Online Program

Effect of pap smear guidelines on clinical provision of cervical cancer screenings

Tuesday, November 5, 2013

Margo Mullinax, Ph.D., MPH, School of Health, Physical Education, and Recreation, Indiana University, Bloomington, IN
Hsien-Change Lin, PhD, MA, Applied Health Science Department, Indiana University, Bloomington, IN
Background: It is universally agreed that women need to undergo Papanicolaou (Pap) smear screening in an effort to detect cervical cancer. However, the 2009 American College of Obstetricians and Gynecologists pap smear guidelines were, overall, a call for less frequent screening. It is important to understand the relationship between guidelines and clinician practices to see if guidelines recommendations are being enforced for all groups. Objectives: The objective of this study was to assess clinician adherence to medical guidelines around providing pap smears. Methods: We used a multi-year cross-sectional research design to examine the number of pap smears given during 2007-2010 as reported by clinicians in the National Ambulatory Medical Care Survey to look for changes in the data before and after screening guidelines changed. In the multivariate analyses, pap smear rates were examined using a logistic regression with year-fixed effects. The multivariate analysis predicted the dependent variable, receiving a pap smear, by: (1) age, (2) ethnicity, (3) race, (4) insurance status, and (5) year of visit. Results: Assessed from the 3,082 women seen between 2007-2010, the majority of women who received a pap smear were not Hispanic (47.9%), were white (14.9%), between the ages of 40-70 (49.8%), and paid with private insurance (49.4%). A small percentage of women under the age of 21 and women over 71 received a pap smear. There were higher odds of receiving a pap smear for women who are Black relative to women who are White (OR=1.60; 95% CI 1.51-2.19, P<0.01), and women who paid with private insurance were more likely to receive a pap smear than any other payment type. The year of visit did not hold significant in the logistic regression model; however, overall number of women seen for any screening test did decrease in 2010, after the guidelines changed. Conclusion: There is a need, therefore, to look at pap smear guidelines, campaigns, and funding priorities with a focus on clinics that meet the needs of women of a lower socioeconomic status. The emphasis for cervical cancer prevention must focus on access. Disparities seem to relate to minority women accessing healthcare at lesser rates, which is consistent with previous research.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Evaluate clinician adherence to medical guidelines around providing pap smears. Identify predictors of recieing a pap smear. Discuss women’s health disparities related to pap smear access.

Keyword(s): Cancer Screening, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Project Coordinator at the Center for Sexual Health Promotion, where I have worked on a wide range of research projects at all stages while completing my PhD program in Health Behavior through the School of Public Health at Indiana University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.