title: Adherence to screening guidelines for breast and cervical cancer in postmenopausal women with coronary heart disease: an ancillary study of volunteers for hers.
abstract: Postmenopausal women with coronary heart disease (CHD) who volunteered for the Heart and Estrogen/Progestin Replacement Study (HERS) randomized clinical trial had high rates of gynecological abnormalities. We examined compliance with gynecological cancer screening and factors affecting this behavior. Women who met inclusion criteria for HERS and were seen for screening by the study gynecologist were considered eligible for this study. Data were abstracted from study records, and additional information was obtained by telephone questionnaire. Adherence to mammography, breast examination, pelvic examination, and Pap smear recommendations was assessed. Provider behavior and its effect on compliance were assessed. Compliance rates were 59.1% for monthly breast self-examination (BSE), 67.2% for yearly mammography, 73% for yearly Pap smear and pelvic examination, and 75.7% for provider breast examination. Over 50% of patients had most of their screening tests done within the last year. Provider behavior was significantly related to patient screening compliance for mammography, breast examination, Pap smear, and pelvic examination. Provider gender was not significantly related to adherence. There were no significant differences in compliance rates based on the type of most recent coronary event. Compliance rates did not differ significantly between patients with and without gynecological abnormalities, except for mammography (78.3% versus 48.3%, p = 0.02). The majority of patients were compliant with gynecological screening. Among patients with gynecological abnormalities, mammography compliance was significantly lower. Provider behavior was an important factor in influencing women to obtain preventive screening. There were no significant differences in compliance based on provider gender or type of coronary event preceding HERS enrollment.
authors.affiliation: Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: P Z
authors.initials: PZ
authors.lastname: Castellano
authors.forename: N K
authors.initials: NK
authors.lastname: Wenger
authors.forename: W L
authors.initials: WL
authors.lastname: Graves
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D016504:Breast Self-Examination / Q000706:statistics & numerical data; D003327:Coronary Disease; D005260:Female; D005845:Georgia / Q000453:epidemiology; D019983:Guideline Adherence; D015438:Health Behavior; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008499:Medical Records; D008875:Middle Aged; D065006:Papanicolaou Test; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017698:Postmenopause; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data; D016387:Women's Health