Document Detail

The burden of prevention: downstream consequences of Pap smear testing in the elderly.
MedLine Citation:
PMID:  14738656     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Although cervical cancer is an unusual cause of death among women 65 and older, most elderly women in the US report continuing to undergo periodic Pap smear screening.
OBJECTIVE: To describe the incidence of Pap smears and downstream testing among elderly women.
SETTING: Claims-based analysis of female Medicare enrollees age 65 and older.
METHODS: Using three years of Medicare Part B 5% Files (1995-1997), we differentiated between women undergoing screening Pap smears and those undergoing Pap smears for surveillance of previous abnormalities or Pap smear follow-up. We determined the proportion of elderly women undergoing Pap smear testing and rates of downstream testing and procedures after an initial Pap smear.
RESULTS: Four million female Medicare beneficiaries over 65 years underwent Pap smear testing between 1995 and 1997, representing 25% of the eligible population. After adjusting for underbilling for Pap smears under Medicare, 43% of women over 65 are estimated to have undergone Pap smear testing during the 3-year period. The large majority (90%) of Pap smears were for screening, while 10% were done for surveillance or follow-up. For every 1000 women with a screening Pap smear, 39 had at least one downstream intervention within eight months of the initial Pap smear, including seven women who underwent colposcopy and two women who had other surgical procedures. Rates of downstream interventions were considerably higher for women undergoing Pap smear follow-up (302 per 1000 with at least one downstream intervention), and surveillance of previous abnormalities (209 per 1000 with a downstream intervention).
CONCLUSION: Cervical cancer screening is widespread among elderly American women, and follow-up testing is not uncommon, particularly among the ten percent of women who appear to be in a cycle of repeated testing. This substantial volume of testing occurs despite the rarity of cervical cancer deaths and unknown benefits of screening in this age group.
B E Sirovich; D J Gottlieb; E S Fisher
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of medical screening     Volume:  10     ISSN:  0969-1413     ISO Abbreviation:  J Med Screen     Publication Date:  2003  
Date Detail:
Created Date:  2004-01-23     Completed Date:  2004-08-02     Revised Date:  2014-07-28    
Medline Journal Info:
Nlm Unique ID:  9433359     Medline TA:  J Med Screen     Country:  England    
Other Details:
Languages:  eng     Pagination:  189-95     Citation Subset:  IM    
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MeSH Terms
Cohort Studies
Follow-Up Studies
Hysterectomy / statistics & numerical data
Papanicolaou Test*
Preventive Medicine / standards*
Reproducibility of Results
United States
Uterine Cervical Neoplasms / epidemiology,  surgery
Vaginal Smears / standards*,  statistics & numerical data

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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