Pap screening in a U.S. health plan.
The U.S. Preventive Services Task Force recommends cervical cancer screening begin with the onset of sexual activity and be repeated at least every 3 years until age 65. Previous studies examining the annual utilization and frequency of Pap screening have relied on patient self-report, found to be less reliable than medical records and administrative data. We estimate the age-specific rate and frequency of Pap screening in a U.S. health plan using 1998-2002 administrative data on 150,052 female enrollees within the Kaiser Permanente Northwest health plan, Portland, OR. We analyze the age-specific rate of cervical and vaginal Pap screening and age-specific proportion of routinely screened women receiving cervical screening at various yearly intervals. Of the enrolled women, 31.2% received a Pap smear in 1998, with utilization highest for ages 25-29 (62.4%). Among routinely screened women, 36% were estimated to receive annual cervical smears, versus 22% biennial, 13% triennial, and 29% less frequent screening. Less frequent screening was observed with increasing age. These are the first age-specific estimates of Pap screening frequency and annual utilization in a general healthcare setting, derived from administrative data, rather than self-report. Overall Pap utilization was lower than found in national surveys based on self-report. Despite limited evidence of benefit from more frequent screening, a substantially higher proportion of women was found to receive annual rather than either biennial or triennial screening. Sporadic screening was also more prevalent than expected based on prior self-reported data. Further opportunities exist for improving screening adherence, even within traditionally less vulnerable populations.
Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA. ralph_insinga@merck.com
Ralph P
RP
Insinga
Andrew G
AG
Glass
Brenda B
BB
Rush
D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D065006:Papanicolaou Test; D015203:Reproducibility of Results; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*