Underuse, overuse, and guideline-based use of cervical cancer screening: social disparities in temporal screening trajectories in the French CONSTANCES cohort.

backgroundThe Pap test has been an important part of women's medical care for 40 years. Its utilization over time allows us to study both under- and over-screening. Our objective is to study the trends over time in each woman's screening status while simultaneously examining both its underuse and overuse.

methodsOur final sample included 55,141 women. We used sequence analysis methods to characterize trajectories of cervical cancer screening use for each woman. We then obtained 3 clusters of sequences. We performed bivariate analyses by comparing variables of interest according to each woman's cluster membership.

resultsThis study of Pap test reimbursement data shows that 70.7% of our sample was screened more often than necessary according to the guidelines for at least some periods of this study. The cluster analysis highlighted the consistency of the screening status. Once a woman "adopted" a screening rhythm, it appeared to continue over time. Most women who overused cervical cancer screening by Pap tests at the beginning of our observation period overused it throughout the follow-up period; the same consistency was found for those up-to-date at the start, and for those underscreened. The women in the overscreened group were in better health, younger, lived with a partner more often, and had the most favorable social characteristics.

conclusionOur results showed an unequal distribution of social, demographic, and health characteristics across screening patterns. The majority of our sample was screened more often than necessary according to the guidelines then in effect. Once a woman "adopted" a screening rhythm, it appeared to continue over time.