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William J. Hueston, MD; Matthew A. Stiles, MD

Arch Intern Med. 1994;154(13):1473-1477.

Abstract
Background
There has been evidence that, in primary care practices, health screening tests are not ordered in random fashion but instead are coupled or bundled into distinct groups. This study was performed to determine if the Papanicolaou (Pap) smear serves as a marker for other health screening tests.

Methods
The study consisted of a retrospective chart review of female patients over the age of 18 years at three' rural health clinics, followed by a prospective study of patients during a 3-month period in five rural family practice clinics. The study focused on whether a Pap smear was performed and whether a breast examination, mammogram, rectal examination or stool occult blood test, or serum cholesterol testing was performed.

Results
In both the retrospective and prospective series, patients who received Pap smears were significantly more likely to receive breast examinations, mammograms, colorectal screening, and cholesterol tests. In addition, the coupling of other screening tests with the Pap smear appeared to increase with advancing patient age, with a decline after age 70 years. In patients who did not have Pap smears, only cholesterol testing increased as patients aged.

Conclusion
Health screening tests in women are associated with the performance of a Pap smear. Providers may use the Pap smear as a marker of whether a woman has received screening for several other medical problems. Thus, the Pap smear can be considered a "sentinel" test for health screening in women, and efforts to identify women at high risk and increase health promotion and disease prevention in this group should focus on women who have not received this test.

(Arch Intern Med. 1994;154:1473-1477)

Author Affiliations
From the Menifee Medical Center, Frenchburg, Ky, and St Claire Medical Center, Morehead, Ky. Dr Hueston is now with Eau Claire (Wis) Family Practice Residency.

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