Gynecological cancers are an important cause of morbidity and mortality. Secondary prevention programmes attempt to improve their prognosis. High participation rates are needed to ensure the desired population impact. We sought to assess the use of mammography and Pap smear and analyze predictors of screening adherence. We included women surveyed in the Spanish National Health Survey 2006. Cancer screening included mammography in the last 2 years and Pap smear in the last 3 years. The target age range of the screening programmes was 50-69 years in breast cancer screening and 25-64 years in cervical cancer screening. Independent variables included: sociodemographics, chronic diseases and lifestyles. Predictors of mammography or Pap smear adherence were explored using logistic regression. The screening coverage for the target age range was 84.1% (95% confidence interval=82.9-85.2) in breast cancer and 67.4% (95% confidence interval=66.5-68.4) in cervical cancer. Mammography uptake was positively associated with age, being married, higher educational level, having visited a physician or gynecologist, supplementary private health coverage and osteomuscular disease. Some unhealthy lifestyles were associated with nonadherence to mammography. Positive predictors of Pap smear adherence behaved in the same way as for mammography and also higher monthly incomes and eating a healthy diet were associated with higher screening compliance. In conclusion, adherence to breast cancer screening in Spain is acceptable in the target age group; nevertheless Pap smear screening must be improved. In both cases, an effort must be made to recruit those women who are less likely to undergo screening, as they are those who are at higher risk of suffering these diseases.

The low tumour stage of our patients may explain the few local and lymph node disease recurrences seen in our study. We have shown tumour size to be directly related to the probability of local recurrence.