title: Screening histories and contact with physicians as determinants of cervical cancer risk in Montreal, Quebec.
abstract: BACKGROUND
  Cervical cancer (cca) is largely a preventable disease if women receive regular screening, which allows for the detection and treatment of preinvasive lesions before they become invasive. Having been inadequately screened is a common finding among women who develop cca. Our primary objective was to determine the Pap screening histories of women diagnosed with cca in Montreal, Quebec. Secondary objectives were to determine the characteristics of women at greatest risk of cca and to characterize the level of physician contact those women had before developing cca.
  
  
  METHODS
  The Invasive Cervical Cancer Study, a population-based case-control study, consisted of Greater Montreal residents diagnosed with histologically confirmed cca between 1998 and 2004. Respondents to the 2003 Canadian Community Health Survey and a sample of women without cca obtained from Quebec medical billing records served as controls.
  
  
  RESULTS
  During the period of interest, 568 women were diagnosed with cca. Immigrants and women speaking neither French nor English were at greatest risk of cca. Most of the women in the case group had been screened at least once during their lifetime (84.8%-90.4%), but they were less likely to have been screened within 3 years of diagnosis. Having received care from a family physician or a medical specialist other than a gynecologist within the 5 years before diagnosis was associated with a greater risk of cca development.
  
  
  CONCLUSIONS
  Our findings provide evidence of the need for an organized population-based screening program. They also underscore the need for provider education to prevent missed opportunities for cca screening when at-risk women seek medical attention.
authors.affiliation: Division of Cancer Epidemiology, McGill University, Montreal, QC.
authors.forename: A R
authors.initials: AR
authors.lastname: Spence
authors.affiliation: Department of Obstetrics and Gynecology, King Khaled University Hospital, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Alobaid
authors.affiliation: Division of Gynecologic Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC.
authors.forename: P
authors.initials: P
authors.lastname: Drouin
authors.affiliation: Institut national de santé publique du Québec, Montreal, QC.
authors.forename: P
authors.initials: P
authors.lastname: Goggin
authors.affiliation: Department of Obstetrics and Gynecology, Mc-Gill University Health Centre, Montreal, QC.
authors.forename: L
authors.initials: L
authors.lastname: Gilbert
authors.affiliation: Division of Gynecologic Oncology, Centre hospitalier de l'Université de Montréal, Montreal, QC.
authors.forename: D
authors.initials: D
authors.lastname: Provencher
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC. ; Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, Montreal, QC.
authors.forename: P
authors.initials: P
authors.lastname: Tousignant
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC.
authors.forename: J A
authors.initials: JA
authors.lastname: Hanley
authors.affiliation: Division of Cancer Epidemiology, McGill University, Montreal, QC. ; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC.
authors.forename: E L
authors.initials: EL
authors.lastname: Franco
keywords: Cervical cancer; Papanicolaou test; screening