title: Cancer screening in public health clinics: the importance of clinic utilization.
abstract: OBJECTIVE
  To determine how screening for breast and cervical cancer in public health clinics was associated with overall clinic utilization.
  
  
  METHODS
  Evidence of screening and clinic visits between June 1989 and May 1992 was obtained by medical record audit for a random sample of 1825 women aged 40 to 75 attending eight public health clinics in the San Francisco Bay Area.
  
  
  RESULTS
  With an average number of visits (4 per year), women who did not receive a physical examination were much less likely than those who did to obtain a clinical breast examination (OR = 0.03), mammography referral (OR = 0.1), or a mammogram (OR = 0.4) within 2 years, or a Papanicolaou smear (OR = 0.1) within 3 years. Without a physical examination, the odds of screening or referral increased with the first visit (OR = 1.2 for referral, breast examination, and Pap; 1.3 for mammography), but with a decreasing marginal effect of each additional visit (ratio of successive one-visit OR values = 0.992 for referral and breast examination; 0.995 for Pap; 0.98 for mammography). With a physical exam, visits were associated with mammography only (first visit OR = 1.2; OR ratio = 0.992).
  
  
  CONCLUSIONS
  In public health clinics, screening is associated either with receipt of routine care or repeated visits for treatment. Women who fall through the cracks are those who come to the clinic with a medical problem but otherwise receive few services. Interventions in public health clinics need to facilitate the provider's ability to use medically related visits as opportunities to increase adherence to screening recommendations.
authors.affiliation: University of California, Berkeley, CA 94720, USA. jbloom@uclink4.berkeley.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Bloom
authors.forename: S L
authors.initials: SL
authors.lastname: Stewart
authors.forename: J
authors.initials: J
authors.lastname: Koo
authors.forename: R A
authors.initials: RA
authors.lastname: Hiatt
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003151:Community Health Centers / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D000073718:Pancreatitis-Associated Proteins; D065006:Papanicolaou Test; D010808:Physical Examination / Q000706:statistics & numerical data; D015980:Public Health Practice; D012495:San Francisco; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data