Gilbert T J, Sugarman J R, Cobb N
Fred Hutchinson Cancer Research Center, Division of Public Health Services, Seattle, WA, USA.
J Am Board Fam Pract. 1995 May-Jun;8(3):183-8.
Mortality that is due to cervical cancer among American Indian and Alaska Native women in the Pacific Northwest exceeds that among women of other races. Nevertheless, little information is available regarding the prevalence and follow-up of abnormal Papanicolaou smears among American Indian and Alaska Native women in the region.
We conducted a retrospective review of medical records of American Indian and Alaska Native women seen at 12 Indian Health Service and tribally operated clinics in Washington, Oregon, and Idaho who had an abnormal Papanicolaou smear in 1992.
Of 4547 Papanicolaou smear results reviewed, 280 (6.2 percent) had an abnormal result (dysplasia or carcinoma in situ). Of the recommended colposcopies, 167 of 224 (75 percent) were completed. Women with high-grade squamous intraepithelial lesions were more likely to obtain recommended colposcopy than were women with low-grade squamous intraepithelial lesions. Women treated at clinics that referred patients to outside providers for colposcopy were more likely to have colposcopy than were those who were offered the procedure on site.
The proportion of Pacific Northwest American Indian and Alaska Native women in Indian Health Service and tribal clinics with abnormal Papanicolaou smears and the proportion who receive colposcopy are similar to those in other populations. The higher rate of cervical cancer mortality among American Indian and Alaska Native women could be due to failure to screen high-risk women. Cytologic screening rates, methods to improve adherence to colposcopy recommendations, and the contribution of other factors to the cause of cervical cancer mortality need to be characterized in this population.
太平洋西北地区的美国印第安人和阿拉斯加原住民女性宫颈癌死亡率高于其他种族女性。然而，关于该地区美国印第安人和阿拉斯加原住民女性巴氏涂片异常的患病率及随访情况，目前所知甚少。
我们对1992年在华盛顿州、俄勒冈州和爱达荷州的12家印第安卫生服务机构及部落诊所就诊且巴氏涂片异常的美国印第安人和阿拉斯加原住民女性的病历进行了回顾性研究。
在审查的4547份巴氏涂片结果中，280份（6.2%）结果异常（发育异常或原位癌）。在推荐的阴道镜检查中，224例中有167例（75%）完成了检查。高级别鳞状上皮内病变的女性比低级别鳞状上皮内病变的女性更有可能接受推荐的阴道镜检查。在将患者转诊至外部机构进行阴道镜检查的诊所接受治疗的女性比在现场提供该检查的诊所接受治疗的女性更有可能接受阴道镜检查。
印第安卫生服务机构及部落诊所中，太平洋西北地区美国印第安人和阿拉斯加原住民女性巴氏涂片异常的比例以及接受阴道镜检查的比例与其他人群相似。美国印第安人和阿拉斯加原住民女性宫颈癌死亡率较高可能是由于高危女性筛查不足。该人群的细胞学筛查率、提高阴道镜检查建议依从性的方法以及其他因素对宫颈癌死亡率的影响需要进一步明确。
