SAN DIEGO Cervical cancer screening in STD clinics is feasible and highly effective, according to results from a 2-year single clinic study.
"From previous studies we know that women who attend STD clinics are at greater risk for having abnormal cervical cytology, but screening is often perceived as a barrier, that clinics are very busy, and there are other conflicting interests that bring the patient there," Dr. Susan S. Philip said in an interview during a poster session at the annual meeting of the Infectious Diseases Society of America. "I'd like to argue that it's feasible and it's a good idea to screen women who come to STD clinics for cervical cancer Pap testing."
Between 2004 and 2006 she and her associates offered Pap testing to 10,275 females with a mean age of 27 years who visited San Francisco's public STD clinic and who reported having no Pap test in the previous year. The researchers compared the rates of screening by clinicians trained in family planning versus those who lacked such training. They also analyzed certain demographic characteristics of the study population and defined abnormal Pap results as atypical squamous cell of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LGSIL), or high-grade squamous intraepithelial lesion (HGSIL).
Of the 10,275 visits by females for STD testing, 2,158 (21%) included Pap testing, reported Dr. Philip of the STD prevention and control services at the San Francisco Department of Public Health. "That number seems low, but some of those women may have presented with other urgent STD-related needs, so testing was deferred," she explained.
Of clinicians trained in family planning, 25% offered Pap tests to the women, compared with 18% of clinicians who were not, a difference that was statistically significant. "Perhaps we need to see about additional training for those clinicians who are not historically trained in family planning to increase their comfort with the Pap test," Dr. Philip said.
Only 11 of the 2,158 Pap specimens (0.51%) were unsatisfactory by laboratory standards. "We feared that the rate of unsatisfactory specimens would be higher in our STD clinic, maybe because we weren't all trained in family planning or because other conditions were going on at the cervix of the woman in terms of chlamydia or gonorrhea," Dr. Philip said. But "we showed it's possible to get a good sample from these women."
Of the 2,147 satisfactory Pap specimens, 1,944 (90.5%) were normal and 203 (9.5%) were abnormal. Of the abnormal specimens, 124 (61%) were reported as ASCUS, 68 (33.5%) reported as LGSIL, and 11 (5%) reported as HGSIL. Overall, 21.2% of Asian/Pacific Islanders, 16.3% of African Americans, 15.8% of Hispanics, and 1.5% of whites had abnormal Pap results.
Dr. Philip acknowledged certain limitations of the study, including its observational design and the fact that 73% of patients who visit the clinic are men.
"Data from our clinic might not be generalizable to other STD clinic populations, but we encourage people to integrate cervical cancer screening in their own clinic," she said.
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