Inadequate screening in patients evaluated by nongynecologists for cervical cancer: a case control analysis

Am J Obstet Gynecol. 2008 May;198(5):e48-50. doi: 10.1016/j.ajog.2007.12.024. Epub 2008 Mar 14.


Objective: The purpose of this study was to determine the rate of unsatisfactory Papanicolaou tests between gynecology and nongynecology providers at a single institution.

Study design: Vanderbilt University Medical Center data were used to obtain a list of all liquid-based cervical Papanicolaou smears that were collected between September 2002 and October 2006. Unsatisfactory samples were identified as 2 groups (gynecology vs nongynecology) for statistical comparison.

Results: There were 69,129 Papanicolaou smears that had been collected between September 2002 and October 2006; 47,165 smears were in the gynecology group, and 21,964 smears were in the nongynecology group. Of these, 1206 smears were designated to be "unsatisfactory." A nongynecology provider was more likely to have an unsatisfactory Papanicolaou test result, compared with a gynecology physician (3% [602/21,964] vs 1% [604/47,165]; P < .001). The odds of having an unsatisfactory Papanicolaou test result was 2 times higher with nongynecology, compared with gynecology, physicians (odds ratio, 2.17; 95% CI, 1.94-2.43).

Conclusion: Rates of liquid-based smears reported as unsatisfactory are higher among nongynecology providers. Competency-based learning programs might help to address this discrepancy.

MeSH terms

  • Adult
  • Case-Control Studies
  • Clinical Competence*
  • Female
  • Humans
  • Odds Ratio
  • Papanicolaou Test*
  • Regression Analysis
  • Retrospective Studies
  • Uterine Cervical Neoplasms / diagnosis*
  • Vaginal Smears* / methods
  • Vaginal Smears* / standards