Fewer than half of Ontario women who have abnormal results from their Pap smear tests then go on to get the recommended followup care, new research has found.

Very young women were the least likely to have appropriate followup of abnormal results - or to get the test done at all, found the study by researchers at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences.

Post-menopausal women were the least likely to have a second test after an initial unsatisfactory Pap smear.

Dr. Arlene Bierman, a physician at St. Michael's and principal investigator of the project, says this is the first time anyone in Ontario has studied how often women are going in for followup care after abnormal Pap tests.

"We were quite surprised with these results," Bierman told Canada AM Thursday.

"It's an important message for women that you need to go for your Pap smears, check the results and then go get followup."

Pap tests screen for cervical cancer by looking for changes in cervical cells that might indicate the early stages of cancer, a disease that progresses slowly in most women.

After an abnormal finding, women should return to their doctors to do either a repeat test or to have a colposcopy, a procedure that uses a scope to examine more closely a woman's cervix and vagina.

The study didn't investigate why women don't go for followup care, but Bierman says previous research has found that many women are afraid to return to their doctors once they learn of abnormal results. But she notes that an abnormal test does not mean cancer.

"Women should go find out more, because actually, cervical cancer can be prevented with Pap smears. We can find early changes and if it's treated, it doesn't progress to cancer. So it's one of the preventable cancers," she said.

She says this study focused on women who received test results suggesting they had early, low-grade lesions. "I'm sure that people with severe lesions are probably followed up. But 15 per cent of low-grade lesions can cause problems," she noted.

Low-income women less likely to be screened regularly

The study also found that in 2004-2005, only 69 per cent of women with no history of cervical cancer or prior hysterectomy had at least one Pap test in the last three years. That means that more than 30 per cent of Ontario women were not up to date in their screenings.

"That translates into a million women in Ontario who should have been screened but weren't. So we really need women to go in and get their tests," Bierman said.

Women living in lower-income neighbourhoods were less likely to have had at least one Pap test in the previous three years compared to women in higher-income neighbourhoods. Only 61 per cent of low-income women were screened compared to 75 per cent of high-income women.

Bierman says while women need to make sure they are getting the tests they need, there need to be systems to track women's results and ensure they're called back. There also need to be systems to provide women with reminders to come in for tests.

An estimated 1,300 Canadian women will be diagnosed with cervical cancer this year, according the Canadian Cancer Society, and an estimated 380 will die from the disease. The Pap test is considered the best way to detect for pre-cancerous changes. Since it was introduced almost 30 years ago, the death rate from cervical cancer has declined almost 50 per cent.

Health Canada offers these tips for minimizing a woman's risk of cervical cancer.

  • Have a Pap test at age 18 or as soon as you become sexually active, as part of your routine health examination. A second test should be taken after one year, especially if you begin screening after age 20.
  • If your first two tests show no abnormality, you should be re-screened every three years, to age 69. You do not need to be re-screened if you have never had sexual intercourse or if you have had a hysterectomy.
  • If you are over the age of 69, and have had at least two clear Pap tests, no cervical abnormalities for nine years and no history of cancer, you do not need regular screening.
  • If an abnormality is detected during a Pap test, you should be re-tested every six months for two years.
  • Limit your number of sexual partners and be aware of your partners' sexual history.
  • Limit your number of unprotected sexual encounters. Using condoms also lowers your risk.

The Society of Obstetricians and Gynaecologists of Canada also advises that women aged nine to 26 should consider receiving HPV vaccination. HPV, or the human papillomavirus, is an extremely common sexually transmitted virus and the primary cause of cervical cancer.

While the vaccine can help reduce your chances of being infected with HPV, it is not a substitute for regular Pap test screening.