Mammography and Pap smear screening of Yaqui Indian women.

The Pascua-Yaqui Tribe of Arizona receives its health care services at a local neighborhood health center in Tucson and a satellite clinic located on the reservation. Using a computerized data base from the health center, the authors determined the use rates by Pascua-Yaqui women ages 35-65 of the Papanicolaou smear and mammography screening. Among active users of the health center, 31-36 percent had received a Papanicolaou smear, according to the yearly data bases examined from 1986 to 1990, while 65 percent of the women had received at least one smear test over the entire 5-year period. Regarding mammography screening, 41-43 percent of the women ages 50-65 had received a mammogram in the years studied, and 51-58 percent of the women ages 40-49 had been screened. In all, 67 percent had received at least one mammogram during the 1988-90 period when the center offered mammography. This population of 35-65-year-old American Indian women, for whom financial access is not a barrier, were receiving Papanicolaou smears and mammograms at rates comparable with other segments of the U.S. population but at lower rates than those recommended by the American Cancer Society and National Cancer Institute. The challenge for the health center is to reach those women who are eligible for services but do not use them and to address the nonfinancial barriers to care such as language, transportation, and gender-specific issues.     

Repeated Pap smear screening among Mexican-American women

The factors that influence repeated cervical cancer screening among Latina women are not well understood. Studies of compliance in this population over-emphasize initial or recent screening and under-emphasize how this practice is repeated over time. The purpose of this study was to identify the demographic and psychosocial factors associated with repeated Pap smear screening among low-income Mexican-American women living in two urban communities in Texas. A total of 1804 Mexican-American women were interviewed as part of a community survey. Multiple regression results indicate that demographic characteristics such as age, marital status, level of acculturation and health insurance were associated with the total number of Pap smears reported for the 5 years prior to the interview. Pap smear beliefs were the strongest predictor of repeated screening, while global beliefs about cancer did not significantly explain the results. Health promotion interventions should take into consideration the cultural and psychosocial needs of Mexican-American women, placing emphasis on their specific screening-related beliefs, if they are to succeed in promoting repeated compliance with Pap smear screening guidelines.     

Community-based cultural predictors of Pap smear screening in Nova Scotia

BACKGROUND: Pap smear screening is effective in reducing the incidence of cervical cancer. However, some subgroups of women are less likely to be screened than others. Since Canadian provincial health databases do not contain data fields identifying ethnicity or language, analyses employing these variables are typically not available. This paper overcomes this problem by using community- rather than person-based measures. Associations with having had a recent Pap smear are reported by community income, language, ethnic group, and urban/rural status, as well as the woman's age. METHODS: The provincial Health Card Number and Cytology Registries were linked to ascertain the screening status of women in mainland Nova Scotia and Cape Breton. Postal codes were linked to census enumeration areas and then to Statistics Canada census data to create community-based cultural measures for each woman. RESULTS: Women in mainland Nova Scotia were more likely to have had a recent Pap smear (Odds Ratio (OR)=1.36; 95% Confidence Interval (CI):1.33-1.39). Women living in low income (OR=1.19; CI:1.15-1.22), Aboriginal (OR=1.60; CI:1.46-1.76), mixed Black (OR=1.25; CI:1.19-1.30) and rural (OR=1.09; CI:1.07-1.11) communities and who were older were less likely to have had a recent Pap smear. DISCUSSION: These findings were not unexpected. In the United States and elsewhere, associations between Pap screening status and women with low income, rural residence, Aboriginal and Black heritage have been reported using person-based methods. Our findings demonstrate a method of providing measures of ethnicity and language that should be considered for use in Canadian studies of service utilization, disease status, and well-being.     

A survey of state Medicaid policies for coverage of screening mammography and Pap smear services.

In the winter of 1990, we surveyed all states and the District of Columbia to ascertain Medicaid policies on screening mammography and Pap smear--two critical preventive cancer screens for women. Forty-four state Medicaid programs cover screening mammography and all 51 jurisdictions cover Pap smear services. However, the extent of coverage and reimbursement rates vary widely across states. Only a small minority of states reported age or frequency limits for screening; five of these are in conflict with nationally recommended guidelines.     

Pap smear and mammogram screening in Mexican-American women: the effects of acculturation.

OBJECTIVES. For Mexican Americans, acculturation is a multidimensional process of adopting attitudes, values, and behavior from the non-Hispanic White culture. This study examines the effects of different dimensions of acculturation on the cancer screening behavior of Mexican-American women. METHODS. Subjects were 450 randomly selected Mexican-American women age 40 years and older living in El Paso, Texas. Personal interviews solicited information on age, income, education, health insurance, Pap smear and mammogram use, and acculturation. Acculturation was measured with five scales that assessed English proficiency, English use, value placed on culture, traditional family attitudes, and social interaction. RESULTS. The 2-year prevalence of Pap smear and mammogram screening increased with each gain in acculturation on English proficiency and use. These associations disappeared when adjusted for age, income, insurance, and education. After adjusting for sociodemographic factors and other acculturation dimensions, a strong traditional Mexican attitude toward family was positively related to mammography use. CONCLUSIONS. Taking advantage of the positive influence of Hispanic familism on cancer screening behavior may increase the effectiveness of cancer control interventions in Mexican Americans.     

Use of mammography and Pap smear in Estonia,a country without organized cancer screening

Summary Objectives: To analyze mammography and Pap smear status in Estonia where no organized population-based cancer screening is available. Methods: 5000 individuals (aged 16–64) were randomly chosen from the national population register; among them, 1755 women filled out postal questionnaires. Results: 50% of respondents aged 45–64 reported having taken a mammogram, 51% of women aged 25–64 had the Pap smear at least once in their lifetime. Corresponding figures for the past two years were 37% and 30%. Irrespective of age, women taking fewer tests over the past two years were rural workers, unemployed, and health behavior recommendations ignorers. In most cases, initiative for mammogram came from women, and from the physician in the case of Pap smear. Moderate increase in mammography use occurred after a project for early detection of breast cancer was launched. Conclusion: Women must continuously be informed that early detection of breast and cervical cancer is possible. Young women should be encouraged to ask for Pap testing. Knowledge of family physicians should be improved. Submitted: 13 February 2006; Revised: 4 October 2006; Accepted: 8 November 2006     

Sociodemographic factors of Pap smear screening in Taiwan

Substantial evidence exists that regular screening is effective in preventing cervical cancer. However, the existing services are underused by many women in Taiwan. To examine the effects of sociodemographic characteristics on the underuse of Papanicolaou (Pap) smear screening, from September to December 1993 we conducted a questionnaire interview on a sample of 4,400 women aged 20 years and older in Taipei city using multistage sampling with probability proportional to size. Our results indicate that 40% of the women sampled have never had a Pap smear and 86% have not had one in the past year. Age is the strongest factor affecting Pap smear use, particularly for women below age 30 and over the age of 65. In addition, women with lower levels of education, women who are not employed, never-married women who live outside the city tend to underuse Pap smear screening. These findings help indicate priority groups which should be targeted to increase screening and consequently reduce cervical cancer. Our data also provides a good baseline for comparison of rates of Pap smear screening by various sociodemographic factors in the future.     

Colorectal cancer screening behavior in women attending screening mammography: Longitudinal trends and predictors

PURPOSE: Nationally representative surveys demonstrate that the adherence to screening mammography guidelines are associated with increased prevalence of colorectal cancer (CRC) screening; however, the incidence of CRC screening in the screening mammography population is unknown. Our purpose was to describe non-fecal occult blood test (FOBT) CRC screening utilization by women prior to and subsequent to screening mammography at a large academic medical center. MATERIALS AND METHODS: Using the institutional administrative data base, 17,790 women aged 50 and older who underwent screening mammography between 1998 and 2002 were retrospectively identified. We determined that women were current with non-FOBT CRC screening at the time of mammography if they had undergone flexible sigmoidoscopy or double-contrast barium enema in the 5 years or colonoscopy since 1995, the earliest for which data are available. We excluded FOBT as a form of CRC screening because the administrative data base did not adequately capture episodes of FOBT. Women who were not current were considered eligible for non-FOBT CRC screening. We then assessed the number of women who underwent flexible sigmoidoscopy, barium enema, or colonoscopy within 12 months following mammography. Age, insurance status, Breast Imaging Reporting and Data System classification, recommendations after screening mammography and year of mammography were examined as potential predictors of non-FOBT CRC screening completion. RESULTS: At the time of mammography, 13.3% women were current with non-FOBT CRC screening. Of women eligible for non-FOBT CRC screening at the time of mammography, 1.1% completed non-FOBT CRC screening within 12 months after mammography. The rate of non-FOBT CRC screening completion increased over time. After multivariate analysis, being insured by a commercial managed care organization or by Medicaid remained significant predictors of non-FOBT CRC screening. CONCLUSION: The prevalence of non-FOBT CRC screening is low in the population of women undergoing screening mammography, with an incidence of 1.0%. Future studies should examine whether delivering CRC screening interventions at a screening mammography visit increase adherence to non-FOBT CRC screening.     

Association between CBE,FOBT, and Pap smear adherence and mammography adherence among older low-income women

BACKGROUND: Adherence to regular and timely mammography screening, especially in older low-income women, continues to fall below objectives. The primary aim of this study was to examine whether engaging in other cancer screenings was associated with mammography adherence for older women. METHODS: Women, ages 52 and over, without a self-reported history of breast cancer (N = 862) were selected from a larger sample of women residing in Washington, DC, census tracts with >/=30% of households below 200% of the federal poverty threshold. A computer-assisted telephone survey was used to collect data on health care system factors, demographics, cultural beliefs, clinical breast exam (CBE), Pap smear, fecal occult blood testing (FOBT), and mammography. Adherence was defined as receipt of the last two screening tests within recommended intervals for age. RESULTS: After controlling for other variables, adherence to CBE (OR = 4.15; 95% CI, 2.55-6.73) and Pap smear (OR = 1.82; 95% CI, 1.07-3.12) were highly predictive of mammography adherence. Adherence to FOBT (OR = 1.66; 95% CI, 0.97-2.84) was marginally predictive. CONCLUSIONS: Results of this study indicate that nonadherence to other cancer screenings can help identify women in need of additional interventions to improve mammography adherence.     

Predictors of cervical Pap smear screening awareness,intention, and receipt among Vietnamese-American women

BACKGROUND: Compared with white women, Vietnamese women in the United States have a higher rate of cervical cancer and lower Papanicolau (Pap) test utilization. We evaluated factors associated with awareness of the Pap test, intention to obtain it, and its receipt in Vietnamese-American women. METHODS: In 2000, we conducted a telephone survey of Vietnamese-American women aged >or=18 years living in Santa Clara County, California, and Harris County, Texas. We collected data on sociodemographics, healthcare system access and attitudes, as well as Pap test awareness, attitudes, intentions, and practices. RESULTS: Of 1566 subjects, 74% had heard of the Pap test, and 76% had had at least one. Only 42% of those who never had a Pap test had considered obtaining one. There were no significant differences between the two sites. Women aged >or=65 had the lowest rates for all three outcomes. For all women, younger age, being married, having requested a Pap test, physician recommendation, and preferring a female standby if the doctor was male were associated with Pap test intention. Being married, higher level of education, having a female doctor, having a respectful doctor, having requested the test, and physician recommendation were associated with Pap test receipt. CONCLUSION: Vietnamese-American women have low rates of Pap test awareness, intention, and receipt. The patient-doctor interaction is an important determinant. Efforts to increase Pap test utilization in this population need to be directed at encouraging physicians to offer the Pap test and empowering women to ask for the test.     

Rates and independent correlates of Pap smear testing among Korean-American women.

OBJECTIVES: This study reports population estimates of Pap smear testing among Korean-American women and evaluates correlates of testing. METHODS: Korean Americans in 2 California counties were surveyed by telephone. Frequencies were age-adjusted to the 1990 census to produce population estimates of testing. Logistic regression models were used to evaluate independent correlates of testing RESULTS: Only 50% of the Korean-American women surveyed had a Pap test in the previous 2 years. The strongest independent correlate was having had a regular check-up in the previous 2 years (odds ratio 7.2, 95% confidence interval 4.2, 12.1). CONCLUSIONS: Rates of Pap testing among Korean-American women are well below national objectives. Collaboration and community-sensitive research are essential to collect data and design programs to improve the health of ethnic minority communities.     

Inequalities in Pap smear screening for cervical cancer in Brazil

Objective

To examine the risk factors associated with never being screened for cervical cancer (CC) in Brazil.

Methods

Using the National Household Sample Survey 2008 (PNAD), we analyzed data from 102,108 Brazilian women ages 25–64 years. The patients were analyzed as having been or never having been screened with a Pap smear (Yes/No). Age-adjusted prevalence of never-screening was analyzed using a Chi-squared test. Crude and adjusted models using Poisson regression were performed.

Results

The prevalence of never-screened women for CC was 12.9%, 11.5% and 22.2% in Brazil in general, urban and rural areas, respectively. The Brazilian region with the highest prevalence of never-screening was the North (17.4%, 14.7% and 27.3% in general, urban and rural areas, respectively). The factors associated with a higher risk for never being screened were the following: poverty, younger age, lower educational level, non-white skin color, a greater number of children, no supplemental health insurance and not having visited a doctor in the past 12 months.

Conclusion

Socioeconomic and demographic conditions lead to inequalities in access to Pap smear screening in Brazil. Public health policy addressing these risk groups is necessary.     

Pap smear screening in an equal-access health care system. Yield of screening and predictors of squamous intraepithelial lesions and atypical squamous cells of undetermined significance

PURPOSE: The purpose of this study was to examine predictors of squamous intraepithelial lesions (SIL) and atypical squamous cells of undetermined significance (ASCUS) in an equal access health care setting.METHODS: A cohort of 10,713 active-duty United States Air Force women who provided one cervical/vaginal smear (CVS) as part of routine medical care between January 1, 1994 and December 31, 1996 were selected for this study. Each of the specimens was characterized by a "Bethesda System" diagnosis: within normal limits, repair/reactive, ASCUS, low grade SIL, high grade SIL, invasive carcinoma, infectious disease or unsatisfactory.RESULTS: Significant disease was associated with age younger than 30 years, enlisted rank, Hispanic ethnicity and the presence of genital warts on examination. SIL was associated with age 21-25 and Hispanic ethnicity in the logistic regression model. A diagnosis of ASCUS was associated with age younger than 30, marital status as single/never married, presence of genital warts on physical examination, and a history of previous abnormal CVS since entering military service. Age younger than 30, a marital status of single/never married and a previous abnormal CVS were associated with ASCUS in the logistic regression model.CONCLUSIONS: The disparity noted between women of low and high socioeconomic status was not seen here; those with the lowest income and education were not significantly more likely to have SIL or ASCUS when age was considered in the model. The significant association between Hispanic ethnicity and SIL, which should be further explored, may indicate the need for increased screening in this population.     

Pap smear use in a population of older Mexican-American women

BACKGROUND: Hispanic women and older women (age > or = 50 years) in general have been identified as populations of women who often underutilize Papanicolaou (Pap) smears. OBJECTIVE: To report the rates of cervical cancer screening in a group of older Mexican American women and to identify the correlates of having a Pap smear in the past three years. DATA SOURCE: The Mammography Use by Older Mexican-American Women Survey, a stratified area probability sample of 452 women ages 50-74 from three southeast Texas counties. Self-report data was collected with in-person interviews from 1997 to 1999. RESULTS: We found that 93.1% of the women reported at least one Pap smear in their lifetime and that 64.1% reported a Pap smear in the past three years. Odds of reporting a recent Pap smear was lower for older women (OR 0.51, 95% CI 0.32-0.82) and those below the poverty line (OR 0.52, 95% CI 0.33-0.82). The odds were higher for women who had a regular doctor for female care (OR 6.49, 95% CI 2.96-14.23) or a regular clinic or hospital source for female care (OR 5.50, 95% CI 2.55-11.89). Among these older Mexican-American women, cultural factors (language of interview, acculturation, fatalism) did not have a significant effect on screening use. CONCLUSION: Recent Pap smear use (64.1%) falls well below the year 2010 goal of 90%. Efforts need to be made to overcome barriers to Pap smear utilization for these women, such as providing access to female medical care.     

Pap smear rates among Haitian immigrant women in eastern Massachusetts

OBJECTIVE: Given limited prior evidence of high rates of cervical cancer in Haitian immigrant women in the U.S., this study was designed to examine self-reported Pap smear screening rates for Haitian immigrant women and compare them to rates for women of other ethnicities. METHODS: Multi-ethnic women at least 40 years of age living in neighborhoods with large Haitian immigrant populations in eastern Massachusetts were surveyed in 2000-2002. Multivariate logistic regression analyses were used to examine the effect of demographic and health care characteristics on Pap smear rates. RESULTS: Overall, 81% (95% confidence interval 79%, 84%) of women in the study sample reported having had a Pap smear within three years. In unadjusted analyses, Pap smear rates differed by ethnicity (p=0.003), with women identified as Haitian having a lower crude Pap smear rate (78%) than women identified as African American (87%), English-speaking Caribbean (88%), or Latina (92%). Women identified as Haitian had a higher rate than women identified as non-Hispanic white (74%). Adjustment for differences in demographic factors known to predict Pap smear acquisition (age, marital status, education level, and household income) only partially accounted for the observed difference in Pap smear rates. However, adjustment for these variables as well as those related to health care access (single site for primary care, health insurance status, and physician gender) eliminated the ethnic difference in Pap smear rates. CONCLUSIONS: The lower crude Pap smear rate for Haitian immigrants relative to other women of color was in part due to differences in (1) utilization of a single source for primary care, (2) health insurance, and (3) care provided by female physicians. Public health programs, such as the cancer prevention programs currently utilized in eastern Massachusetts, may influence these factors. Thus, the relatively high Pap rate among women in this study may reflect the success of these programs. Public health and elected officials will need to consider closely how implementing or withdrawing these programs may impact immigrant and minority communities.     

Evaluation of a mass-media-led campaign to increase Pap smear screening

A health education campaign designed to encourage women between the ages of 18 and 70, especially 'older' women (defined as those 50 and over), to have a Pap smear took place in New South Wales (NSW), Australia in early 1988. The campaign involved the mass media, some related community activities and mailing of an educational package to all General Practitioners. According to a sample survey the media campaign was recalled by just over 40% of its target audience. Outcome evaluation was based on the analysis of Pap smear records for a representative 10% sample (N = 338 000) of women registered with the Australian universal health insurance scheme in NSW and three control States. From logistic regression models we estimate that, for women over 50 years and older in NSW, there was a 30% increase overall in Pap smears during the 4 months following the campaign and a 50% increase amongst those who had not had a smear in the previous 2 years. Smaller increases were observed in some other States. Increases of 13-20% were observed among the younger age groups in NSW. Although the campaign appears to have prompted short-term increases in screening rates, the effect is too small to make a substantial impact on the size of the under-screened population.