Abstract
Introduction
This study examines factors associated with timely follow-up after Pap test in a program providing cervical cancer detection services to medically underserved California women.
Methods
Data between 01 January 1992 and 30 June 2007 were analyzed. Cox proportional hazard regression was used to identify subgroups of women with delayed time to diagnosis or treatment scheduling. The probability of being scheduled for final diagnosis and treatment was assessed using logistic regression analysis. Demographic and clinical characteristics of the women lost to follow up were examined.
Results
Time from screening to final diagnosis scheduling differed according to age group, race/ethnicity, and Pap test result. Race/ethnicity and age were associated with whether treatment was scheduled or not. While loss to follow up among those scheduled for final diagnosis was associated with certain patients’ characteristics, no such association was found among those who were scheduled for treatment.
Conclusions
Patient’s demographic characteristics determine the odds of being scheduled for final diagnosis and treatment as well as timeliness of follow-up from screening to final diagnosis. Findings suggest that the dual goal of reducing health disparities and cost-effective detection and treatment of precancerous disease to prevent cervical cancers cannot be achieved without consideration of racial/ethnic differences and needs.
Similar content being viewed by others
References
American Cancer Society (last revised: 05/13/2009) What are the key statistics about cervical cancer? http://www.cancer.org/docroot/cri/content/cri_2_4_1x_what_are_the_key_statistics_for_cervical_cancer_8.asp Checked on August 07, 2009
Christopherson WM, Lundin FE, Mendez WM, Parker JE (1976) Cervical cancer control: a study of morbidity and trends over a twenty-one year period. Cancer 38:1357–1366
Clarke EA, Anderson TW (1979) Does screening by “Pap” test help prevent cervical cancer? a case-control study. Lancet 2:1–4
Boyes DA (1981) The value of a Pap test program and suggestions for its implementation. Cancer 48(suppl):613–621
Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ (2001) ASCCP-Sponsored Consensus Conference. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA 287:2120–2129
ACOG Practice Bulletin number 66, September 2005 (2005) Management of abnormal cervical cytology and histology. Obstet Gynecol 106:645–664
Yabroff KR, Washington KS, Leader A, Neilson E, Mandelblatt A (2003) Is the promise of cancer screening program being compromised? quality of follow-up care after abnormal screening results. Med Care Res Rev 60:294–331
Marcus AC, Crane LA (1998) A review of cervical cancer screening intervention research: implications for public health programs and potential research. Prev Med 27:13–31
Howell LP, Gurusinghe S, Tabnak F (2009) Impact of ASC-H terminology on the detection of HSILs in medically underserved California women. Diagn Cytopathol 37(2):103–110
Fox P, Arnsberger P, Zhang XL (1997) Am examination of differential follow-up rates in cervical cancer screening. J Community Health 22(3):199–209
Mandelblatt J, Kerner J, Zauber A, Burnett W (1991) Determinants of late stage diagnosis of breast and cervical cancer: the impact of age, race, social class, and hospital type. Am J Public Health 81(5):646–649
Carey P, Gjerdingen DK (1993) Follow-up of abnormal Papanicolaou tests among women of different races. J Fam Pract 37:583–589
McDougal JA, Mdeleine MM, Daling JR, Li CI (2007) Racial and ethnic disparities in cervical cancer incidence rates in the United States, 1992–2003. Cancer Causes Control 18:1175–1186
Mitchell J, McCormack LA (1997) Time trends in late-stage diagnosis of cervical cancer: differences by race ethnicity and income. Med Care 35(12):1220–1224
Hiatt RA, Pasick RJ, Stewart S et al (2001) Community based cancer screening for underserved women: design and baseline findings from the breast and cervical intervention study. Prev Med 33:190–203
Zapka JG, Puleo E, Taplin SH, Goins KC, Yood MU (2004) Processes of care in cervical and breast cancer screening and follow-up–the importance of communication. Prev Med 39:81–90
Bastani R, Yabroff KR, Myers RE, Glenn B (2004) Interventions to improve follow-up of abnormal findings in cancer screening. Cancer 101(5 Suppl):1188–1200
Tanjasiri SP, Tran JH, Kagawa-Singer M et al (2004) Exploring access to cancer control services for Asian-American and Pacific Islander communities in southern California. Ethn Dis 14:S14–S19
Acknowledgment
The authors thank Drs. Donald O. Lyman, Georjean Stoodt, Kathleen Acree, and Neal Kohatsu for support of this study and Dr. Sherie Smalley for her review, comments, and support. The authors also thank graduate students Rona Tang and Fang Yao for preliminary data analysis and Phil Rylett, Programmer Analyst for the maintenance of the CDP: EWC database.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tabnak, F., Müller, HG., Wang, JL. et al. Timeliness and follow-up patterns of cervical cancer detection in a cohort of medically underserved California women. Cancer Causes Control 21, 411–420 (2010). https://doi.org/10.1007/s10552-009-9473-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-009-9473-1