title: Tubal ligation frequency in Oklahoma women with cervical cancer.
abstract: OBJECTIVE
  Infrequent Pap screening is an important risk factor for cervical cancer. We studied the association between contraceptive methods, screening frequency, and cancer.
  
  
  METHODS
  Women (n=2004) enrolled in the cross-sectional Study to Understand Cervical Cancer Endpoints and Determinants (SUCCEED) underwent colposcopy to evaluate an abnormal Pap test. Questionnaire data were compared between those with cervical intraepithelial neoplasia (CIN) 3/adenocarcinoma in situ (AIS) and those with invasive cancer to identify factors associated with cancer. Logistic regression was used to calculate age-stratified measures of association between contraceptive method and Pap frequency as well as tubal ligation (TL) and cancer risk.
  
  
  RESULTS
  In all age groups, women with TL were more likely to have had no Pap screening in the previous 5 years compared to women using other contraception: 26-35 years (OR 4.6, 95% CI 2.4-8.6; p<0.001), 36-45 years (OR 3.8, 95% CI 2.1-7.0; p<0.001), and 46-55 years (OR 2.2, 95% CI 1.0-4.9; p=0.050). Subjects with cancer (n=163) were more likely to have had a TL (41% vs. 21%, p<0.001) than those with CIN 3/AIS (n=370). Age-stratified analyses showed increased odds of tubal ligation in women with cancer versus those with CIN 3/AIS between 25 and 45 years, with a significant increase in women 26 to 35 years old (OR 3.3, 95% CI 1.4-8.1; p=0.009). Adjusting for Pap frequency changed the effect only slightly, suggesting that increased risk was not fully mediated by lack of screening.
  
  
  CONCLUSIONS
  Contraceptive type is associated with Pap screening. Women with TLs obtain less frequent Pap testing and may be at an increased risk for cervical cancer.
authors.affiliation: Division of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. Cara-Mathews@ouhsc.edu
authors.forename: Cara A
authors.initials: CA
authors.lastname: Mathews
authors.forename: Julie A
authors.initials: JA
authors.lastname: Stoner
authors.forename: Nicolas
authors.initials: N
authors.lastname: Wentzensen
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Moxley
authors.forename: Meaghan E
authors.initials: ME
authors.lastname: Tenney
authors.forename: Erin R
authors.initials: ER
authors.lastname: Tuller
authors.forename: Tashanna
authors.initials: T
authors.lastname: Myers
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Landrum
authors.forename: Grainger
authors.initials: G
authors.lastname: Lanneau
authors.forename: Rosemary E
authors.initials: RE
authors.lastname: Zuna
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gold
authors.forename: Sophia S
authors.initials: SS
authors.lastname: Wang
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D003127:Colposcopy; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009825:Oklahoma; D012307:Risk Factors; D013246:Sterilization, Tubal; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control