Adequacy of cervical cancer screening among innercity women: results from a defined population

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Abstract
Despite declines in mortality of cervical cancer, a sizable minority of women fail to obtain routine screening with the Papanicolaou smear and are at risk from this disease. Before implementing a long-term community-based intervention study to improve screening rates and reduce the stage of disease at diagnosis, a cervical cancer screening canvass of a defined population of poor, inner-city Baltimore residents was conducted between 1987 and 1989. A total of 4089 at-risk women were interviewed (81.3% response), of whom 95.5% reported ever having a Pap test, and 28% gave histories of inadequate recent screening. Reporting never having received a Pap test was associated with age, infrequent contact with the medical care system, and no recall of being advised how often to obtain Pap tests. Race was not a significant predictor. Logistic regression analysis yielded two important factors—no recent physician visit or recall of periodicity recommendation. For current screening adequacy, age, medical care encounters and recall of physician advice were significant in bivariate analysis as well as in multivariate analysis: no racial differences were seen. The results demonstrate the key role played by primary health care providers and the power of physician advice in reinforcing the need to maintain routine screening examinations. Since most of the women interviewed had an encounter with the medical care system, ‘missed opportunities’ for early cancer detection continue to occur.

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