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The Challenge of Follow-Up in a Low-Income Colposcopy Clinic: Characteristics Associated With Noncompliance in High-Risk Populations

Chase, Dana M. MD1; Osann, Kathryn PhD2; Sepina, Nicole BS2; Wenzel, Lari PhD2; Tewari, Krishnansu S. MD1

Journal of Lower Genital Tract Disease: October 2012 - Volume 16 - Issue 4 - p 345–351
doi: 10.1097/LGT.0b013e318249640f
Original Articles

Objective The study aimed to identify sociodemographic and disease-specific factors associated with follow-up in an inner-city multiethnic colposcopy clinic.

Materials and Methods All charts of patients referred to colposcopy clinic for abnormal cervical cytology and/or high-risk human papillomavirus infections to the University of California, Irvine, Colposcopy Clinic in Santa Ana from November 2006 to December 2007 were reviewed. Compliance was defined as at least 1 follow-up evaluation within 3 to 14 months from initial colposcopy appointment. To determine compliance, the following factors were evaluated in a multivariate analysis: race, age, spoken language, insurance status, annual income, marital status, referral cytology, histology, and pregnancy status.

Results Among the 1,046 scheduled appointments, 50% were attended. Of the patients, 458 with a minimum of 14 months of follow-up were included. The mean (SD) age of these patients was 31.0 (10.7) years. 58% were white and 55% spoke Spanish. A total of 248 patients (54%) had appropriately timed repeat testing, whereas 210 (46%) failed to return within 14 months. In univariate analysis, women who were referred from outside the clinic, single, younger than 40 years, and with self-pay or government-funded insurance were more likely to be noncompliant although this was not statistically significant. In multivariate analysis, referral from outside the clinic, self-pay, or government-funded insurance, Spanish-speaking, and single marital status were all significantly associated with noncompliance. Although cervical intraepithelial neoplasia 2 or 3 was not associated with noncompliance, 45% of women with cervical intraepithelial neoplasia 2 or 3 still did not comply with recommendations.

Conclusions This inner-city clinic is perhaps successful at maintaining compliance for women at highest risk for cervical cancer when the triage originates from within the clinic and when the patient is married, English-speaking, and privately insured. However, reasons for those patients at highest risk for noncompliance in this clinic may need to be better characterized.

Despite success at following up most patients seen in an inner-city colposcopy clinic, follow-up remains challenging for some whose characteristics should be better elucidated.

1University of California, Irvine Medical Center, Orange; and 2University of California, Irvine, Irvine, CA

Correspondence to: Krishnansu S. Tewari, MD, Division of Gynecologic Oncology at St Joseph Center for Cancer Prevention and Treatment and the Chao Family Comprehensive Cancer Center, 101 The City Drive South, Orange, CA 92868. E-mail:

The authors have no conflicts of interest to disclose.

©2012The American Society for Colposcopy and Cervical Pathology