title: Factors associated with a lack of pap smear utilization in women exposed in utero to diethylstilbestrol.
abstract: BACKGROUND
  Women in the 1940s-1960s were prescribed diethylstilbestrol (DES), a nonsteroidal estrogen, to prevent miscarriages, but the practice was terminated after it was discovered that the daughters so exposed in utero were at increased risk for developing clear cell adenocarcinoma (CCA) of the vagina or cervix at early ages. Pap smear screening is one of the principal methods used to identify tumor development and is necessary in this group of women to maintain their health. Currently, little is known about the factors associated with nonutilization of this screening tool in this high-risk population of women.
  
  
  METHODS
  National cohort data from the National Cancer Institute (NCI) DES Combined Cohort Follow-up Study during 1994, 1997, 2001, and 2006 were used to determine which factors were associated with Pap smear screening nonutilization in 2006 among DES-exposed and unexposed women. Self-reported questionnaire data from 2,861 DES-exposed and 1,027 unexposed women were analyzed using binary logistic regression models.
  
  
  RESULTS
  DES exposure, not having a previous gynecologic dysplasia diagnosis, lack of insurance, originating cohort, increasing age, and previous screening behavior were all factors associated with not reporting a Pap smear examination in the 2006 questionnaire, although college education reduced nonutilization.
  
  
  CONCLUSIONS
  Understanding which factors are associated with not acquiring a screening exam can help clinicians better identify which DES-exposed women are at risk for nonutilization and possibly tailor their standard of care to aid in the early detection of cervical and vaginal adenocarcinomas in this high-risk group.
authors.affiliation: 1 School of Health Sciences, Walden University , Minneapolis, Minnesota.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Camp
authors.forename: Angela W
authors.initials: AW
authors.lastname: Prehn
authors.forename: Ji
authors.initials: J
authors.lastname: Shen
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Herbst
authors.forename: William C
authors.initials: WC
authors.lastname: Strohsnitter
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Hobday
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Robboy
authors.forename: Ervin
authors.initials: E
authors.lastname: Adam
mesh_terms: D000230:Adenocarcinoma / Q000139:chemically induced* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D016022:Case-Control Studies; D002648:Child; D004054:Diethylstilbestrol / Q000009:adverse effects*; D004968:Estrogens, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000706:statistics & numerical data; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000139:chemically induced / Q000175:diagnosis*; D014625:Vaginal Neoplasms / Q000139:chemically induced / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*
chemical_list: D004968:Estrogens, Non-Steroidal; D004054:Diethylstilbestrol