Whitehouse Katherine C, Montealegre Jane R, Follen Michele, Scheurer Michael E, Aagaard Kjersti
Department of Obstetrics and Gynecology, General Division, Baylor College of Medicine, Houston, Texas, USA.
Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA ; Division of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, Texas, USA.
J Reprod Infertil. 2014 Apr;15(2):94-104.
Routine dysplasia screening decreases the rates of cervical cancer. Since many women seek gynecological care to secure contraception, it was hypothesized that sterilized women will be less likely to undergo routine cervical cancer screening. Prior studies tried to evaluate this relationship, but results were conflicting. The study sought to further explore the sociodemographic and behavioral risk factors that might predispose sterilized women to be screening non-adherent and more likely to have cervical dysplasia.
Secondary analysis of women (n=1688) enrolled in a cross-sectional study in North America and divided into screening (n=925) and diagnostic (n=763) groups was performed. Information about sociodemographic and behavioral risk factors, surgical sterilization and date of last Pap test were obtained from questionnaires. Cervical histology was obtained from pathology records. Univariable analyses identified differences in risk factors between groups. Multivariable logistic regression models were constructed to evaluate Pap adherence and cervical dysplasia.
Sterilized women were 39% more likely to be screening non-adherent (p≤0.05) especially if divorced, separated or widowed (OR=1.62), Hispanic (OR=1.57) and with a higher number of vaginal births (OR=2.00). Education was an effect measure modifier, significantly associated with non-adherence (OR=1.60). The association between sterilization and non-adherence remained significant when adjusted for confounders (AOR=1.47). Sterilization was associated with an 80% increased odds of cervical dysplasia in women over 40.
Sterilized women with certain sociodemographic factors are more likely to be non-adherent with Pap screening and more prone to dysplasia. These findings may assist practitioners in counseling at-risk patients.
常规发育异常筛查可降低宫颈癌发病率。由于许多女性寻求妇科护理以确保避孕，因此推测已绝育女性接受常规宫颈癌筛查的可能性较小。既往研究试图评估这种关系，但结果相互矛盾。本研究旨在进一步探讨可能使已绝育女性易于不坚持筛查且更易发生宫颈发育异常的社会人口学和行为风险因素。
对参与北美一项横断面研究的女性（n = 1688）进行二次分析，这些女性被分为筛查组（n = 925）和诊断组（n = 763）。通过问卷获取有关社会人口学和行为风险因素、手术绝育及末次巴氏试验日期的信息。从病理记录中获取宫颈组织学信息。单变量分析确定了两组之间风险因素的差异。构建多变量逻辑回归模型以评估巴氏涂片检查的依从性和宫颈发育异常情况。
已绝育女性不坚持筛查的可能性高39%（p≤0.05），尤其是离婚、分居或丧偶者（OR = 1.62）、西班牙裔（OR = 1.57）以及经阴道分娩次数较多者（OR = 2.00）。教育程度是一个效应修饰因素，与不依从显著相关（OR = 1.60）。在对混杂因素进行校正后，绝育与不依从之间的关联仍然显著（AOR = 1.47）。绝育与40岁以上女性宫颈发育异常的几率增加80%相关。
具有某些社会人口学因素的已绝育女性更有可能不坚持巴氏涂片筛查且更易发生发育异常。这些发现可能有助于从业者为高危患者提供咨询。
