title: Cervical cancer screening for survivors diagnosed with cancer before age 25.
abstract: OBJECTIVE
  The study aims to better understand Pap test utilization for cancer survivors diagnosed before age 25 in British Columbia (BC), Canada.
  
  
  METHODS
  A population-based cross-sectional data linkage study that included 1285 5-year female cancer survivors diagnosed with cancer before age 25 and 12,185 randomly selected and birth-year-matched BC female residents. Pap participation rates in 2008-2010, both uncorrected and corrected for hysterectomy status, were compared between two groups. Adjusted prevalence ratios (PRadj) were calculated to examine (1) associations between factors and Pap rates in each group and (2) interactions between factors and groups, using log-binomial regression models.
  
  
  RESULTS
  Overall Pap rates, both uncorrected and corrected, were higher for survivors (71.8%; 72.9%) than population (69%; 69.7%). Pap rates were 4.8-5.1 and 17.8-22.4% higher for survivors aged 30-39 and 50-59 respectively. Significantly higher Pap test utilization was associated with previous Pap tests (PRadj= 1.83, 95%CI = 1.76-1.89) and previous cervical procedures (1.20, 95%CI = 1.15-1.25). Hysterectomy rates were doubled for survivors (7.4%) than population (3.7%). This did not affect Pap participation rate comparisons between two groups. In both groups, 51.6-70% of females with hysterectomies still received Pap tests.
  
  
  CONCLUSIONS
  Survivors' Pap test utilization was significantly higher than population, but lower than the Canadian benchmark of 90%. Hysterectomy correction does not affect this observation. Cervical cancer screening is suboptimal for survivors. Females with prior hysterectomies might have received unnecessary Pap tests.
  
  
  CONCLUSIONS
  Survivors without prior hysterectomies should continue to undergo Pap tests recommended by provincial guidelines, to optimize their health.
authors.affiliation: Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada. otseng@bccrc.ca.|Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada. otseng@bccrc.ca.
authors.forename: Olivia L
authors.initials: OL
authors.lastname: Tseng
authors.affiliation: Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada.|Department of Statistics, Simon Fraser University, Burnaby, British Columbia, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: Spinelli
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Dawes
authors.affiliation: Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mary L
authors.initials: ML
authors.lastname: McBride
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods*; D012189:Retrospective Studies; D017741:Survivors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods*
keywords: Cancer follow-up care; Cervical cancer screening; Childhood cancers; Pap test; Survivorship research