The feasibility of risk-based cervical cancer screening

Objective This study examined the feasibility of risk-based cervical cancer screening in primary care practices in Lansing, Michigan (United States). Methods We 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 patientsʹ medical records: Pap smear results, presence of a sexual history, and screening for sexually transmitted infections (STI). Results Of 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%). Conclusion Women 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.