Missed opportunities for cervical cancer screening of HMO members developing invasive cervical cancer (ICC)

Objective, To identify potential missed opportunities and to suggest interv entions for cervical cancer screening in members of a prepaid health plan b y examining the membership histories and medical records of women who had n o Pap smear performed in the 3 years prior to the diagnosis of ICC. Methods. Medical records of all 642 members of a prepaid health plan develo ping ICC during the period from 1988 to 1994 were reviewed and details of p atient interaction with the health care system were abstracted. Assessment of screening history and history of clinic visits was limited to the period 36 months prior to diagnosis, but excluded the last 6 months prior to diag nosis, so as to avoid including smears or visits which were part of the eva luation that led to the recognition of ICC. Results. Of women developing ICC, 384/642 (60%) had not had a smear in the period from 36 months to 6 months preceding the diagnosis. Of these 384 uns creened women, 241 (63%) had been insured by our HMO for at least 30 of the 36 months prior to diagnosis. Contact with the medical system in one of th e primary care outpatient clinics was documented in 180/241 (75%) of these long-standing members during the specified period, Considering only Interna l Medicine and Family Practice clinic visits, 169/241 (70%) had been seen a t least once and 101/241 (42%) had been seen 3 or more times. Conclusion, Most long-standing HMO members developing ICC without benefit o f recent Pap smear screening were seen in primary care outpatient clinics i n the 3 years preceding their diagnosis. (C) 1998 Academic Press.