Predictors of early rescreening in the National Cervical Screening Program, Australia

Objective: To identify variables that predict early rescreening after a neg ative Pap smear report. Methods., Cohort study using the records of a statewide Cervical Cytology R egistry in Victoria, Australia. The cohort comprised 31,082 women who had a negative Pap smear report during the first half of 1996 and who were rescr eened within the subsequent 36 months. Early rescreening was defined as a f urther Pap smear within 21 months. Results. The strongest predictor of early rescreening was a recommendation at the time of issuing the negative Pap smear report by the laboratory for retesting before two years (adjusted odds ratio = 3.81, 95% confidence inte rval (CI) 3.58-4.05). Mention of reactive or inflammatory change as part of the negative Pap smear report was also a powerful predictor (adjusted odds ratio 1.67, 95% CI 1.50-1.85). Significant predictors associated with the women were young age, high socio-economic status and residence in the capit al city. Significant predictors associated with the practitioner were if ei ther the index or subsequent smear was collected by an obstetrician/gynaeco logist or a hospital-based clinic, or if the practitioner collecting the in dex smear was a female. The population-attributable risk per cent associate d with the laboratory recommendation was 27%. Conclusions. This data suggests that a multi-faceted strategy targeting pat hology laboratories, practitioners and women may be needed to reduce early rescreening. Implications. Early rescreening is wasteful of health resource s. New screening programs should be designed to avoid this problem.