BACKGROUND: U.S. professional medical societies and the national health systems of all other industrialized nations recommend that most women need not undergo Papanicolaou (Pap) smear screening annually. There are no data, however, regarding the frequency at which women actually undergo screening.
OBJECTIVE: To describe the frequency of cervical cancer screening in the United States.
DESIGN: National Health Interview Survey, a cross-sectional population-based telephone survey conducted by the National Center for Health Statistics.
PARTICIPANTS: Representative sample of U.S. women age 21 and older who denied a history of cancer (N=16,467).
MEASUREMENTS: Pap smear screening frequency, categorized as no regular screening or screening at 1 of 3 discrete screening intervals (every year, every 2 years, or every 3 years) based on each woman’s reported number of Pap smears in the previous 6 years.
RESULTS: The vast majority (93%) of American women report having had at least one Pap smear in their lifetime. Among women with no history of abnormal smears, 55% undergo Pap smear screening annually, 17% report a 2-year screening interval, 16% report being screened every 3 years, and 11% are not being screened regularly. Even the very elderly report frequent screening—38% of women age 75 to 84 and 20% of women age 85 and older reported annual Pap smears. Overall, 20% of women reported having had at least one abnormal Pap smear. Among these women, rates of frequent Pap smear screening are considerably higher—80% undergo annual screening, with only a modest decline in screening frequency with increasing age.
CONCLUSIONS: The majority of American women report being screened for cervical cancer more frequently than recommended. Lengthening the screening interval would not only reduce the volume of specimens that cytotechnologists are required to read, but would also reduce the follow-up testing after abnormal smears.
cervical cancer screening Pap smear test frequency overutilization
IARC Working Group on Evaluation of Cervical Cancer Screening Programmes. Screening for squamous cervical cancer: duration of low risk after negative results of cervical cytology and its implication for screening policies. Br Med J. 1986;293:659–64.Google Scholar
Frame PS, Frame JS. Determinants of cancer screening frequency: the example of screening for cervical cancer. J Am Board Fam Pract. 1998;11:87–95.PubMedGoogle Scholar
Colditz GA, Hoaglin DC, Berkey CS. Cancer incidence and mortality: the priority of screening frequency and population coverage. Milbank Q. 1997;75:147–73.PubMedCrossRefGoogle Scholar
Fahs MC, Mandelblatt J, Schecter C, Muller C. Cost effectiveness of cervical cancer screening for the elderly. Ann Intern Med. 1992;117:520–7.PubMedGoogle Scholar
American College of Physicians. Guidelines: screening for cervical cancer. In: Eddy DM, ed. Common Screening Tests. Philadelphia, Pa: American College of Physicians; 1991:413–4.Google Scholar
Koopmanschap MA, Lubbe KTN, van Oortmarssen GJ, van Agt HMA, van Ballegooijen M, Habbema JDF. Economic aspects of cervical cancer screening. Soc Sci Med. 1990;30:1081–7.CrossRefGoogle Scholar
American Cancer Society. Summary of Current Guidelines for the Cancer-Related Checkup: Recommendations. Atlanta, Ga: American Cancer Society; 1988.Google Scholar
U.S. Preventive Services Task Force. Screening for cervical cancer. In: Guide to Clinical Preventive Services, 2nd edn. Baltimore, Md: Williams & Wilkins; 1996:105–18.Google Scholar
Saslow D, Runowicz CD, Solomon D, et al. American Cancer Society Guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin. 2002;52:342–62.PubMedCrossRefGoogle Scholar
Anonymous. ACOG committee opinions. Recommendations on frequency of Pap test screening. Number 152, March 1995 Committee on Gynecologic Practice. American College of Obstetricians and Gynecologists. Intl J Gynaecol Obstet. 1995;49:210–1.CrossRefGoogle Scholar
Parboosingh J. Screening for cervical cancer: Canadian programmatic guidelines. Can Fam Phys. 1999;45:383–93.Google Scholar
Hermens RP, Hak E, Hulscher ME, Mulder J, Braspenning JCC, Grol RPTM. Do general practices adhere to organizational guidelines for effective cervical cancer screening? Fam Pract. 1998;15:112–8.PubMedCrossRefGoogle Scholar
Bergstrom R, Sparen P, Admi H-O. Trends in cancer of the cervix uteri in Sweden following cytological screening. Br J Cancer. 1999;81:159–66.PubMedCrossRefGoogle Scholar
Quinn M, Babb P, Jones J, Allen E, on behalf of the United Kingdom Association of Cancer Registries. Effect of screening on incidence of and mortality from cancer of the cervix in England: evaluation based on routinely collected statistics. Br Med J. 1999;318:904–8.Google Scholar
Wai D, Ferrier A, Collings S, Laverty C. Have the most recent Pap smear guidelines affected GP practices? Austral Fam Phys. 1996;(suppl 1):44–8.Google Scholar
Mandelblatt JS, Lawrence WF, Womack SM, et al. Benefits and costs of using HPV testing to screen for cervical cancer. JAMA. 2002;287:2372–81.PubMedCrossRefGoogle Scholar
National Center for Health Statistics. Data File Documentation, National Health Interview Survey, 2000 (machine readable data file and documentation). Hyattsville, Md: National Center for Health Statistics; 2002. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS?Datasets/NHIS//. Accessed October 30, 2002.Google Scholar
National Center for Health Statistics. Survey Description, National Health Interview Survey, 2000. Hyattsville, Md: National Center for Health Statistics; 2002. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2000/ srvydesc.pdf. Accessed January 21, 2004.Google Scholar
Sawaya GF, Kerlikowske K, Lee NC, Gildengorin G, Washington AE. Frequency of cervical smear abnormalities within 3 years of normal cytology. Obstet Gynecol. 2000;96:219–23.PubMedCrossRefGoogle Scholar
Sawaya GF, Grady D, Kerlikowske K, et al. The positive predictive value of cervical smears in previously screened postmenopausal women: the Heart and Estrogen/progestin Replacement Study (HERS). Ann Intern Med. 2000;133:942–50.PubMedGoogle Scholar
Incidence of Pap test abnormalities within 3 years of a normal Pap test—United States 1991–1998 (Editorial Note) MMWR Morb Mortal Wkly Rep. 2000;49:1001–3.Google Scholar
Castleberry BM, Wargelin LL. 1998 Wage and vacancy survey of medical laboratories. Lab Med. 1999;30:174–8.Google Scholar
Pear R. 1988 Standards for medical labs go unenforced by administration. New York Times. March 20, 1991:1.Google Scholar
Centers for Disease Control. Regulations for implementing Clinical Laboratory Improvement Amendments of 1988: a summary. JAMA. 1992;267:1725–34.CrossRefGoogle Scholar
Holowaty P, Miller AB, Rohan T, To T. Natural history of dysplasia of the uterine cervix. J Natl Cancer Inst. 1999;91:252–8.PubMedCrossRefGoogle Scholar
Melnikow J, Nuovo J, Willan AR, Chan BKS, Howell LP. Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol. 1998;92:727–35.PubMedCrossRefGoogle Scholar
Ostör AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol. 1993;12:186–92.PubMedCrossRefGoogle Scholar
Kavanagh AM, Santow G, Mitchell H. Consequences of current patterns of Pap smear and colposcopy use. J Med Screen. 1996;3:29–34.PubMedGoogle Scholar
McGovern PG, Lurie N, Margolis KL, Slater JS. Accuracy of self-report of mammography and Pap smear in a low-income urban population. Am J Prev Med. 1998;14:201–8.PubMedCrossRefGoogle Scholar
Bowman JA, Sanson-Fisher R, Redman S. The accuracy of self-reported Pap smear utilisation. Soc Sci Med. 1997;44:969–76.PubMedCrossRefGoogle Scholar
Suarez L, Goldman DA, Weiss NS. Validity of Pap smear and mammogram self-reports in a low-income Hispanic population. Am J Prev Med. 1995;11:94–8.PubMedGoogle Scholar
Whitman S, Lacey L, Ansell D, Chen EH, Dell J, Phillips CW. Do chart reviews and interviews provide the same information about breast and cervical cancer screening? Int J Epidemiol. 1993;22:393–7.PubMedCrossRefGoogle Scholar
McKenna MT, Speers M, Warnecke R. Agreement between patient self-reports and medical records for Pap smear histories. Am J Prev Med. 1992;8:287–91.PubMedGoogle Scholar
Bowman JA, Redman S, Dickinson JA, Gibberd R, Sanson-Fisher RW. The accuracy of Pap smear utilization self-report: a methodological consideration in cervical screening research. Health Serv Res. 1991;26:97–107.PubMedGoogle Scholar
Herman CJ, Lengerich EJ, Stoodt G. Variation in recommendation for breast and cervical cancer screening among primary care physicians in North Carolina, 1991. South Med J. 1996;89:583–90.PubMedGoogle Scholar
Rolnick SJ, LaFerla JJ, Jackson J, Akkerman D, Compo R. Impact of a new cervical Pap smear screening guideline on member perceptions and comfort levels. Prev Med. 1999;28:530–4.PubMedCrossRefGoogle Scholar
Lawson HW, Henson R, Bobo JK, Kaeser MK. Implementing recommendations for the early detection of breast and cervical cancer among low-income women. MMWR Morb Mortal Wkly Rep. 2000;49:36–55.Google Scholar
Nanda K, McCrory DC, Myers ER, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med. 2000;132:810–9.PubMedGoogle Scholar