Compliance issues in cervical dysplasia - Tips from Other Journals

Date: June, 1992

Cervical cancer continues to be a major cause of mortality and morbidity in American women. It is estimated that 13,000 new cases of cervical cancer occurred in 1991. In North Carolina, the mortality rate for cervical cancer is three times higher in black women than in white women. It is well documented that poor screening plays a role in the incidence and mortality rates of cervical cancer. Once dysplasia has been detected by an abnormal Papanicolaou smear, treatment is effective in 82 to 94 percent of cases. Dysplasia often progresses to in situ or invasive carcinoma because the women do not receive treatment. Lack of treatment may result from noncompliance or inadequate access to health care. Laedtke and Dignan studied compliance with treatment for cervical dysplasia in women from 14 counties in North Carolina.

The study included 147 women who had been screened at either a county health department or a community health center and were referred for follow-up to a dysplasia clinic for low-income patients. The initial follow-up visit included colposcopy, Pap smear and four-quadrant cervical biopsy. After the cytologic and histologic results were evaluated, patients were sent letters informing them of the follow-up recommendations.

Fifty-five women (32 percent) did not comply with follow-up instructions. Compliance was not found to be related to race or the other demographic variables considered. Noncompliance was greater in patients who had to travel longer distances to reach the referral clinic, but this difference did not reach statistical significance. Of the patients who underwent colposcopy, only 20.5 percent required no treatment.

This study confirms that a significant compliance problem exists in women who are screened for cervical cancer. Almost one-third of women with abnormal Pap smears failed to keep appointments for colposcopy, and a smaller number of women failed to return for definitive treatment. Further studies are needed to improve our understanding of the reasons for noncompliance and to develop means to enhance compliance. (Southern Medical Journal, January 1992, vol. 85, p. 5.)

COPYRIGHT 1992 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

 
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