THE PAPANICOLAOU SMEAR AS A SENTINEL SCREENING-TEST FOR HEALTH SCREENING IN WOMEN

Background: There has been evidence that, in primary care practices, h ealth screening tests are not ordered in random fashion but instead ar e coupled or bundled into distinct groups. This study was performed to determine if the Papanicolaou (Pap) smear serves as a marker for othe r health screening tests. Methods: The study consisted of a retrospect ive chart review of female patients over the age of 18 years at three rural health clinics, followed by a prospective study of patients duri ng a 3-month period in five rural family practice clinics. The study f ocused on whether a Pap smear was performed and whether a breast exami nation, mammogram, rectal examination or stool occult blood test, or s erum cholesterol testing was performed. Results: In both the retrospec tive and prospective series, patients who received Pap smears were sig nificantly more likely to receive breast examinations, mammograms, col orectal screening, and cholesterol tests. In addition, the coupling of other screening tests with the Pap smear appeared to increase with ad vancing patient age, with a decline after age 70 years. In patients wh o did not have Pap smears, only cholesterol testing increased as patie nts aged. Conclusion: Health screening tests in women are associated w ith the performance of a Pap smear. Providers may use the Pap smear as a marker of whether a woman has received screening for several other medical problems. Thus, the Pap smear can be considered a ''sentinel'' test for health screening in women, and efforts to identify women at high risk and increase health promotion and disease prevention in this group should focus on women who have not received this test.