Cervical cancer in women with comprehensive health care access: Attributable factors in the screening process
Cervical cancer in women with comprehensive health care access: Attributable factors in the screening process
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DOI：
10.1093/jnci/dji115
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发表时间：
2005-05-04
影响因子：
10.3
通讯作者：
Taplin, SH
中科院分区：
文献类型：
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作者：
Leyden, WA;Manos, MM;Taplin, SH
背景浸润性宫颈癌是高度可预防的，但它继续发生，即使在妇女中有机会获得癌症筛查和治疗服务。为了减少这些妇女的宫颈癌，必须更好地了解其发生的原因。我们研究了与参加健康计划的妇女中宫颈癌诊断相关的因素。研究方法：我们确定了1995年1月1日至2000年12月31日诊断的所有浸润性宫颈癌病例（n = 833），这些病例是7个预付综合健康计划的长期成员，并回顾了每个妇女在癌症诊断前3年的医疗记录。根据诊断前4-36个月的巴氏试验史，将妇女分为三类：未能进行巴氏试验筛查，未能通过巴氏试验检测，或未能随访异常检测结果。结果：大多数病例（n = 464; 56%）是在诊断前4-36个月内没有进行巴氏试验的妇女。在其余病例中，263例（32%）归因于巴氏试验检测失败，106例（13%）归因于随访失败。年纪大了（比值比[OR] = 6.48，95%置信区间[CI] = 3.89至10.79）或生活在较高贫困地区（OR = 1.72，95%CI = 1.11 ~ 2.67）或文化程度较低（OR= 1.52; 95% CI = 1.07 - 2.16）与被分配到筛选失败类别与其他两个类别之一的可能性相关。在464名未接受巴氏筛查的患者中，共有375名（81%）在癌症诊断前4-36个月至少接受过一次门诊访视。44%的患者的癌症诊断过程是由常规筛查检查触发的，而53%的患者出现与宫颈癌一致的症状;其余3%是在接受非宫颈护理过程中偶然发现的。结论：为了降低接受筛查和治疗的妇女中浸润性宫颈癌的发病率，应提高巴氏筛查的依从性。此外，提高巴氏筛查准确性的战略可以更早地发现宫颈癌。
Background. Invasive cervical cancer is highly preventable, yet it continues to occur, even among women who have access to cancer screening and treatment services. To reduce cervical cancer among such women, reasons for its occurrence must be better understood. We examined factors associated with the diagnosis of cervical cancer among women enrolled in health plans. Methods: We identified all cases of invasive cervical cancer (n = 833) diagnosed from January 1, 1995, through December 31, 2000, among women who were long-term members of seven prepaid comprehensive health plans and reviewed each woman's medical records for the 3 years prior to her cancer diagnosis. Women were classified into one of three categories based on Pap test histories 4-36 months before diagnosis: failure to screen with a Pap test, failure in detection by a Pap test, or failure in follow-up of an abnormal test result. Results: The majority of cases (n = 464; 56%) were in women who had no Pap tests during the period 4-36 months prior to diagnosis. Of the remaining cases, 263 (32%) were attributed to Pap test detection failure and 106 (13%) to follow-up failure. Being older (odds ratio [OR] = 6.48, 95% confidence interval [CI] = 3.89 to 10.79) or living in an area of higher poverty (OR = 1.72, 95% CI = 1.11 to 2.67) or having a lower education level (OR= 1.52; 95% CI = 1.07 to 2.16) was associated with the likelihood of being assigned to the failure to screen category versus either of the other two categories. A total of 375 (81%) of the 464 patients who had not had Pap screening had had at least one outpatient visit 4-36 months prior to cancer diagnosis. The cancer diagnostic process was triggered by a routine screening examination in 44% of patients, whereas 53% of the patients presented with symptoms consistent with cervical cancer; the remaining 3% were identified fortuitously during the course of receiving noncervical care. Conclusions: To reduce the incidence of invasive cervical cancer among women with access to screening and treatment, Pap screening adherence should be increased. In addition, strategies to improve the accuracy of Pap screening could afford earlier detection of cervical cancer.