Robert M. Hamm, PhD

Department of Family and Preventive Medicine

University of Oklahoma Health Sciences Center

Project funded by Cancer Research Foundation of America.

Summary from March 1 1997 application.

Pap screens detect precursors of cervical cancer. The project aims to estimate the proportion of women identified with cervical abnormalities who fail to return for the recommended follow up after an initial evaluation and/or treatment. The question is important because conservative management of cervical dysplasia -- watching and treating only if it gets worse -- can only succeed if patient returns for ongoing exams. If she fails to get the exams, and her dysplasia progresses toward cancer, it may not be treated in time. At the least, it may require a more invasive surgical procedure than it would have if the patient had followed up on schedule.

The project will prospectively follow 300 women who come to one of 4 clinics for evaluation of Pap abnormalities. Patient will fill out a questionnaire addressing potential risk factors. These include demographics, employment, history with the clinic, transportation availability, personality factors, health insurance coverage, and beliefs about the disease. Other information will be derived from medical records and from instruments filled out by physician and nurse, including their report of the information given to the patient. The project will produce a profile of the hypothesized risk factors in these patients, who are typical of those served by university colposcopy clinics and public cervical dysplasia clinics.

Funding will be sought from CRFA next year for gathering data in the second year of the study about whether the patient returned for the recommended follow up. Linked with the data from the first year, this will allow us to produce models predicting patient follow up behavior from information available at initial visit. The measured follow up rate will be used in an analysis designed to decide whether the typical patient with mild cervical dysplasia should be treated with immediate cryotherapy (freezing of the cervix to cure the dysplasia) or "watchful waiting". In addition, the models predicting follow up from individual patient characteristics will be used to develop guidelines for whether it is safe to manage an individual patient's mild cervical dysplasia with "watchful following", or whether it would be safer for her to perform cryotherapy immediately.