Abnormal Pap smear management among migrant farm workers in New York

Objective: This study examined whether female migrant farm workers with an abnormal Pap smear received appropriate follow-up.

Methods: The sample included women who had had an abnormal Pap smear (ASC-US, LSIL, HSIL) at a migrant health clinic in upstate New York in 2009.  Data were extracted from the clinic’s medical charts in 2011.  In addition to the Pap result and follow-up, information was collected on age, pregnancy status, insurance coverage and first language.  Appropriate follow-up was defined using the American Congress of Obstetricians and Gynecologists (ACOG) guidelines for management of abnormal Paps: 1) HPV testing for women with ASC-US or LSIL, with follow-up colposcopy for those HPV-positive and a repeat Pap for those HPV-negative; 2) colposcopy for all women with HSIL. Relative risks were computed to identify factors associated with appropriate follow-up (p < 0.05).

Results: 153 women, age 15 to 61, were found to have had an abnormal Pap. ASC-US, LSIL, and HSIL accounted for 65%, 24%, and 10% of the Pap smear abnormalities, respectively.  97 women (63%) did not receive ACOG-recommended follow-up: 69% of women with ASC-US; 58% of women with LSIL and 40% of women with HSIL. None of the variables tested (age, pregnancy status, insurance coverage and language) significantly predicted appropriate follow-up, perhaps due to small sample size.

Conclusions: In this sample, 63% of female migrant farm workers with abnormal Paps had no record of appropriate follow-up, though some could have received care elsewhere.  More research is needed to understand the breakdown in referral and follow-up processes.