Abstract
Background
Cervical cancer remains a significant yet preventable disease despite the widespread availability of Pap test screening, which detects cervical cancer and its precursor lesions. The aims of this study were to: i) estimate and compare age- and hysterectomy-adjusted Pap test rates across the 37 Ontario public health units (PHUs), and ii) explore the association between several factors and Pap test rates (at the ecological level).
Methods
Cytobase, an Ontario Pap test registry, captures more than 80% of all Pap tests in Ontario. Cytobase was used to determine Pap test rates adjusted for age, hysterectomy and Cytobase coverage for the year 2001. Multiple linear regression analyses were used to evaluate the relationship between Pap test rates and various factors at an ecological level.
Results
Age-, hysterectomy- and Cytobase-adjusted one-year Pap rates ranged from 11.6% to 73.9% among PHUs. The overall rate for Ontario was 40.7%. Multivariate analyses indicated that the presence of a teaching hospital was associated with higher Pap test rates.
Conclusion
One-year Pap test rates varied greatly across the 37 public health units in Ontario. Pap test rates determined using Cytobase were lower than self-reported rates obtained from the Canadian Community Health Survey, possibly due to “over-reporting”. In general, women were not screened as frequently as recommended by the Ontario Cervical Screening Program. A positive association was observed between Pap test rates and the presence of a teaching hospital. Data quality issues limit the ability to monitor cervical screening. A provincial registry would address these issues.
MeSH terms: Mass screening, cervix neoplasms, vaginal smears
Résumé
Contexte
Le cancer du col utérin est une maladie évitable encore très répandue malgré la grande disponibilité du test de Papanicolaou, qui permet de dépister ce type de cancer et ses lésions précurseurs. Notre étude visait: i) à estimer et à comparer les taux de dépistage par le test de Papanicolaou, ajustés selon l’âge et la présence d’une hystérectomie, dans les 37 bureaux de santé publique de l’Ontario, et ii) à analyser l’association entre divers facteurs et les taux de dépistage par le test de Papanicolaou (au palier écologique).
Méthode
Les résultats de plus de 80 % des tests de Papanicolaou en Ontario sont entrés dans le registre ontarien Cytobase. Nous avons utilisé ce registre pour déterminer les taux de dépistage par le test de Papanicolaou, ajustés selon l’âge, l’hystérectomie et la couverture de Cytobase pour l’année 2001. Au moyen d’analyses de régression linéaire multiple, nous avons évalué la relation entre ces taux de dépistage et divers facteurs au palier écologique.
Résultats
Les taux de dépistage par le test de Papanicolaou ajustés selon l’âge, l’hystérectomie et la couverture de Cytobase sur un an variaient de 11,6 % à 73,9 % d’un bureau de santé publique à l’autre. Le taux pour l’ensemble de l’Ontario était de 40,7 %. Selon nos analyses multivariables, la présence d’un hôpital d’enseignement était associée à des taux de dépistage supérieurs.
Conclusion
Les taux de dépistage par le test de Papanicolaou sur un an variaient considérablement dans les 37 bureaux de santé publique de l’Ontario. Les taux apparaissant dans le répertoire Cytobase étaient plus faibles que les taux déclarés par les intéressées dans l’Enquête sur la santé dans les collectivités canadiennes (il y a peut-être eu surdéclaration dans l’Enquête). Dans l’ensemble, les femmes n’étaient pas testées aussi souvent que le recommande le Programme ontarien de dépistage du cancer du col de l’utérus. Nous avons observé une association positive entre les taux de dépistage par le test de Papanicolaou et la présence d’un hôpital d’enseignement. Des problèmes de qualité des données limitent notre capacité de surveiller le dépistage du cancer du col utérin. Un registre provincial serait une solution.
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