Rakowski W, Clark M A, Ehrich B
Department of Community Health, Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island 02912, USA.
Prev Med. 1999 Dec;29(6 Pt 1):487-95. doi: 10.1006/pmed.1999.0578.
Previous studies have found an association between current smoking and lower rates of mammography and Pap testing. The objective of this study was to investigate the association of smoking status with breast and cervical cancer screening across the 1990-1994 National Health Interview Surveys (NHIS). The NHIS provides a consistent set of independent and dependent variables across several surveys, with data collected by a similar in-person interview methodology from year to year. This report employs more databases than have been used in other analyses that have examined associations between smoking and cancer screening.
Data were from the health promotion and cancer control supplements to the 1990-1994 NHIS. The target population was women ages 42-75. Associations were examined between smoking status (never, former, <1 pack/day, >/=1 pack/day) and three screening indicators: ever had a mammogram, mammogram in the past 2 years, and Pap test in the past 3 years. Sample sizes ranged from about 3,000 to over 10,800 depending on the respective NHIS survey and dependent variable. Data analyses were conducted by bivariate and multiple logistic regression.
Women who smoked >/=1 pack of cigarettes per day were significantly less likely to have had mammography screening in all NHIS surveys, compared to women who never smoked. Adjusted odds ratios were 0.63 to 0.74 for ever had a mammogram, and 0.56 to 0.66 for mammography in the past 2 years. Women who smoked >/=1 pack per day also had lower Pap test rates than women who never smoked in 1992-1994 (adjusted odds ratios of 0.51-0.71). Results for lighter smokers were not as consistent. Former smokers often had significantly higher screening rates than never smokers.
Research still needs to identify reasons for lower screening among women who smoke. Factors to explore include the social networks of smokers and broader health behavior patterns. Clinicians should consider heavier smoking as a marker for risk of not obtaining screening and make assessment of screening status a priority at each visit.
以往研究发现，当前吸烟与乳房X光检查及巴氏涂片检查的较低比率之间存在关联。本研究的目的是通过1990 - 1994年国家健康访谈调查（NHIS）来调查吸烟状况与乳腺癌和宫颈癌筛查之间的关联。NHIS在多项调查中提供了一组一致的自变量和因变量，并且每年通过类似的面对面访谈方法收集数据。本报告使用的数据库比其他研究吸烟与癌症筛查之间关联的分析中所使用的数据库更多。
数据来自1990 - 1994年NHIS的健康促进和癌症控制补充调查。目标人群为42至75岁的女性。研究了吸烟状况（从不吸烟、曾经吸烟、每天少于1包、每天≥1包）与三项筛查指标之间的关联：曾经做过乳房X光检查、过去两年内做过乳房X光检查、过去三年内做过巴氏涂片检查。样本量根据各自的NHIS调查和因变量从约3000到超过10800不等。数据分析采用双变量和多元逻辑回归进行。
在所有NHIS调查中，与从不吸烟的女性相比，每天吸烟≥1包的女性进行乳房X光检查筛查的可能性显著降低。曾经做过乳房X光检查的调整后比值比为0.63至0.74，过去两年内做过乳房X光检查的调整后比值比为0.56至0.66。在1992 - 1994年，每天吸烟≥1包的女性巴氏涂片检查率也低于从不吸烟的女性（调整后比值比为(0.51 - 0.71)）。轻度吸烟者的结果不太一致。曾经吸烟者的筛查率往往显著高于从不吸烟者。
研究仍需确定吸烟女性筛查率较低的原因。需要探索的因素包括吸烟者的社交网络和更广泛的健康行为模式。临床医生应将重度吸烟视为未进行筛查风险的一个标志，并在每次就诊时将评估筛查状况作为优先事项。
