Search tips
Search criteria 


Logo of jnmaLink to Publisher's site
J Natl Med Assoc. 2003 September; 95(9): 825–832.
PMCID: PMC2594474

Inadequate follow-up for abnormal Pap smears in an urban population.


PURPOSE: To determine the factors associated with inadequate follow-up for abnormal Pap smears among a cohort of Boston women from urban academic clinics. METHODS: Subjects were women > 18 years with abnormal cervical cytology between February 1999 and April 2000. Inadequate follow-up was defined as lack of subsequent cervical cytology or pathology specimen within four months of the initial abnormal specimen for high-grade lesions or within 7 months for low-grade lesions. RESULTS: Of the 423 subjects, the mean age was 33 years. Sixty percent were black, 23% Hispanic, 15% white, 2% Asian. The population was largely uninsured or publically insured. The overall inadequate follow-up rate was 38%. In bivariate analysis, age was a significant risk factor; 46% of women ages 18-29 had inadequate follow-up (p < 0.01). In multivariate analysis, women aged 18-29 years were more likely than women 50 years and older to have inadequate follow-up (OR 2.7, 95% CI 1.1-6.4), as were women with Medicaid insurance compared with private insurance (OR 1.9, 95% CI 1.01-3.5). After 12 months, 26% of women with abnormal Pap smears still had not received follow-up. CONCLUSIONS: In a predominantly urban minority population, the overall rate of inadequate follow-up for abnormal Pap smears was high at 38%. Programs to address follow-up of abnormal cervical cytology should focus on minority populations, especially younger and all low-income women.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Benard VB, Lee NC, Piper M, Richardson L. Race-specific results of Papanicolaou testing and the rate of cervical neoplasia in the National Breast and Cervical Cancer Early Detection Program, 1991-1998 (United States). Cancer Causes Control. 2001 Jan;12(1):61–68. [PubMed]
  • Suh-Burgmann E, Darragh T, Smith-McCune K. Atypical squamous cells of undetermined significance: management patterns at an academic medical center. Am J Obstet Gynecol. 1998 May;178(5):991–995. [PubMed]
  • Kurman RJ, Henson DE, Herbst AL, Noller KL, Schiffman MH. Interim guidelines for management of abnormal cervical cytology. The 1992 National Cancer Institute Workshop. JAMA. 1994 Jun 15;271(23):1866–1869. [PubMed]
  • Laedtke TW, Dignan M. Compliance with therapy for cervical dysplasia among women of low socioeconomic status. South Med J. 1992 Jan;85(1):5–8. [PubMed]
  • Marcus AC, Crane LA, Kaplan CP, Reading AE, Savage E, Gunning J, Bernstein G, Berek JS. Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies. Med Care. 1992 Mar;30(3):216–230. [PubMed]
  • Lane DS. Compliance with referrals from a cancer-screening project. J Fam Pract. 1983 Nov;17(5):811–817. [PubMed]
  • Nathoo V. Investigation of non-responders at a cervical cancer screening clinic in Manchester. Br Med J (Clin Res Ed) 1988 Apr 9;296(6628):1041–1042. [PMC free article] [PubMed]
  • Paskett ED, White E, Carter WB, Chu J. Improving follow-up after an abnormal Pap smear: a randomized controlled trial. Prev Med. 1990 Nov;19(6):630–641. [PubMed]
  • Carey P, Gjerdingen DK. Follow-up of abnormal Papanicolaou smears among women of different races. J Fam Pract. 1993 Dec;37(6):583–587. [PubMed]
  • Frisch LE. Effectiveness of a case management protocol in improving follow-up and referral of Papanicolaou smears indicating cervical intraepithelial neoplasia. J Am Coll Health. 1986 Nov;35(3):112–115. [PubMed]
  • Paskett ED, Carter WB, Chu J, White E. Compliance behavior in women with abnormal Pap smears. Developing and testing a decision model. Med Care. 1990 Jul;28(7):643–656. [PubMed]
  • McKee MD, Lurio J, Marantz P, Burton W, Mulvihill M. Barriers to follow-up of abnormal Papanicolaou smears in an urban community health center. Arch Fam Med. 1999 Mar-Apr;8(2):129–134. [PubMed]
  • Michielutte R, Diseker RA, Young LD, May WJ. Noncompliance in screening follow-up among family planning clinic patients with cervical dysplasia. Prev Med. 1985 Mar;14(2):248–258. [PubMed]
  • Fruchter RG, Boyce J, Hunt M. Missed opportunities for early diagnosis of cancer of the cervix. Am J Public Health. 1980 Apr;70(4):418–420. [PubMed]
  • Janerich DT, Hadjimichael O, Schwartz PE, Lowell DM, Meigs JW, Merino MJ, Flannery JT, Polednak AP. The screening histories of women with invasive cervical cancer, Connecticut. Am J Public Health. 1995 Jun;85(6):791–794. [PubMed]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association