title: Disengagement of general practitioners in cervical cancer screening.
abstract: In the absence of organized cervical cancer screening (CCS) programs, gynecologists remain principal actors in obtaining a Pap smear, followed by general practitioners (GPs). In France, with the growing scarcity of gynecologists and social inequalities in access to opportunistic screening, GPs are valuable resources for women's gynecologic follow-up. We aimed to investigate the characteristics of GPs who do not perform CCS, analyzing the effect of GPs' sex and their evolution over time. On the basis of data from three cross-sectional surveys conducted among representative samples of French GPs in 1998, 2002, and 2009 (n=5199), we constructed univariate and multivariate logistic mixed models (level 2: county, level 1: GP) with random intercept stratified on GPs' sex to investigate the characteristics of the GPs associated with no practice of CCS ever. Almost one-third of all GPs did not perform CCS ever and it increased with time. Male GPs were always more likely not to perform it (odds ratio=0.50, 95% confidence interval=0.42-0.59). The percentage of GPs not performing CCS increased more markedly among male than among female GPs, and increased more among the youngest age group. Increasingly fewer GPs engage in CCS when the growing scarcity of medical gynecologists calls for more participation. Female GPs remain significantly more active in CCS than male GPs. The participation in CCS is determined differently according to the practitioner's sex.
authors.affiliation: aINSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexual and Reproductive Health Team bUniv Paris-Sud, UMRS 1018, F-94276, le Kremlin Bicêtre cINED, F-75012 dDepartment of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, INSERM, UMRS 1136 eDepartment of Social Epidemiology, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, UPMC Univ Paris 6, UMRS 1136, Paris fFrench National Institute of Prevention and Health Education (INPES), Saint-Denis gIRD, UMR 5569, HydroSciences, Montpellier, France.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Poncet
authors.forename: Laurent
authors.initials: L
authors.lastname: Rigal
authors.forename: Henri
authors.initials: H
authors.lastname: Panjo
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gautier
authors.forename: Pierre
authors.initials: P
authors.lastname: Chauvin
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Cadot
authors.forename: Virginie
authors.initials: V
authors.lastname: Ringa
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D055815:Young Adult