Cervical-Cancer Screening - New Guidelines and the Balance between Benefits and Harms

Department of Obstetrics, Gynecology, and Reproductive Sciences,, University of California, San Francisco, USA.
New England Journal of Medicine (Impact Factor: 54.42). 11/2009; 361(26):2503-5. DOI: 10.1056/NEJMp0911380
Source: PubMed
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    ABSTRACT: Background: Since 2003, U.S. Preventive Services Task Force guidelines recommend against Pap testing for women without a cervix following a hysterectomy and those aged >65 years. Few population-based studies have investigated factors associated with overuse of Pap testing in the U.S. Purpose: To evaluate patient characteristics associated with overuse of Pap testing. Methods: A cross-sectional study was conducted using data from the 2010 National Health Interview Survey (NHIS) for women aged >= 30 years. NHIS is a nationally representative survey that employs a random, stratified, multi-stage cluster sampling design. In 2010, the NHIS administered a Cancer Control Supplement with questions on cervical cancer screening and hysterectomy status. Conducted in 2011-2013, all analyses account for the stratification and clustering of data within the complex NHIS survey design. Multivariate logistic regression models were used in all analyses. Results: Among women who have undergone a hysterectomy, younger age, Hispanic and black race/ethnicity, exceeding 400% of poverty level, and private health insurance coverage were significantly associated with receipt of a recent Pap test since hysterectomy. Among women aged >65 years, non-Hispanic white ethnicity, higher education level, exceeding 400% of poverty level, and no hysterectomy were significantly associated with receipt of a recent Pap test. Conclusions: Targeted efforts to reduce unnecessary testing among older women and women with a hysterectomy in compliance with clinical recommendations for cervical cancer prevention are needed. Specific attention should be paid to privately insured women with incomes above 400% of the federal poverty level.
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