Utilization patterns of cervical cancer screening in Italy

The aim of this study is to identify the use of cervical cancer screening and sociodemographic determinants associated with proper screening, overscreening, and underscreening in the Italian target population. Cross-sectional data from the national last available survey 'Health and use of health care in Italy,' conducted between December 2004 and September 2005, were analyzed. Multiple logistic regression was used to evaluate the risk factors associated independently with Pap test utilization. Our final sample included 36,161 women aged 25-64 years. Among women who reported having a Pap smear at least once, 20,920 (81.6%) repeated the Pap smear after the first one: 15,454 (74.3%) more than once every 3 years ('OVER' screening) and 2599 (12.4%) less than once every 3 years ('UNDER' screening). Among the independent risk factors associated with 'OVER' screening were higher social class [odds ratio (OR)=1.26, 95% confidence interval (CI) 1.15-1.39], being a former smoker (OR=1.16, 95% CI 1.05-1.28), and having had two or more pregnancies in the last 5 years (OR=1.43, 95% CI 1.20-1.70), whereas 'UNDER' screening was associated with the age group of 55-64 years (OR=2.11, 95% CI 1.76-2.53) and being divorced (OR=1.32, 95% CI 1.02-1.71). Improving Pap test compliance according to the proper timing is important for future reduction in cervical cancer mortality.