title: Are the University Hospitals in Puerto Rico following Current Guidelines for Cervical Cancer Screening?
abstract: OBJECTIVE
  Cervical cancer is the fifth most common cancer among women in Puerto Rico (PR). Information about which obstetricians and gynecologists in PR are following current cervical cytology guidelines is not available. Our two objectives were to determine whether current guidelines for abnormal cervical cytology management were being followed adequately by OB-GYN residents and faculty at 3 university hospitals and, in addition, to evaluate the knowledge of the current guidelines that is possessed by these individuals.
  
  
  METHODS
  A retrospective medical record review (records from January 2009 through December 2010) of patients with abnormal cervical cytology results (n=166) to evaluate the management they were given and a cross-sectional survey of OB-GYN residents (n=34) and faculty (n=46) to evaluate their knowledge of cervical cytology guidelines were both performed.
  
  
  RESULTS
  One hundred and sixty-six medical records were reviewed. The level of management for 45% of the patients was found to have been optimal."Thirty-three percent were lost to follow-up. Eleven percent of the patients were managed sub optimally and the management of 12% of the patients was considered to have been poor. The survey showed that the faculty were less updated with regard to current guidelines for the management of cervical cytology than were the residents. Study limitations were the lack of electronic medical records in the hospital--which makes access to patient information more difficult--and the low response rate of the faculty.
  
  
  CONCLUSIONS
  OB-GYN physicians and residents were not consistent with their management, according to current guidelines, of cervical cytological abnormalities. The high-risk nature of the patients and their poor adherence to treatment (loss to follow-up) may have been the cause of this inconsistency. Meetings aimed at addressing the lack of compliance by local OB-GYN physicians with the guidelines for cervical cancer screening have been Better screening strategies are also needed if we are to improve patient compliance in our population.
authors.affiliation: Obstetrics and Gynecology Department, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Keimari
authors.initials: K
authors.lastname: Méndez
authors.affiliation: Obstetrics and Gynecology Department, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Nilmar
authors.initials: N
authors.lastname: Rodríguez
authors.affiliation: Obstetrics and Gynecology Department, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Isalis
authors.initials: I
authors.lastname: Sánchez
authors.affiliation: Obstetrics and Gynecology Department, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Yolianne
authors.initials: Y
authors.lastname: Lozada
authors.affiliation: Obstetrics and Gynecology Department, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Idelvais
authors.initials: I
authors.lastname: Piñero
authors.affiliation: Obstetrics and Gynecology Department, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Dora
authors.initials: D
authors.lastname: Donate
authors.affiliation: Obstetrics and Gynecology Department, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Josefina
authors.initials: J
authors.lastname: Romaguera
mesh_terms: D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008499:Medical Records; D017410:Practice Guidelines as Topic; D011647:Puerto Rico; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult
keywords: Abnormal cytology; Cervical cancer screening; Guidelines