Papanicolaou smear history and diagnosis of invasive cervical carcinoma among members of a large prepaid health plan

Abstract

BACKGROUND Despite the widespread use of Papanicolaou (Pap) smear screening, substantial morbidity and mortality from cervical carcinoma continue in the U.S. Although access to screening is a major barrier to use of the Pap smear, invasive cervical carcinoma (ICC) still is observed in health plan members who have comprehensive preventive care coverage. METHODS For all women diagnosed with ICC between 1988 and 1994 in a large prepaid health plan, the authors retrospectively reviewed the medical records for prediagnosis Pap smear history to identify antecedents to ICC. RESULTS Of 642 women diagnosed as having ICC, 455 (71%) had been plan members for ≥ 30 of the 36 months before diagnosis. Of these 455 women, 240 (53%) had no Pap smear during the 6–36 months prior to diagnosis (i.e., were nonadherent to screening), 127 (28%) had only “normal” Pap smear results, 42 (9%) had at least 1 abnormal Pap smear and were adequately followed, 17 (4%) had at least 1 abnormal result without adequate follow‐up, and 29 (6%) were classified as “other.” Compared with adherent women, more nonadherent women presented with later stage disease, were symptomatic at the time of diagnosis, were older, and were of a race/ethnicity other than non‐Hispanic white. CONCLUSIONS Nonadherence to screening recommendations was found to be the most important modifiable antecedent to ICC in this population. The rate of incidence of ICC could be reduced by interventions to increase screening in women who do not have Pap smears regularly and by the use of newer screening technologies to reduce the false‐negative rate of Pap smears. Cancer 2000;88:2283–9. © 2000 American Cancer Society.

How do women who choose not to participate in population‐based cervical cancer screening reason about their decision?

“…Women who do not attend CCS have a greater risk of developing cervical cancer [8,9]. As a result, much research in the area focuses on factors influencing CCS attendance and strategies aiming to increase CCS participation.…”

Pathways to diagnosis of cervical cancer: screening history, delay in follow up, and smear reading

“…Without exception, the major finding from these exercises previously is that a significant proportion of women with invasive cervical cancer are either not screened or underscreened. [9][10][11][12][13] The New Zealand National Cervical Screening Programme (NCSP) was established in 1990 and recommends routine three yearly screening of all women aged 20-70 years. The NCSP is nationally organised and co-ordinated, but there is no national register of eligible women to ensure that all are invited and recalled at appropriate intervals for cervical smears.…”

Increasing participation in cervical cancer screening: Telephone contact with long‐term non‐attendees in Sweden. Results from RACOMIP, a randomized controlled trial

“…9 Other studies have confirmed that population coverage is vital for success and that women who participate are well protected from cervical cancer. 10,11 For Swedish women aged 23-50, coverage of screening, including opportunistic smears taken outside the screening program, was 78% during a 3.5-year period ending 2009. 12 This is high coverage in an international context, 13 but regional differences are substantial (range 64-91%).…”