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Coverage and Factors Associated With Cervical Cancer Screening: Results From the AFRODITA Study: A Population-Based Survey in Spain

Puig-Tintoré, Luis M. MD1; Castellsagué, Xavier MD2; Torné, Aureli MD1; de Sanjosé, Silvia MD2; Cortés, Javier MD3; Roura, Esther MD2; Méndez, Cristina MD4; Bosch, F. Xavier MD2

Journal of Lower Genital Tract Disease: April 2008 - Volume 12 - Issue 2 - p 82-89
doi: 10.1097/LGT.0b013e3181599c16
Original Articles
Spanish Translation

Objective. To quantify the coverage and monitor the factors associated with opportunistic cervical cytological screening in Spain.

Materials and Methods. Population-based survey of selected women through the Access Panel technique representative of the general population. A total of 6,852 women (60%) replied to the questionnaire; 981 (14.3%) were excluded from the analysis because they did not meet the screening criteria. Data were adjusted for regions, age group, socioeconomic level (SEL), and municipality size. Moreover, information was collected on preventive gynecological revisions received. Categorical variables were evaluated through the χ2 test of heterogeneity or through a liner test for trend. Multivariate prevalence odds ratios were used to identify statistically significant determinants of screening using logistic regression modeling.

Results. The percentage of women 18 to 65 years old with a Pap smear within the last 3 years was 75.6%. Insufficient coverage was observed in women older than 55 years (66%), who live in rural areas (66%), with lower SEL (65%), and in some regions (61%-66%). The factors positively associated with screening were age 26 to 55 years, certain regions, higher SEL, larger municipality size, ever being pregnant, early age at first sexual intercourse, knowledge about cervical cancer and human papillomavirus, and, very strongly, ever use of contraceptive methods. An overuse of cytology can be assumed, as a result of opportunistic screening.

Conclusions. In Spain, the coverage of cytological screening reached 75% of the population, but with inefficiencies in some aspects. To rationalize its use, the Spanish consensus screening protocol must be followed.

The coverage of opportunistic cervical cancer screening in Spain is high, but it needs to be improved in some aspects that are analyzed in detail.

1Gynecologic Oncology, Hospital Clínic, University of Barcelona, Catalonia, Spain, 2Epidemiology and Cancer Registry Unit, Institut Català d'Oncologia, Barcelona, Catalonia, Spain, 3Gynaecology, Policlinic Miramar, Palma de Mallorca, Balearic Islands, Spain, and 4GlaxoSmithKline, Madrid, Spain

Reprint requests to: Luis M. Puig-Tintoré, MD, Gynecologic Oncology, Hospital Clínic, University of Barcelona, C. Villarroel, 170, 08036 Barcelona, Spain. E-mail:

©2008The American Society for Colposcopy and Cervical Pathology