title: Cytology use for cervical cancer screening in Portugal: results from the 2005/2006 National Health Survey.
abstract: BACKGROUND
  Understanding the patterns of cervical cytology use in preventive care may provide useful information for an efficient transition from opportunistic screening to organized programmes. We aimed to identify the determinants of non-use and underuse of cervical cytology in Portuguese women.
  
  
  METHODS
  As part of the fourth National Health Survey (2005/2006), 2191 women aged between 25 and 64 years were evaluated. The previous use of cervical cytology was classified as never or ever, and, among the latter, those having performed the latest cytology testing >5 years before were considered to underuse cervical cytology. We assessed the determinants of non-use and underuse through age- and education-adjusted odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs).
  
  
  RESULTS
  Overall, 23.5% of women had never used cervical cytology and 10.7% reported underuse. This prevalence increased with age and decreased with education and income. Compared with the national mean, the lowest risk of non-use and underuse was observed in Norte (non-use: OR = 0.31, 95% CI: 0.23-0.42; underuse: OR = 0.60, 95% CI: 0.40-0.91) and the highest in Alentejo (non-use: OR = 2.33, 95% CI: 1.78-3.06; underuse: OR = 2.37, 95% CI: 1.43-3.93). Women without a private health insurance (OR = 2.65, 95% CI: 1.29-5.47), who had no doctor appointments in the preceding 3 months (OR = 2.06, 95% CI: 1.22-3.48) and those who had never performed a mammography (OR = 17.78, 95% CI: 9.09-34.78) were more likely to have never performed a cervical cytology.
  
  
  CONCLUSIONS
  This study shows inequalities in the use of cervical cancer screening in Portugal and provides useful information for a better allocation of resources for cancer screening.
authors.affiliation: 1 Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
authors.forename: Mariana
authors.initials: M
authors.lastname: Oliveira
authors.forename: Bárbara
authors.initials: B
authors.lastname: Peleteiro
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003581:Cytodiagnosis / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology