Papanicolaou test coverage without a cytology registry.

Because of problems in following women over time, it is difficult to assess the degree of Papanicolaou test coverage among the general population. In a region with no cytology register or recall system, the authors used data from Manitoba's universal health insurance plan to determine the actual number of women tested and the number of tests per woman from 1970 to 1984 inclusive. By cross-sectional analysis, the proportion screened annually was found to be highest for women aged 25-34 years (50-57%) and decreased with increasing age. The proportion screened annually for women over 25 remained essentially unchanged over the 15 years (34-39%). From a probability sample of women aged 35-64 years (n = 17,711), it was found that 91% had at least one test and 78% had three or more tests over 15 years. Untested women tended to be single, older, and from rural or remote areas. To assess multiple testing, the authors used the cross-sectional data to determine the number of women with two or more tests per year. About 4% of women had two or more tests annually, and 60% of these were accompanied by a diagnosis suggestive of an abnormal gynecologic condition. On the basis of published recommended schedules for Papanicolaou testing, the authors conclude that the widespread testing in Manitoba shows that the voluntary system has been working fairly well. High rates of coverage were achieved but with a degree of overtesting for some women.