title: Sociodemographic factors associated with cervical cancer screening coverage and follow-up of high grade abnormal results in a population-based cohort.
abstract: BACKGROUND
  A cervical cytology based screening program is effective if there is regular screening of the 'at risk' population and close follow-up of those labeled abnormal.
  
  
  METHODS
  This is a population cohort study of women between 20-69 year old who were eligible in Ontario from 2008-2010. We used administrative data to evaluate the rates of cervical cancer screening and follow-up of high grade Pap tests. Variation in cervical cytology coverage and follow-up of high grade abnormal results are associated with age, area level income and health region. Multivariate logistic regression was used to identify independent factors associated with screening and followup.
  
  
  RESULTS
  3.7million women were eligible for screening of which 72% had a Pap smear in the prior 3years. These rates varied by age, income and region (p<0.0001). Women residing in the lowest income neighborhoods were half as likely to be screened (p<0.0001). 83% of those with an high grade intraepithelial lesion Pap test result had follow-up with colposcopy or treatment within 6months and this varied by year, age, income and region (p<0.0001).
  
  
  CONCLUSIONS
  Despite universal health coverage, cervical cancer screening rates are suboptimal with older and low income women being at greatest risk. Follow-up among women with high grade abnormal tests is mediocre at 3months and acceptable at 6months. Novel models of cervical cancer screening program implementation are needed to address these inadequacies.
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada; Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada. Electronic address: laurie.elit@jcc.hhsc.ca.
authors.forename: L
authors.initials: L
authors.lastname: Elit
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Saskin
authors.affiliation: Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Raut
authors.affiliation: Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Elliott
authors.affiliation: Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada; Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Ontario Cervical Screening Program, Cancer Care Ontario, Toronto, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Marrett
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003127:Colposcopy; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D065006:Papanicolaou Test; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014626:Vaginal Smears / Q000706:statistics & numerical data*