The feasibility of risk-based cervical cancer screening

ObjectiveThis study examined the feasibility of risk-based cervical cancer screening in primary care practices in Lansing, Michigan (United States).MethodsWe recruited adult women regardless of the reason for visit from March to June of 2001. Women completed a risk factor questionnaire including number of current and lifetime sexual partners, history of sexually transmitted diseases and smoking. We also explicitly extracted from the patients' medical records: Pap smear results, presence of a sexual history, and screening for sexually transmitted infections (STI).ResultsOf 1271 eligible women, 809 (64%) completed the questionnaire and 601 agreed to have their records reviewed. Women of minority race represented 28.6% of the sample and one-third were insured through Medicaid. The mean number of lifetime partners was 9 and average age of first intercourse was 17. Eighty-six percent of women provided complete information. Most women (83%) had at least one risk factor for cervical cancer. We found low rates of documented sexual history taking (54%) and STI testing (4%).ConclusionWomen seeking care from a primary care clinician will provide, if asked, sensitive information, making risk-based cervical cancer screening feasible. However, since so many women had at least one identifiable risk factor, multivariate models or alternative approaches to assessing risk need to be developed.