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The Relationship of Papanicolaou Testing and Contacts With the Medical Care System to Stage at Diagnosis of Cervical Cancer
Sandra A. Norman, PhD;
Evelyn O. Talbott, DrPH;
Lewis H. Kuller, MD, DrPH;
Paul D. Stolley, MD, MPH;
Margaret S. Dunn, RN, MA;
Kathleen Baffone, RN;
Bernard Klionsky, MD;
Gene B. Weinberg, DrPH
Arch Intern Med. 1991;151(1):58-64.
Abstract
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The relationship of Papanicolaou (Pap) testing and cian visits to stage at diagnosis of cervical cancer was assessed by interviews with 149 women with invasive cervical cancer and 214 women with in situ cervical cancer. A significantly smaller percent of study subjects with invasive disease than in situ disease had at least one Pap test in the 3 years prior to diagnosis (age- and race-adjusted odds ratio: 3.38). The two groups did not differ in visits to a physician for other reasons during this period. Pap testing decreased with increasing age for both groups, but not physician visits. While 65% percent of the subjects with invasive disease aged between 65 and 79 years had never had a Pap test until diagnosis, 88% had seen a physician in the preced ing 3 years. Women with regional or distant invasive disease were least likely to have had Pap tests, and, within this group, those aged between 35 and 64 years were also least likely to have seen a physician. Strategies for early detection must reflect missed opportunities and the need to bring those not receiving care into the system.
(Arch Intern Med. 1991;151:58-64)
Author Affiliations
From the Clinical Epidemiology Unit, Section of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia (Drs Norman and Stolley and Ms Dunn); Department of Epidemiology, University of Pittsburgh (Pa) Graduate School of Public Health (Drs Talbott and Kuller and Ms Baffone); Department of Pathology, University of Pittsburgh (Pa) School of Medicine (Dr Klionsky); and Pennsylvania Department of Health, Harrisburg (Dr Weinberg).
Footnotes
Accepted for publication September 12, 1990.
Reprint requests to 225L NEB/6095, University of Pennsylvania, Philadel phia, PA 19104 (Dr Norman).
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