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

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.