title: 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 > or = 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.
authors.affiliation: Department of Quality and Utilization, Kaiser Permanente Medical Care Program, Oakland, California 94612, USA.
authors.forename: H Y
authors.initials: HY
authors.lastname: Sung
authors.forename: K A
authors.initials: KA
authors.lastname: Kearney
authors.forename: M
authors.initials: M
authors.lastname: Miller
authors.forename: W
authors.initials: W
authors.lastname: Kinney
authors.forename: G F
authors.initials: GF
authors.lastname: Sawaya
authors.forename: R A
authors.initials: RA
authors.lastname: Hiatt
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D065006:Papanicolaou Test; D010349:Patient Compliance; D017061:Prepaid Health Plans; D012189:Retrospective Studies; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*