Fred Hutchinson Cancer Research Center, Seattle, WA
Manoj Menon , Angel Desai , Mahri Haider , Genji Terasaki
Background: Average-risk women between the ages of 21 and 65 are recommended to receive cervical cancer screening every 3 years. The mortality secondary to cervical cancer has decreased by over 75% in the U.S. since the routine implementation of the Pap test. However, cervical cancer continues to take a toll among women with limited access to care including ethnic minorities and immigrants – likely secondary to disparities in screening. The International Medicine Clinic (IMC) at Harborview Medical Center provides adult refugees and immigrants with access to primary health care services, including age-appropriate cancer screening. Here we document cervical cancer screening rates among women at the IMC and describe predictors of screening. Methods: We extracted data from our medical record on all women between the ages of 21 and 65 who presented for care at the IMC between 2/1/11 and 1/31/12. Patient age, language, and date of most recent cervical cancer screening were collected. The gender and level of clinical training of the provider were also abstracted. We utilized bivariate analyses to identify measures with p < 0.20 for inclusion in a multivariate logistic regression model. Results: We analyzed data from 565 women; 15 women had a prior hysterectomy and were excluded from this analysis. The median age was 52 years (IQR 18). Somali was the most common language (25.3%) spoken followed by Amharic (13.5%), Vietnamese (12.5%), Khmer (10.0%), Tigrinya (9.1%), English (7.1%), and Spanish (6.4%). Cervical cancer screening was performed on 346 (62.9%) of women in the previous 3 years. The provider was female for 263 patients (47.8%). The majority of patients were seen by an attending physician (452; 82.2%). In multivariate analyses, younger patients (p < .001) and patients seen by female providers (p = .05) were more likely to have received cervical cancer screening. Patients who spoke either Somali (p = .02) or Tigrinya (p = .03) were less likely to receive cervical cancer screening (p = .03). Conclusions: The percentage of women who had not been screened for cervical cancer in our clinic is high. In order to increase utilization of cervical cancer screening, a better understanding of both patient and provider factors is necessary.
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