We explored the impact of detection bias on cervical carcinoma risk factors in a population-based case-control study in Utah. Risk estimates for most cervical carcinoma risk factors were virtually the same in women who reported frequent Pap tests as those obtained from the population at large. Women who reported infrequent Pap tests, however, had higher estimates of risk than the general population. The largest difference was observed for those who used frequent vaginal douching, where a risk estimate of 9.5 was observed among women who reported infrequent Pap tests compared with 2.7 for women who reported frequent Pap tests.
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