Papanicolaou smear history and diagnosis of invasive cervical carcinoma among members of a large prepaid health plan

BAGKGROUND. Despite the widespread use of Papanicolaou (Pap) smear screenin g, substantial morbidity and mortality from cervical carcinoma continue in the U.S. Although access to screening is a major barrier to use of the Pap smear, invasive cervical carcinoma (ICC) still is observed in health plan m embers who have comprehensive preventive care coverage. METHODS. For all women diagnosed with ICC between 1988 and 1994 in a large prepaid health plan, the authors retrospectively reviewed the medical recor ds for prediagnosis Pap smear history to identify antecedents to ICC. RESULTS. Of 642 women diagnosed as having ICC, 455 (71%) had been plan memb ers for greater than or equal to 30 of the 36 months before diagnosis. Of t hese 455 women, 240 (53%) had no Pap smear during the 6-36 months prior to diagnosis (i.e., were nonadherent to screening), 127 (28%) had only "normal " Pap smear results, 42 (9%) had at least 1 abnormal Pap smear and were ade quately followed, 17 (4%) had at least 1 abnormal result without adequate f ollow-up, and 29 (6%) were classified as "other." Compared with adherent wo men, more nonadherent women presented with later stage disease, were sympto matic at the time of diagnosis, were older, and were of a race/ethnicity ot her than non-Hispanic white. CONCLUSIONS. Nonadherence to screening recommendations was found to be the most important modifiable antecedent to ICC in this population. The rate of incidence of ICC could be reduced by interventions to increase screening i n women who do not have Pap smears regularly and by the use of newer screen ing technologies to reduce the false-negative rate of Pap smears. Cancer 20 00;88: 2283-9. (C) 2000 American Cancer Society.