Celentano D D, Klassen A C, Weisman C S, Rosenshein N B
School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205.
J Clin Epidemiol. 1988;41(6):531-41. doi: 10.1016/0895-4356(88)90057-1.
Considerable evidence shows a large proportion of older women have either never had a Pap test or have significant gaps in their history of cervical cancer screening. Differences in health care utilization patterns by age, cohort differences in use of medical subspecialities, and provider reluctance to perform cancer screening within the general medical care encounter have been suggested as reasons for underscreening. Our study conducted in 1985 documents prior health care utilization patterns of 153 cases of Maryland women with invasive cervical cancer compared with a matched control group. Analysis within three age groups showed that cases were significantly less likely to have ever had a Pap test or to receive regular Pap testing, primarily due to differences in medical care utilization patterns. Never having an obstetrician-gynecology visit, a recent (less than 3 years) internist visit, or not having any out-patient visit were significant risk factors. Other risks included older age at first Pap test, reporting not being told to have routine Pap tests, and not using contraceptives. In a multiple logistic regression analysis, recent out-patient visits and lifetime use of an obstetrician-gynecologist remained significant after adjusting for age interactions with recent Pap test history, underscoring the importance of medical care utilization patterns for screening of cancer of the uterine cervix among the elderly.
大量证据表明，很大一部分老年女性要么从未做过巴氏试验，要么在宫颈癌筛查史方面存在显著空白。年龄导致的医疗保健利用模式差异、医学亚专业使用方面的队列差异以及医疗服务提供者在普通医疗过程中不愿进行癌症筛查，都被认为是筛查不足的原因。我们在1985年进行的研究记录了153例马里兰州浸润性宫颈癌女性患者与匹配对照组之前的医疗保健利用模式。在三个年龄组内的分析表明，病例组进行巴氏试验或接受定期巴氏检查的可能性显著较低，主要是由于医疗保健利用模式的差异。从未看过妇产科医生、近期（不到3年）看过内科医生或没有任何门诊就诊经历是显著的风险因素。其他风险包括首次巴氏试验时年龄较大、报告未被告知进行常规巴氏试验以及未使用避孕药具。在多元逻辑回归分析中，调整年龄与近期巴氏试验史的相互作用后，近期门诊就诊和一生中有妇产科医生就诊经历仍然具有显著意义，这突出了医疗保健利用模式对老年女性宫颈癌筛查的重要性。
