Cancer Causes & Control

, 20:1 | Cite as

Accuracy of self-reports of Pap and mammography screening compared to medical record: a meta-analysis

  • Michelle HowardEmail author
  • Gina Agarwal
  • Alice Lytwyn
Review Article



To conduct a systematic review and meta-analysis of the accuracy of self-reported Pap smear and mammography screening compared to medical record.


About 37 articles were reviewed and accuracy indices of self-report were calculated. Meta-analysis with random effects was used. Study heterogeneity was investigated and meta-regressions were done including in the models those factors that were hypothesized, a priori, to potentially explain heterogeneity.


Pooled sensitivity and specificity for Pap recall were 94.7% (95% confidence interval [CI]; 93.0%–96.4%) and 47.4% (95% CI; 39.0%–55.7%), and for mammography were 94.9% (95% CI; 93.4%–96.4%) and 61.8% (95% CI; 54.1%–69.5%), respectively. There was significant heterogeneity for all indices. Stratifying by the study population source (population versus clinic-based), population characteristics (minority or low socio-economic status versus not), length of recall (within past 12 months versus longer), and expected completeness of the medical record (authors searched radiology or pathology reports of all likely facilities women may have attended, versus studies that did not) did not eliminate heterogeneity.


Women tend to over-report their participation in Pap and mammography screening in a given timeframe. The pooled estimates should be interpreted with caution due to unexplained heterogeneity.


Papanicolaou Smear Mammography Health surveys Bias Review systematic Meta-analysis 


Funding Source

This was an un-funded study, supported with in-kind contributions from the Department of Family Medicine, McMaster University.


  1. 1.
    Parkin DM, Pisani P, Ferlay J (1999) Global cancer statistics. CA Cancer J Clin 49:33–64. doi: 10.3322/canjclin.49.1.33 PubMedCrossRefGoogle Scholar
  2. 2.
    U.S. Preventive Services Task Force (2002) Screening for breast cancer. Agency for Healthcare Research and Quality, Washington, DCGoogle Scholar
  3. 3.
    Janerich DT, Hadjimechael O, Schwartz PE et al (1995) The screening histories of women with invasive cervical cancer, Conneticut. Am J Public Health 85:791–794PubMedCrossRefGoogle Scholar
  4. 4.
    McCarthy EP, Burns RB, Coughlin SS et al (1998) Mammography use helps to explain differences in breast cancer stage at diagnosis between older black and white women. Ann Intern Med 128:773–775Google Scholar
  5. 5.
    Maxwell CJ, Bancej CM, Snider J, Vik SA (2001) Factors important in promoting cervical cancer screening among Canadian women: findings from the 1996–97 National Population Health Survey (NPHS). Can J Public Health 92:127–133PubMedGoogle Scholar
  6. 6.
    Adams EK, Breen N, Joski PJ (2007) Impact of the national breast and cervical cancer early detection program on mammography and Pap test utilization among white, Hispanic and African American women: 1996–2000. Cancer 109:348–358. doi: 10.1002/cncr.22353 PubMedCrossRefGoogle Scholar
  7. 7.
    Centers for Disease Control and Prevention DoCPaC (2004) The National breast and cervical cancer detection program: saving lives through screening. Center for Disease Control and Prevention, Atlanta, GAGoogle Scholar
  8. 8.
    Stein AD, Lederman RI, Shea S (1996) Reproducibility of the women’s module of the behavioral risk factor surveillance system questionnaire. Ann Epidemiol 6:47–52. doi: 10.1016/1047-2797(95)00092-5 PubMedCrossRefGoogle Scholar
  9. 9.
    May DS, Trontell AE (1998) Mammography use by elderly women: a methodological comparison of two national data sources. Ann Epidemiol 8:439–444. doi: 10.1016/S1047-2797(98)00010-6 PubMedCrossRefGoogle Scholar
  10. 10.
    Swan J, Breen N, Coates RJ, Rimer BK, Lee NC (2003) Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer 97:1528–1540. doi: 10.1002/cncr.11208 PubMedCrossRefGoogle Scholar
  11. 11.
    Warnecke RB, Sudman S, Johnson TP, O’Rourke D, David AM, Jobe JB (1997) Cognitive aspects of recalling and reporting health-related events: Papanicolaou smears, clinical breast examinations, and mammograms. Am J Epidemiol 146:982–992PubMedGoogle Scholar
  12. 12.
    Armstrong K, Long JA, Shea JA (2004) Measuring adherence to mammography screening recommendations among low-income women. Prev Med 38:754–760. doi: 10.1016/j.ypmed.2003.12.023 PubMedCrossRefGoogle Scholar
  13. 13.
    Rauscher GH, Johnson TP, Cho YI, Walk JA (2008) Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomarkers Prev 17:748–757. doi: 10.1158/1055-9965.EPI-07-2629 PubMedCrossRefGoogle Scholar
  14. 14.
    Vernon SW, Briss P, Tiro JA, Warnecke RB (2004) Some methodologic lessons learned from cancer screening research. Cancer 101:1131–1145. doi: 10.1002/cncr.20513 PubMedCrossRefGoogle Scholar
  15. 15.
    Stange K, Zyzanski SJ, Smith TF et al (1998) How valid are medical records and patient questionnaires for physician profiling and health services research? A comparison with direct observation of patient visits. Med Care 36:851–867. doi: 10.1097/00005650-199806000-00009 PubMedCrossRefGoogle Scholar
  16. 16.
    Newell SA, Girgis A, Sanson-Fisher RW, Savolainen NJ (1999) The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population. Am J Prev Med 17:211–229. doi: 10.1016/S0749-3797(99)00069-0 PubMedCrossRefGoogle Scholar
  17. 17.
    Bossuyt PMM, Reitsma JB, Bruns DE et al (2003) The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med 138:W1–W12PubMedGoogle Scholar
  18. 18.
    Saslow D, Runowicz CD, Solomon D et al (2002) American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 52:346–362Google Scholar
  19. 19.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174. doi: 10.2307/2529310 PubMedCrossRefGoogle Scholar
  20. 20.
    Barrat A, Cockburn J, Smith D, Redman S (1999) Reliability and validity of women’s recall of mammographic screening. Aust N Z J Public Health 24:79–81. doi: 10.1111/j.1467-842X.2000.tb00728.x CrossRefGoogle Scholar
  21. 21.
    Bowman JA, Sanson-Fisher R, Redman S (1997) The accuracy of self-reported Pap smear utilisation. Soc Sci Med 44:969–976. doi: 10.1016/S0277-9536(96)00222-5 PubMedCrossRefGoogle Scholar
  22. 22.
    DiMatteo MR, Robinson JD, Heritage J, Tabbarah M, Fox SA (2003) Correspondence among patients’ self-reports, charts, and audio/videotapes of medical visits. Health Commun 15:393–413. doi: 10.1207/S15327027HC1504_02 PubMedCrossRefGoogle Scholar
  23. 23.
    Etzi S, Lane DS, Grimson R (1994) The use of mammography vans by low-income women. The accuracy of self-reports. Am J Public Health 84:107–109PubMedCrossRefGoogle Scholar
  24. 24.
    Martin LM, Leff M, Calonge N, Garrett C, Nelson DE (2000) Validation of self-reported chronic conditions and health services in a managed care population. Am J Prev Med 18:215–218. doi: 10.1016/S0749-3797(99)00158-0 PubMedCrossRefGoogle Scholar
  25. 25.
    McPhee SJ, Nguyen TT, Shema SJ et al (2002) Validation of recall of breast and cervical screening by women in an ethnically diverse population. Prev Med 35:1463–1473. doi: 10.1006/pmed.2002.1096 CrossRefGoogle Scholar
  26. 26.
    Montano DE, Phillips WR (1995) Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit. Am J Public Health 85:795–800PubMedCrossRefGoogle Scholar
  27. 27.
    Zapka JG, Bigelow C, Hurley T et al (1996) Mammography use among socioeconomically diverse women. The accuracy of self-report. Am J Public Health 86:1016–1021PubMedCrossRefGoogle Scholar
  28. 28.
    Bowman JA, Redman S, Dickinson JA, Gibberd R, Sanson-Fisher RW (1991) The accuracy of Pap smear utilization self-report: a methodological consideration in cervical screening research. Health Serv Res 26:197–207Google Scholar
  29. 29.
    Newell S, Girgis A, Sanson-Fisher R, Ireland M (2000) Accuracy of patients’ recall of Pap and cholesterol screening. Am J Public Health 90:1431–1435PubMedCrossRefGoogle Scholar
  30. 30.
    Eaker S, Adami I, Sparen P (2001) Reasons women do not attend screening for cervical cancer: a population-based study in Sweden. Prev Med 32:491. doi: 10.1006/pmed.2001.0844 CrossRefGoogle Scholar
  31. 31.
    Walter SD, Clarke EA, Hatcher H, Sitt LW (1988) A comparison of physician and patient reports of Pap smear history. Am J Epidemiol 41:401–410Google Scholar
  32. 32.
    Boyce JG, Fruchter RG, Romanzi L, Sillman FH, Maiman M (1990) The fallacy of the screening interval for cervical smears. Obstet Gynecol 76:627–632PubMedGoogle Scholar
  33. 33.
    Fowles JB, Fowler E, Croft C, McCoy CE (1997) Comparing claims data and self-reported data with the medical record for Pap smear rates. Eval Health Prof 20:324–342. doi: 10.1177/016327879702000305 PubMedCrossRefGoogle Scholar
  34. 34.
    Fruchter RG, Rones K, Roth T, Webber CA, Camilien L, Boyce JG (1992) Pap smear histories in a medical clinic: accuracy of patients’ self-reports. NY State J Med 92:421–424Google Scholar
  35. 35.
    McKenna MT, Speers M, Mallin K, Warnecke R (1992) Agreement between patient self-reports and medical records for Pap smear histories. Am J Prev Health 8:287–291Google Scholar
  36. 36.
    Pizzaro J, Schneider TR, Salovey P (2002) A source of error in self-reports of Pap test utilization. J Commun Health 27:351–356. doi: 10.1023/A:1019888627113 CrossRefGoogle Scholar
  37. 37.
    Betz Brown J, Adams ME (1992) Patients as reliable reporters of medical care process. Recall of ambulatory encounter events. Med Care 30:400–411. doi: 10.1097/00005650-199205000-00003 CrossRefGoogle Scholar
  38. 38.
    Caplan LS, Mandelson MT, Anderson LA (2003a) Validity of self-reported mammography: examining recall and covariates among older women in a health maintenance organization. Am J Epidemiol 157:267–272. doi: 10.1093/aje/kwf202 PubMedCrossRefGoogle Scholar
  39. 39.
    Fulton-Kehoe D, Burg M, Lane DS (1992) Are self-reported dates of mammograms accurate? Public Health Rev 20:233–240PubMedGoogle Scholar
  40. 40.
    King ES, Rimer BK, Trock B, Balshem A, Angstrom P (1990) How valid are mammography self-reports? Am J Public Health 80:1386–1388PubMedCrossRefGoogle Scholar
  41. 41.
    Lawrence VA, DeMoor C, Glenn E (1999) Systematic differences in validity of self-reported mammography behavior: a problem for intergroup comparisons? Prev Med 29:577–580. doi: 10.1006/pmed.1999.0575 PubMedCrossRefGoogle Scholar
  42. 42.
    Thompson B, Taylor V, Goldberg H, Mullen M (1999) Mammography status using patient self-reports and computerized radiology database. Am J Prev Med 17:203–206. doi: 10.1016/S0749-3797(99)00068-9 PubMedCrossRefGoogle Scholar
  43. 43.
    Crane L, Kaplan CP, Bastani R, Schimshaw SCM (1996) Determinants of adherence among health department patients referred for a mammogram. Women Health 24:43–64. doi: 10.1300/J013v24n02_03 PubMedCrossRefGoogle Scholar
  44. 44.
    Caplan LS, McQueen DV, Qualters JR, Leff M, Garrett C, Calonge N (2003b) Validity of women’s self-reports of cancer screening test utilization in a managed care population. Cancer Epidemiol Biomarkers Prev 12:1182–1187PubMedGoogle Scholar
  45. 45.
    Gordon NP, Hiatt RA, Lampert DI (1993) Concordance of self-reported data and medical record audit for six cancer screening procedures. J Natl Cancer Inst 85:566–570. doi: 10.1093/jnci/85.7.566 PubMedCrossRefGoogle Scholar
  46. 46.
    Hiatt RA, Perez-Stable EJ, Quesenberry C Jr, Sabogal F, Otero-Sabogal R, McPhee SJ (1995) Agreement between self-reported early cancer detection practices and medical audits among Hispanic and non-Hispanic white health plan members in Northern California. Prev Med 24:278–285. doi: 10.1006/pmed.1995.1045 PubMedCrossRefGoogle Scholar
  47. 47.
    McGovern PG, Lurie N, Margolis KL, Slater JS (1998) Accuracy of self-report of mammography and Pap smear in a low-income urban population. Am J Prev Med 14:201–208. doi: 10.1016/S0749-3797(97)00076-7 PubMedCrossRefGoogle Scholar
  48. 48.
    Tumiel-Berhalter LM, Finney MF, Jaen CR (2004) Self-report and primary care medical record documentation of mammograhpy and Pap smear utilization among low-income women. J Natl Med Assoc 96:1632–1639PubMedGoogle Scholar
  49. 49.
    Sawyer JA, Earp J, Fletcher RH, Daye FF, Wynn TM (1989) Accuracy of women’s self-report of their last Pap smear. Am J Public Health 79:1036–1037PubMedCrossRefGoogle Scholar
  50. 50.
    Champion VL, Menon U, Hollinden-McQuillen D, Scott C (1998) Validity of self-reported mammography in low-income African-American women. Am J Prev Med 14:111–117. doi: 10.1016/S0749-3797(97)00021-4 PubMedCrossRefGoogle Scholar
  51. 51.
    Degnan D, Harris R, Ranney J, Quade D, Earp J, Gonzolez J (1992) Measuring the use of mammography: two methods compared. Am J Public Health 82:1386–1388PubMedCrossRefGoogle Scholar
  52. 52.
    Norman SA, Localio AR, Zhou L et al (2003) Validation of self-reported screening mammography histories among women with and without breast cancer. Am J Epidemiol 158:264–271. doi: 10.1093/aje/kwg136 PubMedCrossRefGoogle Scholar
  53. 53.
    Johnson CS, Archer J, Campos-Outcalt D (1995) Accuracy of Pap smear and mammogram self-reports in a southwestern Native American tribe. Am J Prev Med 11:360–363PubMedGoogle Scholar
  54. 54.
    Suarez L, Goldman DA, Weiss NS (1995) Validity of Pap smear and mammogram self-reports in a low-income Hispanic population. Am J Prev Health 11:94–98Google Scholar
  55. 55.
    Paskett ED, Tatum CM, Mack DW, Hoen H, Douglas Case L, Velez R (1996) Validation of self-reported breast and cervical cancer screening tests among low-income minority women. Cancer Epidemiol Biomarkers Prev 5:721–726PubMedGoogle Scholar
  56. 56.
    Sudman S, Bradburn NM (1973) Effects of time and memory factors on response in surveys. J Am Stat Assoc 68:805–815. doi: 10.2307/2284504 CrossRefGoogle Scholar
  57. 57.
    Loftus EF, Klinger MR, Smith KD, Fiedler J (1990) A tale of two questions: benefits of asking more than one question. Public Opin Q 54:330–345. doi: 10.1086/269210 CrossRefGoogle Scholar
  58. 58.
    Siegel PZ, Qualters JR, Mowery PD, Campostrini S, Leutzinger C, McQueen DV (2001) Subgroup-specific effects of questionnaire wording on population-based estimates of mammography prevalence. Am J Public Health 91:817–820PubMedCrossRefGoogle Scholar
  59. 59.
    Reid MC, Lacks MS, Feinstein AR (1995) Use of methodologic standards in diagnostic test research. Getting better but still not good. JAMA 274:645–651. doi: 10.1001/jama.274.8.645 PubMedCrossRefGoogle Scholar
  60. 60.
    Deeks JJ (2001) Systematic reviews in health care. Systematic reviews of evaluations of diagnostic and screening tests. Br Med J 323:157–162. doi: 10.1136/bmj.323.7305.157 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Department of Family MedicineMcMaster UniversityHamiltonCanada
  2. 2.Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonCanada

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