Leach Corinne R, Schoenberg Nancy E
Graduate Center for Gerontology, 306 Wethington Health Sciences Building, 900 S. Limestone, University of Kentucky, Lexington, KY 40536-0200, USA.
Prev Chronic Dis. 2007 Oct;4(4):A95. Epub 2007 Sep 15.
Although rates of invasive cervical cancer have declined precipitously over the past 50 years, nearly 10,000 new cases and 3700 deaths result from this cancer annually. Given the efficacy of early detection, invasive cervical cancer should no longer constitute a health threat; however, national studies reveal that many women, especially older women, do not receive Papanicolaou (Pap) tests.
In this complementary study, we examined data from the National Health Interview Survey focusing on the correlates of screening for women aged 55 years or older, an age group in which invasive cervical cancer rates escalate and rates of obtaining Pap tests decline. To more richly understand grounded perspectives, we queried 25 women who were rarely or never screened about factors and circumstances underlying their decision not to obtain a Pap test.
Quantitative data indicate an association between Pap test use and demographic factors (being married, being younger, and having suburban or urban residence) and access to preventive care (obtaining mammograms, having a regular source of health care, and having contact with an obstetrician/gynecologist). Participants who provided qualitative data echoed this theme of inadequate use of preventive services, particularly among women with weak social ties, who were older, and who lived in rural areas. Shortages of health care professionals and a lack of continuity of care and privacy contribute to suboptimal prevention.
A vicious cycle emerges: many women decline to pursue preventive care because of competing health and financial demands and insufficient resources to seek care. When such women do go to the doctor's office, they feel chastised by providers, which alienates them and thwarts future preventive care.
尽管在过去50年里浸润性宫颈癌的发病率急剧下降，但每年仍有近10000例新发病例和3700人死于这种癌症。鉴于早期检测的有效性，浸润性宫颈癌不应再构成健康威胁；然而，全国性研究表明，许多女性，尤其是老年女性，没有接受巴氏试验。
在这项补充研究中，我们研究了来自国家健康访谈调查的数据，重点关注55岁及以上女性的筛查相关因素，这一年龄组的浸润性宫颈癌发病率上升，而进行巴氏试验的比例下降。为了更深入地了解实际情况，我们询问了25名很少或从未接受过筛查的女性，了解她们不进行巴氏试验的决定背后的因素和情况。
定量数据表明，巴氏试验的使用与人口统计学因素（已婚、年轻、居住在郊区或城市）以及获得预防性护理的机会（进行乳房X光检查、有固定的医疗保健来源、与妇产科医生有联系）之间存在关联。提供定性数据的参与者也呼应了预防性服务使用不足这一主题，特别是在社会关系薄弱、年龄较大且居住在农村地区的女性中。医疗保健专业人员短缺以及缺乏连续护理和隐私导致预防效果不佳。
一个恶性循环出现了：许多女性由于健康和经济需求相互竞争以及寻求护理的资源不足而拒绝寻求预防性护理。当这些女性去看医生时，她们会感到受到医护人员的斥责，这使她们疏远并阻碍了未来的预防性护理。
