Department of Hygiene and Epidemiology, Porto University Medical School, Porto, Portugal.
Eur J Cancer Prev. 2009 Nov;18(6):482-8. doi: 10.1097/CEJ.0b013e328330eb47.
Understanding local patterns of opportunistic uptake of cervical cancer screening provides important baseline information for an efficient transition to organized screening. The objectives of this study were to estimate the prevalence of cervical cytology use at different intervals and to quantify its associated factors in an urban Portuguese population under no organized cervical cancer screening. As part of the first follow-up evaluation of a cohort of adult dwellers from Porto, 1032 women were evaluated between 2005 and 2008. Lifetime use and age at first cervical cytology, frequency of testing, socioeconomic factors, clinical history, and usual source of care were assessed using a structured questionnaire. Age-adjusted and education-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for nonuse and underutilization (over 5 years interval between tests) of cervical cytology were computed by unconditional logistic regression. Life prevalence of cervical cytology testing was 91.2%. Among ever-users, 6.7% were screened at 3-year to 5-year intervals and the prevalence of underuse was 21.4%. Older women (≥70 vs. 30-39 years) were more likely to have never been screened (OR = 32.20, 95% CI: 4.17-248.68) and more prone to underuse (OR = 25.49, 95% CI: 6.89-94.30). Underuse was less likely in the more educated (9-12 vs. 0-3 years, OR = 0.21, 95% CI: 0.08-0.52) and in women receiving private health care (private doctor vs. public health care center, OR = 0.28, 95% CI: 0.12-0.65). In conclusion, under opportunistic screening, the high life prevalence of cervical cytology use hides a small proportion of women tested at the recommended intervals and inequalities in access to and frequency of screening.
了解机会性宫颈癌筛查的本地模式为向有组织的筛查进行有效的过渡提供了重要的基线信息。本研究的目的是评估不同间隔时间内宫颈细胞学检查的使用情况，并量化在无组织宫颈癌筛查的情况下，葡萄牙城市人口中这种检查的相关因素。作为波尔图居民队列的首次随访评估的一部分，2005 年至 2008 年期间对 1032 名女性进行了评估。使用结构化问卷评估了终生使用和首次宫颈细胞学检查的年龄、检查频率、社会经济因素、临床病史和常规医疗来源。使用非条件逻辑回归计算了宫颈细胞学检查未使用和未充分使用（测试间隔超过 5 年）的年龄调整和教育调整比值比（OR）和 95%置信区间（95%CI）。宫颈细胞学检查的终生流行率为 91.2%。在曾经使用者中，有 6.7%的人在 3 年至 5 年的间隔时间内进行筛查，且使用率不足的比例为 21.4%。年龄较大的女性（≥70 岁与 30-39 岁）更有可能从未接受过筛查（OR=32.20，95%CI：4.17-248.68），且更有可能未充分使用（OR=25.49，95%CI：6.89-94.30）。受教育程度较高的女性（9-12 年与 0-3 年，OR=0.21，95%CI：0.08-0.52）和接受私人医疗保健的女性（私人医生与公共医疗保健中心，OR=0.28，95%CI：0.12-0.65）不太可能未充分使用。总之，在机会性筛查下，宫颈细胞学检查的高终生使用率掩盖了一小部分按建议间隔接受检查的女性，以及获得和检查频率方面的不平等。
