Time to clinical investigation for Indigenous and non-Indigenous Queensland women after a high grade abnormal Pap smear, 2000-2009.
OBJECTIVE
To investigate time to follow-up (clinical investigation) for Indigenous and non-Indigenous women in Queensland after a high grade abnormality (HGA) being detected by Pap smear.


METHODS
Population-based retrospective cohort analysis of linked data from the Queensland Pap Smear Register (PSR), the Queensland Hospital Admitted Patient Data Collection, and the Queensland Cancer Registry. 34 980 women aged 20-68 years (including 1592 Indigenous women) with their first HGA Pap smear result recorded on the PSR (index smear) during 2000-2009 were included and followed to the end of 2010.


METHODS
Time from the index smear to clinical investigation (histology test or cancer diagnosis date), censored at 12 months.


RESULTS
The proportion of women who had a clinical investigation within 2 months of a HGA finding was lower for Indigenous (34.1%; 95% CI, 31.8-36.4%) than for non-Indigenous women (46.5%; 95% CI, 46.0-47.0%; unadjusted incidence rate ratio [IRR], 0.65; 95% CI, 0.60-0.71). This difference remained after adjusting for place of residence, area-level disadvantage, and age group (adjusted IRR, 0.74; 95% CI, 0.68-0.81). However, Indigenous women who had not been followed up within 2 months were subsequently more likely to have a clinical investigation than non-Indigenous women (adjusted IRR for 2-4 month interval, 1.21; 95% CI, 1.08-1.36); by 6 months, a similar proportion of Indigenous (62.2%; 95% CI, 59.8-64.6%) and non-Indigenous women (62.8%; 95% CI, 62.2-63.3%) had been followed up.


CONCLUSIONS
Prompt follow-up after a HGA Pap smear finding needs to improve for Indigenous women. Nevertheless, slow follow-up is a smaller contributor to their higher cervical cancer incidence and mortality than their lower participation in cervical screening.
Menzies School of Health Research, Charles Darwin University, Darwin, NT lisa.whop@menzies.edu.au.
Lisa J
LJ
Whop
Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD.
Peter D
PD
Baade
National HPV Vaccination Program Register, Victorian Cytology Service, Melbourne, VIC.
Julia Ml
JM
Brotherton
Cancer Research Division, Cancer Council NSW, Sydney, NSW.
Karen
K
Canfell
Menzies School of Health Research, Charles Darwin University, Darwin, NT.
Joan
J
Cunningham
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC.
Dorota
D
Gertig
ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT.
Kamalini
K
Lokuge
Menzies School of Health Research, Charles Darwin University, Darwin, NT.
Gail
G
Garvey
Menzies School of Health Research, Charles Darwin University, Darwin, NT.
Suzanne P
SP
Moore
Menzies School of Health Research, Charles Darwin University, Darwin, NT.
Abbey
A
Diaz
Cancer Research Division, Cancer Council NSW, Sydney, NSW.
Dianne L
DL
O'Connell
QIMR Berghofer Medical Research Institute, Brisbane, QLD.
Patricia
P
Valery
Centre for Population Health Research, University of South Australia, Adelaide, SA.
David M
DM
Roder
Menzies School of Health Research, Charles Darwin University, Darwin, NT.
John R
JR
Condon
D000328:Adult; D000359:Aftercare / Q000592:standards; D000368:Aged; D003695:Delivery of Health Care / Q000208:ethnology / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods* / Q000639:trends; D011793:Queensland / Q000453:epidemiology / Q000208:ethnology; D012189:Retrospective Studies; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control; D000095283:Australian Aboriginal and Torres Strait Islander Peoples