title: Inadequate screening in patients evaluated by nongynecologists for cervical cancer: a case control analysis.
abstract: OBJECTIVE
  The purpose of this study was to determine the rate of unsatisfactory Papanicolaou tests between gynecology and nongynecology providers at a single institution.
  
  
  METHODS
  Vanderbilt University Medical Center data were used to obtain a list of all liquid-based cervical Papanicolaou smears that were collected between September 2002 and October 2006. Unsatisfactory samples were identified as 2 groups (gynecology vs nongynecology) for statistical comparison.
  
  
  RESULTS
  There were 69,129 Papanicolaou smears that had been collected between September 2002 and October 2006; 47,165 smears were in the gynecology group, and 21,964 smears were in the nongynecology group. Of these, 1206 smears were designated to be "unsatisfactory." A nongynecology provider was more likely to have an unsatisfactory Papanicolaou test result, compared with a gynecology physician (3% [602/21,964] vs 1% [604/47,165]; P < .001). The odds of having an unsatisfactory Papanicolaou test result was 2 times higher with nongynecology, compared with gynecology, physicians (odds ratio, 2.17; 95% CI, 1.94-2.43).
  
  
  CONCLUSIONS
  Rates of liquid-based smears reported as unsatisfactory are higher among nongynecology providers. Competency-based learning programs might help to address this discrepancy.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Vanderbilt University Medical Center, Nashville, TN 37232-2521, USA. Michael.E.Cole@vanderbilt.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Cole
authors.forename: Michael R
authors.initials: MR
authors.lastname: Milam
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Scott
authors.forename: Howard W
authors.initials: HW
authors.lastname: Jones
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002983:Clinical Competence; D005260:Female; D006801:Humans; D016017:Odds Ratio; D065006:Papanicolaou Test; D012044:Regression Analysis; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods / Q000592:standards