title: Pap smear screening among urban Southwestern American Indian women.
abstract: BACKGROUND
  American Indian women have among the highest incidence and mortality rates of cervix cancer in the United States. The incidence of cancer of the cervix among American Indians is 19.5/100,000 versus 7.8/100,000 in U.S. whites, and comparison by geographic region/tribe indicates that the rate is four to six times higher in some tribes. Papanicolaou cytological testing (Pap smear) permits the detection of cervical lesions before they become cancerous, effectively reducing the incidence of cervical cancer by 75-90%. The American Cancer Society recommends a Pap smear every year beginning at age 18 years or when sexually active, and more frequent screening in high-risk populations.
  
  
  METHODS
  A random household cross-sectional survey was conducted in Phoenix, Arizona, to assess cervical cancer screening rates among 519 adult urban American Indian women. Logistic regression was used to identify predictors of Pap smear use.
  
  
  RESULTS
  Three-quarters (76.1%) of urban women American Indian surveyed received a Pap smear within the past 3 years, but only 49.5% received a Pap smear within the last year. Women over age 50 years were significantly less likely to have received a recent Pap smear in comparison to younger women.
  
  
  CONCLUSIONS
  The results of this study indicate that limited access to health care and lack of knowledge about the procedure were important barriers to Pap smear use. Improving cervix cancer screening participation rates is an important step in reducing the disease burden in this high-risk population.
authors.affiliation: Arizona Cancer Center, Tucson, Arizona 85724, USA.
authors.forename: B
authors.initials: B
authors.lastname: Risendal
authors.forename: J
authors.initials: J
authors.lastname: DeZapien
authors.forename: B
authors.initials: B
authors.lastname: Fowler
authors.forename: M
authors.initials: M
authors.lastname: Papenfuss
authors.forename: A
authors.initials: A
authors.lastname: Giuliano
mesh_terms: D000328:Adult; D000367:Age Factors; D001130:Arizona / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American / Q000523:psychology / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D065006:Papanicolaou Test; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000208:ethnology / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*