey was completed by adolescents attending four high schools in three counties in northern Nova Scotia. Questions concerned contraceptive behaviours, socio-economic status and health services use, including PAP testing. Associations of socio-economic factors and contraceptive behaviours with receipt of a PAP test in the previous year were examined in women who were sexually active for at least one year, and who also had visited a physician during the previous year.One thousand and ninety adolescent women aged 15-19 completed surveys, with a response rate of 91%. Of the 396 (36.3%) who reported being sexually active and having visited a physician in the previous year, 393 provided information about PAP testing. Of these, 214 (54.5%) reported receiving a PAP test. Factors associated with PAP testing included viewing one's family as advantaged and living in a major town as opposed to a more rural area. Compared with using hormonal contraception, using either condom without other effective contraception or no effective contraception at last intercourse were negatively associated with PAP testing.These findings suggest that physicians use hormonal contraception as a cue for PAP testing in adolescent women. Guidelines call for regular PAP testing of sexually active adolescents, and efforts to increase adolescent PAP testing should include professional development to increase recognition of sexual activity.

MarkPap test for cervical cancer screening

1021 Background: At ASCO 2001 we introduced a new biomarker driven technology MarkPap(r) for improving visualization of epithelial cell abnormalities on Pap smears. The biomarker is cervical acid phosphatase labeling dysplastic cells. At ASCO 2004, we presented data of two clinical trials. We are presenting results of comparison of the new test with the conventional Pap smear in general population. Material and Methods: MarkPap test is available as MarkPap Research Kit (www.markpap.com). The kit was given to cytopathology laboratories with instructions (2-level Screening Procedure and the Criteria for Reading and Interpretation of MarkPap slides) how to use it for cervical cancer screening. Cervical specimens were obtained from women coming for regular Pap test checkup after they signed an IRB approved informed consent. Doctors collected and split specimens into a control (Pap smear first) and a research sample (MarkPap smear). Demography, Pap test results, and disease progress were recorded on CRF up to ...

Pressing the key pad: trial of a novel approach to health promotion advice

Background. A relatively simple procedure, the Pap test, is effective in detecting early changes in the cervix; however, many at-risk women, even in developed countries, do not have regular Pap tests. Methods. A randomized controlled trial of an interactive voice response (IVR) cervical screening brief advice involving 17,008 households is described. The IVR system automatically made calls to households and explained the nature of the call; selected one eligible woman aged 18–69 years; determined her screening status; delivered a message appropriate to her screening status; offered additional messages to counter common barriers; offered additional information on cervical screening and cancer; offered additional contact numbers; and offered to arrange for someone to call back. Cervical screening rate data were obtained from the Australian Health Insurance Commission (HIC) for 6 months before and following the intervention. Results. The cervical screening rate was found to have increased by 0.43% in intervention compared to the control postcodes, and the increase was greater for older women at 1.34%. Conclusions. The overall conclusion was that IVR technology was a feasible means to contact women to deliver brief interventions aimed at increasing cervical screening rates and could economically target at-risk groups. The potential for linking IVR to centralized Pap test Registers to issue Pap test reminders should be explored.

Pap test and a new biomarker-based technology for enhancing the visibility of abnormal cells

9561 Background: At ASCO 2001, we introduced the Cervical Acid Phosphatase - Papanicolaou (CAP-PAP) test as a new, biomarker-driven technology for detection of abnormal cervical cells on Pap smears. Since this report, we conducted two clinical trials to assess the value of this test for cervical cancer screening in general (N=1,500) and a high-risk population (N=500). This technology is commercially available as the MarkPap™ Research Kit (BioSciCon, Inc., Rockville, MD, USA). Methods: Multicenter, random assignment, assessors blinded, split sample, concurrent control 3-group (test and two controls [Pap smears and ThinPrep thin layers] clinical trial was conducted on 1,500 specimens obtained from eligible subjects coming for regular Pap test. Specimens collected in PreservCyt and transferred onto microscopic slides using the ThinPrep Processor 2000 were split in two samples before processing. Specimens obtained with cervical epithelium abrading devices, were split by the physician in two samples (smears). Primary efficacy endpoints were the portion of detected abnormal samples and the portion of false negative readings. Accuracy was measured against a cytology standard (association or adjudication). Results: * δ= 30% of Ps (performance of the standard control group). MPT= CAP-PAP test. ThP= ThinPrep Pap test. Pap=Pap smears. Pe= performance of the test group (experimental) Conclusion: This data suggests that the new technology is more sensitive (with equivalent specificity) than either conventional Pap smear or ThinPrep Pap test. However, when specimens were collected in PreservCyt, due to alcohol inhibition of the enzyme, this sensitivity was reduced. This work was supported in part by NCI, NIH, via SBIR Phase-1 and Phase-2 grants: 1 R43CA086767–01, and 2-R44CA086767–02. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration BioSciCon, Inc. BioSciCon, Inc. BioSciCon, Inc. NIH (# 1R43CA86767 –01) NCI (2RCA086767–02) BioSciCon, Inc.

In this issue

In this issue

Papanicolaou Test Status Among Inner-City Adolescent Girls

The English medical literature for the past decade lacks any reports on Papanicolaou (Pap) test status among inner-city adolescent girls. Our objectives were (1) to assess the pattern of Pap test status among inner-city adolescent girls and (2) to ascertain the association of the Pap test status with their knowledge, beliefs, and behaviors. All 3,980 inner-city senior high school adolescent female students in two cities in New Jersey were included in the survey. Response rate was 84%; 89% of respondents were minority adolescents. The factors that significantly increased the probability of obtaining a Pap smear were physician recommendation for Pap test, being knowledgeable of Pap test, awareness that other family members had obtained Pap tests, family income and parents' education levels. The age of initiation of first Pap test almost always was before 18 years of age; 13% of sexually active girls were smokers. The major barriers for never having had a Pap test were lack of physician's recommendation, ignorance about the Pap test, cost of the test, lack of information on how and where to obtain it, belief that they were not at risk for cancer, and embarrassment over requesting the test. Inner-city predominantly minority adolescent girls who have considerable sexual activity, multiple sex partners, initiation of intercourse at an early age, and smoking are at high risk for cervical cancer. It makes sense to initiate Pap screening for such high-risk adolescents. Individualized Pap test educational intervention programs adopted to the adolescents' barriers to undergoing Pap testing and physicians' recommendations for this preventive care are needed to encourage high-risk adolescent girls to undergo regular Pap tests and appropriate follow-up.

Emergency Contraceptive Pills: A Simple Proposal to Reduce Unintended Pregnancies

A new form of postcoital contraceptive therapy is described as more effective because of reduced incidence of nausea, vomiting, and breast tenderness. Other forms of emergency contraceptive pills (ECPs) are the "Yuzpe" method or high-dose contraceptives. The new method calls for administration of 3 200-mg tablets of danocrine (Danazol) within 72 hours of unprotected intercourse and a second dose 12 hours later. There are mixed reviews of the efficacy of danocrine and ECPs. In one comparative study of ECP and danocrine use, efficacy of danocrine was greater but not significantly so. Another study found danocrine so ineffective that the study was halted. ECP use would not end unintended pregnancies caused by method failure unless it was condom failure. Estimates of ECP use involve 75% of the 1.7 million women with user or method failure, all 1.9 million women with unintended pregnancies from nonuse of contraceptives, and some of the 1.6 million abortion users. An obstacle to ECP use is lack of knowledge due to lack of Food and Drug Administration approval of Ovral and Danazol and physician concern for legal liability. Another obstacle consists in the logistics of obtaining ECPs and the fear of side effects. Provision of ECP kits with 3-5 regimens in clinic or physician offices is proposed for women without contraindications. Anticipated objections are reported to be encouragement of contraceptive risk taking, the health risks of repeated use, restrictions in Title X programs, and the drug effect on fertilization. Another proposal is to sell ECPs as over the counter drugs or in vending machines and changing US contraceptive prescription laws. Objections to elimination of the physician prescription requirement might be an increase in use among women with contraindications and a decrease in regular checkups and Pap tests. The objections could be overcome with proper package labeling. Paternalism is not a sufficient justification for requiring prescription of contraceptives and medical visits. ECPs, in fact, are already available as low dose contraceptives such as Lo/Ovral, Nordette, Levlen, Triphasil, and Tri-Levlen when 4 pills are used. Instructions for ECP use are given.

Demographic, Psychosocial, and Medical Correlates of Pap Testing: A Literature Review

The approaches used to ensure regular Pap testing must be tailored to sociodemographic, psychosocial, medical, and motivational factors that may change over a woman's life. Careful descriptions of the determinants of Pap testing at different stages are needed; the success of Pap-emphasizing programs designed without this information may be severely limited. We review the literature on demographic and psychosocial correlates of Pap testing and on the relationship of Pap smear frequency to contact with the medical care system and to preventive health behaviors. We include a discussion of factors related to preventive health behavior in general, so that the Pap test can be viewed against a range of behaviors. Pap program efforts must focus more precisely; our review of the available literature provides recommendations for improving Pap screening programs.

The pap test registry—An important initiative for women's health

This desire for a more organised approach to cervical cancer screening is not new. For several years health professionals active in the area of women's health have pointed out that Australia's opportunistic attitude towards cervical screening is problematic. Health professionals have argued that reliance on women to ask their doctors for a Pap test is inadequate because it assumes all women know what a Pap test is and why it is necessary. Statistics however indicate that not all women are aware of the importance of regular Pap testing. Each year in Australia 350 Australian women die from cervical cancer and a further 1000 women are treated for invasive cervical cancer. Overseas studies certainly attest to the effectiveness of organised cervical screening programs. In Iceland alone the implementation of a screening program that includes a Pap test recall and follow up system has resulted in a cervical cancer prevention rate of approximately 70% over a 20 year period. 2 A figure that stands in stark contrast to Australia's estimated prevention rate of 40%. In light of this knowledge then the Victorian Government recently agreed to establish an infrastructure through which a more organised approach to cervical cancer screening could be implemented. The Victorian Cervical Cytology Registry, more commonly known as the Pap Test Registry, was established under an amendment to the Cancer (Central Registers) Act and became operational in November 1989. Located at Prince Henry's Hospital in Melbourne it now functions as a central database for the collection and collation of Pap test results taken in Victoria. This advantages women in two important ways. Firstly it enables the Registry to send reminder letters to any women whose next Pap test is overdue. Secondly it allows the Registry to act as a safety net ensuring that all registered abnormal results are carefully followed up. Additional benefits of the Register include access to important data for epidemiological studies of cervical cancer and screening. Improved accuracy in Pap test reporting through allowing pathologists access to women's Pap test histories. Evaluation on the effectiveness of cervical education campaigns and the ability to feedback information to participating laboratories, useful in the Registry is voluntary. Women can either choose to register and so take advantage of the Registry's Pap test recall and follow up service or they can choose not to. So far 95% of Pap tests currently being taken in Victoria are recorded with the Registry, an indication that women are wholly supportive of the service.

Factors Influencing Women Over 40 Years to Take Precautions Against Cervical Cancer

This study investigated whether the Theory of Reasoned Action (TRA) and the Health Belief Model (HBM) would predict older women's intention to have regular Pap smear tests. The sample was a group of 144 women aged 40 years and over. Results showed that each model was a significant predictor of intention. Results also indicated that for some women the sex of the doctor was a significant factor in their decision to have a Pap test. Interview data indicated that some general practitioners did not believe it was necessary for older women to have a regular Pap test. These findings have application in planning health education campaigns.

Cervical cancer screening practices among older women: Results from the maryland cervical cancer case-control study

Considerable evidence shows a large proportion of older women have either never had a Pap test or have significant gaps in their history of cervical cancer screening. Differences in health care utilization patterns by age, cohort differences in use of medical subspecialities, and provider reluctance to perform cancer screening within the general medical care encounter have been suggested as reasons for underscreening. Our study conducted in 1985 documents prior health care utilization patterns of 153 cases of Maryland women with invasive cervical cancer compared with a matched control group. Analysis within three age groups showed that cases were significantly less likely to have ever had a Pap test or to receive regular Pap testing, primarily due to differences in medical care utilization patterns. Never having an obstetrician-gynecology visit, a recent (<3 years) internist visit, or not having any out-patient visit were significant risk factors. Other risks included older age at first Pap test, reporting not being told to have routine Pap tests, and not using contraceptives. In a multiple logistic regression analysis, recent out-patient visits and lifetime use of an obstetrician-gynecologist remained significant after adjusting for age interactions with recent Pap test history, underscoring the importance of medical care utilization patterns for screening of cancer of the uterine cervix among the elderly.

Pap testing: Opinion and practice among young obstetrician-gynecologists

Since 1976, contradictory recommendations by a number of groups (including the American Cancer Society, the National Cancer Institute, a National Institutes of Health Consensus Development Conference, the Canadian Task Force on Cervical Cancer Screening Programs, and the American College of Obstetricians and Gynecologists) on the timing of Pap testing—including age to begin testing, appropriate frequency of testing, and age to discontinue testing—have been communicated to both physicians and consumers. The opinions and practices of a U.S. national sample of recently trained obstetrician-gynecologists, whose professional association continues to endorse annual Pap tests, were investigated and compared with key points from the various recommendations. The appropriateness of the recommendations themselves is not addressed. Findings show that respondents are aware of recommendations for less frequent Pap testing, but they believe that women should generally receive annual Pap tests and that regular Pap testing should not be discontinued among the elderly. While the intensity of Pap testing services varies by type of practice arrangement, such variation does not occur for opinions regarding Pap testing, with one exception: Those practicing in multispecialty groups (including health maintenance organizations) are more likely to endorse routine Pap testing for elderly women if they see elderly women in their practices. Thus, the physicians in this study are not adhering to recommendations for Pap testing on a less-than-annual basis or for discontinuance in the elderly.