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Li B, Dong L, Wang C, Li J, Zhao X, Dong M, Li H, Ma X, Dong Y, Wu M, Yan Y, Fan A, Xue F. Analysis of the related factors of atypical squamous cells of undetermined significance (ASC-US) in cervical cytology of post-menopausal women. Front Cell Infect Microbiol 2023; 13:1123260. [PMID: 36875525 PMCID: PMC9978476 DOI: 10.3389/fcimb.2023.1123260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Atrophy of the reproductive tract mucosa caused by the decrease of estrogen may increase the detection rate of ASC-US in cervical cytology of post-menopausal women. In addition, other pathogenic infections and inflammation can change the cellular morphology and increase the detection rate of ASC-US. However, further studies are needed to elucidate whether the high detection rate of ASC-US in post-menopausal women leads to the high referral rate of colposcopy. Methods This retrospective study was conducted to document ASC-US in cervical cytology reports at the Department of Cytology at Gynecology and Obstetrics, Tianjin Medical University General Hospital between January 2006 and February 2021. We then analyzed 2,462 reports of women with ASC-US at the Cervical Lesions Department. A total of 499 patients with ASC-US and 151 cytology with NILM participants underwent vaginal microecology tests. Results The average reporting rate of ASC-US in cytology was 5.7%. The detection rate of ASC-US in women aged > 50 years (7.0%) was significantly higher than that in women aged ≤50 years (5.0%) (P<0.05). The CIN2+ detection rate was significantly lower in the post- (12.6%) than in pre-menopausal (20.5%) patients with ASC-US (P <0.05). The prevalence of abnormal reporting rate of vaginal microecology was significantly lower in the pre-menopausal group (56.2%) than that in the post-menopausal group (82.9%) (P<0.05). The prevalence of bacterial vaginosis (BV) (19.60%) was relatively high in the pre-menopausal group, but the abundance of bacteria-inhibiting flora (40.79%) was mainly an abnormality in the post-menopausal group. The vaginal microecological abnormality rate of the women with HR-HPV (-) of ASC-US was 66.22%, which was significantly higher than that of the HR-HPV (-) and the NILM group (52.32%; P<0.05). Discussion The detection rate of ASC-US in women aged > 50 years was higher than that ≤50 years, but the detection rate of CIN2+ was lower in the post-menopausal women with ASC-US. However, vaginal microecological abnormalities may increase the false-positive diagnosis rate of ASC-US. The vaginal microecological abnormalities of the menopausal women with ASC-US are mainly attributed to infectious diseases such as BV, and it mainly occurs in the post-menopausal women was bacteria-inhibiting flora. Therefore, to avoid the high referral rate for colposcopy, more attention should be paid to the detection of vaginal microecology.
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Affiliation(s)
- Bijun Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Lichang Dong
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Chen Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jia Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xue Zhao
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Mengting Dong
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Huanrong Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaotong Ma
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Yalan Dong
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Wu
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Ye Yan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Aiping Fan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
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Increases in Human Papillomavirus Testing Preceding Diagnosis of Cervical Precancer in 5 US States, 2008-2016. J Low Genit Tract Dis 2021; 25:192-198. [PMID: 33797511 DOI: 10.1097/lgt.0000000000000606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to describe trends in human papillomavirus (HPV) testing preceding diagnosis of cervical precancer during a time of changing screening recommendations. MATERIALS AND METHODS We conducted a cross-sectional analysis of data from active, population-based, laboratory surveillance among 1.5 million residents of 5 areas in the United States. We included women aged 21-39 years diagnosed with cervical intraepithelial neoplasia grades 2, 2/3, or 3 or adenocarcinoma in situ (collectively, CIN2+) during 2008-2016, who had a cytology and/or HPV test before diagnosis (n = 16,359). RESULTS The proportion of women with an HPV test preceding CIN2+ increased from 42.9% in 2008 to 73.3% in 2016 (p < .01); testing increased in all age groups (21-24 y: 35.3% to 47.6%, 25-29 y: 40.9% to 64.1%, 30-39 y: 51.7% to 85.9%, all p < .01). The HPV testing varied by cytology result and was highest among women with atypical squamous cells of unknown significance (n = 4,310/4,629, 93.1%), negative for intraepithelial lesion or malignancy (n = 446/517, 86.3%), and atypical glandular cells (n = 145/257, 56.4%). By 2016, at least half of all cases in every surveillance area had an HPV test before diagnosis. CONCLUSIONS During 2008-2016, the proportion of women with an HPV test preceding CIN2+ increased significantly for all age groups, cytology results, and surveillance areas. By 2016, most (85.9%) women aged 30-39 years had an HPV test, consistent with recommendations. Increasing utilization of HPV tests, which have demonstrated improved sensitivity for detecting cervical disease, may in part explain increasing rates of cervical precancer among women 30 years and older.
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Wang YY, Kong LH, Liu Y, Wang S, Fan QB, Zhu L, Lang JH. Retrospective analysis of cervical cancer and precancerous lesions in patients with atypical squamous cells of undetermined significance in China. Medicine (Baltimore) 2019; 98:e18239. [PMID: 31804350 PMCID: PMC6919524 DOI: 10.1097/md.0000000000018239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Atypical squamous cells of undetermined significance (ASCUS) are the most common cytological abnormality of all smear test. No study has demonstrated the prevalence of cervical cancer or its precursor in Chinese patients with ASCUS. This study aims to investigate the prevalence of cervical intraepithelial neoplasia 1 or worse (CIN1+) and CIN3 or worse (CIN3+) in patients with ASCUS in China to provide insight into appropriate management for Chinese health care.In a retrospective cross-sectional study, patients who underwent liquid-based thin layer cytology and human papillomavirus (HPV) co-testing at the Peking Union Medical College Hospital between January 2014 and January 2017, and had ASCUS results on liquid-based thin layer cytology test and underwent follow-up and colposcopic biopsy were included. Age, HPV DNA test, and pathological outcomes were assessed.One hundred forty-four patients with ASCUS and positive HPV test results were included. In the 3-year follow-up, 23 (16.0%) patients had CIN1, 28 (19.4%) had CIN2, and 17 (11.8%) had CIN3 or carcinoma in situ. The risk of CIN3+ was significantly higher in those older than 60 years (42.8%, P = .005), whereas the CIN1+ prevalence displayed no significant difference between age groups. Both hybrid Capture II (HC II) value and cytopathological description of HPV infection showed no statistically significant correlation with CIN1+ or CIN3+.Patients with HPV-positive ASCUS who were older than 60 years had a significantly higher risk of CIN3+, and clinicians should pay more attention to them. Both HC II value and cytopathological description of HPV infection showed no significant correlation with CIN1+ or CIN3+.
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Affiliation(s)
| | - Ling-Hua Kong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing-Bo Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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The Next Generation of Cervical Cancer Screening: Should Guidelines Focus on Best Practices for the Future or Current Screening Capacity? J Low Genit Tract Dis 2019; 22:91-96. [PMID: 29570563 PMCID: PMC5895142 DOI: 10.1097/lgt.0000000000000378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zheng B, Yang H, Li Z, You J, Wei G, Zhang H, Zeng Z, Xie F, Zhao C. Atypical Squamous Cells of Undetermined Significance Cervical Cytology Report Rate and Histologic Follow-up Findings From the Largest College of American Pathologists-Certified Laboratory in China. Arch Pathol Lab Med 2018; 143:748-752. [PMID: 30605022 DOI: 10.5858/arpa.2018-0244-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Reports for atypical squamous cells of undetermined significance (ASC-US) and histologic findings are rare in China. OBJECTIVE.— To analyze the correlation findings of ASC-US cytology with high-risk human papillomavirus (hrHPV) test and histopathologic follow-ups. DESIGN.— ASC-US cases with hrHPV test and histologic follow-ups between 2011 and 2015 were analyzed at a College of American Pathologists-certified laboratory. RESULTS.— A total of 2 206 588 Papanicolaou (Pap) tests were performed, including 1 513 265 liquid-based cytology preparations (68.58%), and 693 323 conventional Pap tests (31.42%). The overall ASC-US reporting rate was 3.77% (83 199 of 2 206 588), with the highest in women aged 40 to 49 years. Of 18 574 women with ASC-US Pap and HPV testing, the hrHPV positivity rate was 34.98% (6498 of 18 574) with the highest in women younger than 30 years. A total of 6012 women with ASC-US Pap test findings had histologic follow-ups within 6 months; the overall cervical intraepithelial neoplasia 2 and above (CIN2+) detection rate was 7.87% (473 of 6012). One thousand nine hundred nine women with ASC-US Pap and HPV testing had histologic results. CIN2+ lesion was found in 13.98% (124 of 887) of women with ASC-US Pap/HPV-positive test results, significantly higher than 2.84% (29 of 1022) for women with ASC-US Pap/HPV-negative test results. Cervical squamous cell carcinoma was found in 3.95% (35 of 887) of women with ASC-US/HPV-positive test results. CONCLUSIONS.— This is one of the largest studies to investigate HPV and histologic follow-up findings in women with ASC-US in China. The ASC-US reporting rate, HPV positivity rate, and CIN2+ detection rate were all within the currently recognized benchmark ranges. These findings may contribute to establishing a baseline for better understanding of the status of cervical screening in China.
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Affiliation(s)
- Baowen Zheng
- From Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong, China (Drs Zheng, You, Wei, and Mr Zeng); the Department of Pathology, Conemaugh Health System, Johnstown, Pennsylvania (Dr Yang); the Department of Pathology, Wexner Medical Center at Ohio State University, Columbus (Dr Li); the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhang and Zhao); and Jinan Kingmed Diagnostics, Jinan, Shandong, China (Dr Xie)
| | - Huaitao Yang
- From Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong, China (Drs Zheng, You, Wei, and Mr Zeng); the Department of Pathology, Conemaugh Health System, Johnstown, Pennsylvania (Dr Yang); the Department of Pathology, Wexner Medical Center at Ohio State University, Columbus (Dr Li); the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhang and Zhao); and Jinan Kingmed Diagnostics, Jinan, Shandong, China (Dr Xie)
| | - Zaibo Li
- From Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong, China (Drs Zheng, You, Wei, and Mr Zeng); the Department of Pathology, Conemaugh Health System, Johnstown, Pennsylvania (Dr Yang); the Department of Pathology, Wexner Medical Center at Ohio State University, Columbus (Dr Li); the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhang and Zhao); and Jinan Kingmed Diagnostics, Jinan, Shandong, China (Dr Xie)
| | - Jia You
- From Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong, China (Drs Zheng, You, Wei, and Mr Zeng); the Department of Pathology, Conemaugh Health System, Johnstown, Pennsylvania (Dr Yang); the Department of Pathology, Wexner Medical Center at Ohio State University, Columbus (Dr Li); the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhang and Zhao); and Jinan Kingmed Diagnostics, Jinan, Shandong, China (Dr Xie)
| | - Guijian Wei
- From Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong, China (Drs Zheng, You, Wei, and Mr Zeng); the Department of Pathology, Conemaugh Health System, Johnstown, Pennsylvania (Dr Yang); the Department of Pathology, Wexner Medical Center at Ohio State University, Columbus (Dr Li); the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhang and Zhao); and Jinan Kingmed Diagnostics, Jinan, Shandong, China (Dr Xie)
| | - Huina Zhang
- From Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong, China (Drs Zheng, You, Wei, and Mr Zeng); the Department of Pathology, Conemaugh Health System, Johnstown, Pennsylvania (Dr Yang); the Department of Pathology, Wexner Medical Center at Ohio State University, Columbus (Dr Li); the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhang and Zhao); and Jinan Kingmed Diagnostics, Jinan, Shandong, China (Dr Xie)
| | - Zhengyu Zeng
- From Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong, China (Drs Zheng, You, Wei, and Mr Zeng); the Department of Pathology, Conemaugh Health System, Johnstown, Pennsylvania (Dr Yang); the Department of Pathology, Wexner Medical Center at Ohio State University, Columbus (Dr Li); the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhang and Zhao); and Jinan Kingmed Diagnostics, Jinan, Shandong, China (Dr Xie)
| | - Fengxiang Xie
- From Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong, China (Drs Zheng, You, Wei, and Mr Zeng); the Department of Pathology, Conemaugh Health System, Johnstown, Pennsylvania (Dr Yang); the Department of Pathology, Wexner Medical Center at Ohio State University, Columbus (Dr Li); the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhang and Zhao); and Jinan Kingmed Diagnostics, Jinan, Shandong, China (Dr Xie)
| | - Chengquan Zhao
- From Guangzhou Kingmed Diagnostics, Guangzhou, Guangdong, China (Drs Zheng, You, Wei, and Mr Zeng); the Department of Pathology, Conemaugh Health System, Johnstown, Pennsylvania (Dr Yang); the Department of Pathology, Wexner Medical Center at Ohio State University, Columbus (Dr Li); the Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Zhang and Zhao); and Jinan Kingmed Diagnostics, Jinan, Shandong, China (Dr Xie)
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Oliveira GGD, Oliveira JMDSCD, Eleutério RMN, Barbosa RDCC, Almeida PRCD, Eleutério J. Atypical Squamous Cells: Cytopathological Findings and Correlation with HPV Genotype and Histopathology. Acta Cytol 2018; 62:386-392. [PMID: 29898441 DOI: 10.1159/000489386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/16/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We aimed to assess potential associations between atypical squamous cell (ASC) subgroups: ASC-US (undetermined significance) and ASC-H (cannot exclude high-grade squamous intraepithelial lesion), regarding cytomorphological features, high-risk (HR) human papillomavirus (HPV) testing, and histological outcomes in a sample of Brazilian women. STUDY DESIGN Cross-sectional study which evaluated 1,346 liquid-based cytologies between January 2010 and July 2016 with ASC results. ASC-US and ASC-H were analyzed for frequency, diagnostic criteria, and cytological findings and compared with HR-HPV tests and histological outcomes. RESULTS Enlarged nucleus was the most frequent ASC-US criterion, but alternative criteria were present in 20% of the total cases. No ASC-US criteria were associated with histological outcomes or HR-HPV positivity. Parakeratosis, corneal pearl, giant cells, and binucleation were strongly associated with ASC-US while hyperkeratosis was associated with high-grade squamous intraepithelial lesions (HSIL) or a superior outcome. HR-HPV was positive in 64.39% of ASC-US and 65.38% of ASC-H. HSIL or superior outcomes also occurred in 13.33% of ASC-US and 64.71% of ASC-H cases. CONCLUSION Alternative criteria for ASC-US were relatively frequent. Reactive cellular changes suggestive of atypias were more abundant in ASC-US. Although ASC-H is associated with worse histological outcomes, no differences in HPV positivity were found in comparison to ASC-US.
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Affiliation(s)
| | | | | | | | | | - José Eleutério
- Department of Pathology, Federal University of Ceará, Fortaleza, Brazil
- Department of Motherhood and Child, Federal University of Ceará, Fortaleza, Brazil
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Watson M, Benard V, Flagg EW. Assessment of trends in cervical cancer screening rates using healthcare claims data: United States, 2003-2014. Prev Med Rep 2018; 9:124-130. [PMID: 29527465 PMCID: PMC5840841 DOI: 10.1016/j.pmedr.2018.01.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/27/2017] [Accepted: 01/20/2018] [Indexed: 01/18/2023] Open
Abstract
Improved understanding of the natural history of cervical cancer has led to changes in screening recommendations, including the addition of the human papillomavirus (HPV) testing as an option in routine screening. Most studies of screening trends have used national self-reported survey data. To better understand recent trends in cervical cancer screening, including cytology (Papanicolaou, or Pap, tests) and human papillomavirus co-tests (HPV + Pap test), we used healthcare claims data to examine screening practices and trends. We analyzed screening among commercially-insured females ages 18-65 during 2005-2014 who were continuously enrolled during three or more contiguous calendar years, to identify those who received cervical cancer screening with a Pap test or co-test. We examined screening prevalence by age group and year. During the latter years of our study period, screening prevalence (regardless of screening method) declined significantly for women in all age groups examined. Despite declines in overall screening, the prevalence of co-testing increased in all age groups except those aged 18-20. In 2014, women aged 30-39 had the highest overall screening uptake (77.5%) and the highest use of co-testing (44.4%); this group also had the lowest overall declines in screening over the time period (-4.5%). These screening measures from healthcare claims were lower than self-reported screening from national surveys of the general population. More research to explore the reasons for these differences is needed to ensure that women are receiving appropriate screening, and to better understand why screening prevalence is declining among this population of commercially insured women.
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Affiliation(s)
- Meg Watson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Vicki Benard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elaine W. Flagg
- Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Senkomago V, Royalty J, Miller JW, Buenconsejo-Lum LE, Benard VB, Saraiya M. Cervical cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in four US-Affiliated Pacific Islands between 2007 and 2015. Cancer Epidemiol 2017; 50:260-267. [PMID: 29120834 PMCID: PMC5739878 DOI: 10.1016/j.canep.2017.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/21/2017] [Accepted: 04/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cervical cancer incidence in the US-Affiliated Pacific Islands (USAPIs) is double that of the US mainland. American Samoa, Commonwealth of Northern Mariana Islands (CNMI), Guam and the Republic of Palau receive funding from the Centers for Disease Control (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to implement cervical cancer screening to low-income, uninsured or under insured women. The USAPI grantees report data on screening and follow-up activities to the CDC. MATERIALS AND METHODS We examined cervical cancer screening and follow-up data from the NBCCEDP programs in the four USAPIs from 2007 to 2015. We summarized screening done by Papanicolaou (Pap) and oncogenic human papillomavirus (HPV) tests, follow-up and diagnostic tests provided, and histology results observed. RESULTS A total of 22,249 Pap tests were conducted in 14,206 women in the four USAPIs programs from 2007-2015. The overall percentages of abnormal Pap results (low-grade squamous intraepithelial lesions or worse) was 2.4% for first program screens and 1.8% for subsequent program screens. Histology results showed a high proportion of cervical intraepithelial neoplasia grade 2 or worse (57%) among women with precancers and cancers. Roughly one-third (32%) of Pap test results warranting follow-up had no data recorded on diagnostic tests or follow-up done. CONCLUSION This is the first report of cervical cancer screening and outcomes of women served in the USAPI through the NBCCEDP with similar results for abnormal Pap tests, but higher proportion of precancers and cancers, when compared to national NBCCEDP data. The USAPI face significant challenges in implementing cervical cancer screening, particularly in providing and recording data on diagnostic tests and follow-up. The screening programs in the USAPI should further examine specific barriers to follow-up of women with abnormal Pap results and possible solutions to address them.
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Affiliation(s)
- Virginia Senkomago
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Janet Royalty
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jacqueline W Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lee E Buenconsejo-Lum
- Department of Family Medicine and Community Health, Pacific Regional Cancer Programs, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | - Vicki B Benard
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Collins T, Stradtman LR, Vanderpool RC, Neace DR, Cooper KD. A Community-Academic Partnership to Increase Pap Testing in Appalachian Kentucky. Am J Prev Med 2015; 49:324-30. [PMID: 26190807 PMCID: PMC4753790 DOI: 10.1016/j.amepre.2015.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Appalachian Kentucky is recognized for elevated rates of cervical cancer, which exerts an undue burden in this medically underserved region. The purpose of this study was to examine the impact of an academic-community partnership, specifically a regional health department and a CDC Prevention Research Center, in conducting outreach aimed at improving Pap testing rates and examining barriers among under-screened women in Appalachian Kentucky. Differences between women with abnormal and negative results were also examined. METHODS The Prevention Research Center provided technical assistance to the district health department that, in turn, hosted "Women's Health Day" events at county health departments, providing incentives to women who had never had a Pap test or those who had not received one in at least 3 years to receive guideline-recommended screening. RESULTS From 2011 to 2014, 317 women were screened for cervical cancer; data were analyzed in 2014. The mean age was 42.1 (SD=13.6) years. More than half (54.5%) of the sample reported high school as their highest level of education, and 57.7% had an annual household income of <$25,000. The most commonly reported barriers to Pap testing were cost (28.4%) and lack of a perceived need for screening (25.6%). Approximately one in five (21.7%) women received abnormal Pap results. CONCLUSIONS As a result of this community-academic public health partnership and its shared resources, Appalachian Kentucky women received needed cervical cancer screening and appropriate follow-up for abnormal results, thereby increasing this population's compliance with guideline-recommended screening.
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Affiliation(s)
- Tom Collins
- Rural Cancer Prevention Center, University of Kentucky College of Public Health, Lexington, Kentucky
| | - Lindsay R Stradtman
- Rural Cancer Prevention Center, University of Kentucky College of Public Health, Lexington, Kentucky.
| | - Robin C Vanderpool
- Department of Health Behavior, University of Kentucky College of Public Health, Lexington, Kentucky
| | | | - Karen D Cooper
- Kentucky River District Health Department, Hazard, Kentucky
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Forward. The reach and health impacts of the national breast and cervical cancer early detection program. Cancer Causes Control 2015; 26:649-50. [PMID: 25794898 DOI: 10.1007/s10552-015-0561-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 01/30/2023]
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Preventing premature deaths from breast and cervical cancer among underserved women in the United States: insights gained from a national cancer screening program. Cancer Causes Control 2015; 26:805-9. [PMID: 25783456 DOI: 10.1007/s10552-015-0541-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 02/20/2015] [Indexed: 02/05/2023]
Abstract
This commentary highlights some of the valuable insights gained from a special collection of papers that utilized data from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and appear in this special issue. The data and experiences of the NBCCEDP can inform the identification of new opportunities and directions for meeting the cancer screening needs of underserved women in a complex and changing health care environment.
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