RESUMO
Background. Cervical cancer is the most important cancer in Mexican women. Early detection is possible by means of the Papanicolaou(Pap) test; however, the coverage in Mexico is low. Methods. A cross-sectional survey was carried out in a representative sample of women from the Tlalpan area of Mexico City. Social, reproductive and health care factors associated with the lack of the Pap test with respect to adequate use and misuse were identified. Both bivariate and logistic regression analyses were used fot he adjustment of variables. Results. Of 1,215 women studied, 22.5 percent had never had a pap smear, 42 percent had misused the test (<90 percent of triennial performance), and 35.5 percent had adequately used the test (=90 percent of triennial performance). The main factors related to the lack of use were the following: not knowing about the Pap test (ORa=35.16, 95 percent C.I. =17.4 - 7.9); having fewer than 6 years of education (ORa = 4.5, 95 percent C.I.=2.5 - 8.4); women younger than 30 years of age (ORa=3.4 95 percent C.I.=2.3 - 5.1); use of contraceptives (OR==0.4, 95 percent C.I.=0.2 - 0.8); history of sexually transmitted disease (ORa=0.3, 95 percent C.I.=0.1 - 0.8), and the principal informant about the Pap test, i.e., the health services personnel (ORa=0.02, 95 percent C.I.=0.0008 - 0.05). Conclusions. The lack of use and the misuse of Pap smears vary importantly among the different social and reproductive factors. But the principal reasons for lack of use were not knowing about the Pap test and a low education level. We propose a greater diffusion on the benefits of the test in the Mexican population, through massive means of communication and health services