Acting on provider recommendations for an abnormal Pap test on the Texas-Mexico border

The Texas-Mexico border has one of the highest cervical cancer mortality rates in the US, perhaps due to the failure of Latinas to receive appropriate follow-up care after an abnormal Pap test. We conducted a prospective cohort study primarily among women referred to a dysplasia clinic on the Texas-Mexico border from April 2006 through May 2008 to determine whether women received appropriate follow-up care for an abnormal Pap test. Women were interviewed in-person at diagnosis prior to treatment (n=460), and by telephone at 3 months (n=365), 6 months (n=330), and 12 months (n=216) following diagnosis (with respective response rates of 89%, 79%, 78% and 55%). This analysis is restricted to Latinas who completed at least one follow-up interview (n=371). At baseline, nearly all women reported their provider recommended taking a closer look at the cervix/colposcopy (95%), repeat Pap test (88%), or another procedure (biopsy/LEEP/ cryosurgery) (88%). The percentage of women reporting they had actually received follow-up care ranged from 63% for repeat Pap test to 35% for biopsy/LEEP/cryosurgery. The only demographic or medical factor examined that significantly predicted appropriate follow-up care was health insurance; women were less likely to report receiving care if they were on Medicaid or self-pay (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.05-0.99). Our findings indicate that health insurance remains a barrier to appropriate follow-up care for an abnormal Pap test among Latinas. Educational interventions focusing on the Medicaid population may ultimately be effective in reducing the cervical cancer mortality rate on the Texas-Mexico border.