Abnormal Pap Smear Follow-Up in a High-Risk Population

• Published in: Cancer epidemiology, biomarkers & prevention Vol. 10; no. 10; pp. 1015 - 1020
• Main Authors: ENGELSTAD, Linda P, STEWART, Susan L, NGUYEN, Bang H, BEDEIAN, Katherine L, RUBIN, Mary M, PASICK, Rena J, HIATT, Robert A
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Association for Cancer Research 01-10-2001
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Case-Control Studies; Cohort Studies; Confidence Intervals; Emergency Service, Hospital; Female; Female genital diseases; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Hospitals, Public; Humans; Logistic Models; Mass Screening - methods; Medical sciences; Middle Aged; Odds Ratio; Papanicolaou Test; Poverty; Prevalence; Reference Values; Risk Assessment; Risk Factors; Sensitivity and Specificity; Time Factors; Tumors; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - pathology; Vaginal Smears; United States; North America; America; Human; Dysplasia; Premalignant lesion; Socioeconomic status; Uterine cervix; Malignant tumor; Medical screening; Female genital diseases; Pathology; Surveillance; Smear; Atypical squamous cell of undetermined significance; Cytopathology; Papanicolaou smear test; Uterine cervix diseases; Public health
• ISSN: 1055-9965; 1538-7755

Low-income women are at high risk of developing cervical cancer attributable not only to the higher prevalence of risk factors
in this population but also to the lack of timely follow-up of abnormal Pap smears. This study evaluates the efficacy of an
aggressive follow-up strategy. Women with abnormal Pap smear results after screening in a public hospital emergency department
were randomly assigned to follow-up either by a case-managed approach using computerized tracking and universal colposcopy
or by traditional care. The main outcome was the proportion of women receiving follow-up in 6 months. A secondary outcome
was the proportion of women receiving follow-up by 6 months and diagnostic resolution in 18 months. Of 54 women in the intervention
group, 65% kept at least one follow-up appointment in 6 months compared with 41% of the 54 women in the control group ( P = 0.012). Half the women in the intervention group versus 19% of women in the control group had follow-up in 6 months and diagnostic resolution in 18 months ( P = 0.001). After adjusting for age, initial Pap smear result, and race/ethnicity, the odds of having follow-up in 6 months
were four times greater for women in the intervention group (odds ratio = 4.0; 95% confidence interval, 1.6–9.7), and the
odds of having both follow-up in 6 months and diagnostic resolution in 18 months were more than six times greater (odds ratio
= 6.5; 95% confidence interval, 2.4–17.8). This study demonstrates that an aggressive follow-up strategy significantly improves
the rate of both initial follow-up and diagnostic resolution of abnormal Pap smears among low-income women with atypical squamous
cells of undetermined significance and atypical glandular cells of undetermined significance when compared with traditional
care.