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

• Published in: Cancer Vol. 88; no. 10; pp. 2283 - 2289
• Main Authors: Sung, Hai‐Yen, Kearney, Kathleen A., Miller, Marie, Kinney, Walter, Sawaya, George F., Hiatt, Robert A.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 15.05.2000
• Subjects: adherence; Adult; Carcinoma - diagnosis; Cervix Uteri; Female; Humans; invasive cervical carcinoma; Middle Aged; Neoplasm Invasiveness; Papanicolaou (Pap) smear; Papanicolaou Test; Patient Compliance; prepaid health plan; Prepaid Health Plans; Retrospective Studies; United States; Uterine Cervical Neoplasms - diagnosis; Vaginal Smears - utilization; United States
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(20000515)88:10<2283::AID-CNCR12>3.0.CO;2-D

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. Nonadherence to screening recommendations is the most important modifiable antecedent to the incidence rate of invasive cervical carcinoma, even among women with easy access to screening in a prepaid health plan.