Papanicolaou test utilization and frequency of screening opportunities among women diagnosed with cervical cancer

Although rates of cervical cancer are low in Canada, the incidence of the disease could be further reduced by the detection of precursor lesions and early-stage cancers in large populations of asymptomatic women through screening with the Papanicolaou (Pap) test,1 promoting Pap testing among women and physicians, and appropriately following up abnormal results.2 Despite the evidence that screening using a Pap test decreases the incidence of cervical cancer, and in spite of efforts to promote Pap testing, 1 in 4 women aged 18 to 69 who participated in Statistics Canada’s 1994–95 National Population Health Survey reported never having had a Pap test or not having a Pap test in the last 3 years.3 Several reasons have been identified in the literature as to why women do not obtain cervical cancer screening. Patient factors that influence screening include socioeconomic and demographic characteristics, andknowledge and attitudes about cervical cancer.1,4-9 The probability of being screened tends to increase with education and income, and is lower for non-Canadian born women, those who do not speak English and those who have negative beliefs about cancer.6,8,9 System and physician factors that influence screening include lack of regular health care, patients’ inability to access screening services, and missed opportunities to screen by health care providers.10 “Missed opportunities” are instances when a woman has contact with a health care provider but the provider does not perform or recommend the screening test when it would be appropriate to do so.10 Physician characteristics that have been associated with missed opportunities to provide preventive care such as a Pap test include type of specialty, education, physician gender and practice location.11-14 The objectives of this study were to examine the screening history of women diagnosed with invasive cervical cancer, to explore whether there were missed opportunities for screening and to investigate the influence of physician characteristics on Pap test utilization in the province of Manitoba.