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McCarthy AM, Tiro JA, Hu E, Ehsan S, Chubak J, Kamineni A, Feldman S, Atlas SJ, Silver MI, Kobrin S, Haas JS. Factors associated with shorter-interval cervical cancer screening for young women in three United States healthcare systems. Prev Med Rep 2023; 35:102279. [PMID: 37361923 PMCID: PMC10285268 DOI: 10.1016/j.pmedr.2023.102279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Frequently changing cervical cancer screening guidelines over the past two decades have been inconsistently adopted in the United States. Current guidelines set the recommended screening interval to three years for average-risk women aged 21-29 years. Few studies have evaluated how patient and provider factors are associated with implementation of cervical cancer screening intervals among younger women. This study evaluated multilevel factors associated with screening interval length among 69,939 women aged 21-29 years with an initial negative Pap screen between 2010 and 2015 across three large health systems in the U.S. Shorter-interval screening was defined as a second screening Pap within 2.5 years of an initial negative Pap. Mixed-effects logistic regression was performed for each site to identify provider and patient characteristics associated with shorter-interval screening. The odds of shorter-interval screening decreased over the study period across all sites, though the proportion of patients screened within 2.5 years remained between 7.5% and 20.7% across sites in 2014-2015. Patient factors including insurance, race/ethnicity, and pregnancy were associated with shorter-interval screening, though the patterns differed across sites. At one site, the variation in shorter-interval screening explained by the provider was 10.6%, whereas at the other two sites, the provider accounted for < 2% of the variation in shorter-interval screening. Our results highlight the heterogeneity in factors driving cervical cancer screening interval across health systems and point to the need for tailored approaches targeted to both providers and patients to improve guideline-concordant screening.
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Affiliation(s)
- Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jasmin A. Tiro
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ellen Hu
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah Ehsan
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven J. Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle I. Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Sarah Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, USA
| | - Jennifer S. Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Sokale IO, Montealegre JR, Oluyomi AO, Thrift AP. Trends and Racial/Ethnic Differences in Predictors of Cervical Cancer Screening among US Women Ages 30-64 Years. Cancer Epidemiol Biomarkers Prev 2023; 32:82-90. [PMID: 36306382 PMCID: PMC9839647 DOI: 10.1158/1055-9965.epi-22-0970] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cervical cancer screening (CCS) participation has decreased in the United States over the last several decades, contributing to cervical cancer's sustained incidence and mortality. This study examined recent trends and racial/ethnic differences in predictors of CCS uptake among US women. METHODS We analyzed combined data from the 2016 to 2020 Behavioral Risk Factor Surveillance System (BRFSS) and included 235,713 women ages 30 to 64 years without a hysterectomy. We used simple linear regression to assess trends over time and multivariable logistic regression models to evaluate racial/ethnic differences in predictors of up-to-date CCS. RESULTS We found little change in CCS over the 5-year interval and screening rates disparities among racial minority women. The overall population showed stable CCS completion rates from 2016 to 2018 (84.2% vs. 84.6%), and then a small dip from 2018 to 2020 (from 84.6% to 83.3%). Despite a slight decline in 2020, HPV-based testing increased significantly among all subgroups and overall, from 2016 to 2020 (from 43.4% to 52.7%). Multivariable regression models showed racial/ethnic differences in predictors of CCS. Across all racial/ethnic subgroups, older women were less likely to receive timely screening. Women who had routine check-ups had higher odds of being up to date. However, the link between CCS and socioeconomic status varied. CONCLUSIONS Age and racial/ethnic disparities persist in CCS, and predictors of screening vary. Notwithstanding, routine health examinations was positively associated with screening regardless of race/ethnicity. IMPACT Our analyses suggest that leveraging primary care to optimize CCS uptake may reduce gaps in screening.
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Affiliation(s)
- Itunu O. Sokale
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
- Corresponding Author. Itunu O. Sokale, MBBS, MPH, DrPH, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM 307, Room 613D, Houston, TX 77030-3498, Phone: 713-798-2972,
| | - Jane R. Montealegre
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Abiodun O. Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Aaron P. Thrift
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
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Qin J, Holt HK, Richards TB, Saraiya M, Sawaya GF. Use Trends and Recent Expenditures for Cervical Cancer Screening-Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years. JAMA Intern Med 2023; 183:11-20. [PMID: 36409511 PMCID: PMC9679959 DOI: 10.1001/jamainternmed.2022.5261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022]
Abstract
Importance Since 1996, the US Preventive Services Task Force has recommended against cervical cancer screening in average-risk women 65 years or older with adequate prior screening. Little is known about the use of cervical cancer screening-associated services in this age group. Objective To examine annual use trends in cervical cancer screening-associated services, specifically cytology and human papillomavirus (HPV) tests, colposcopy, and cervical procedures (loop electrosurgical excision procedure, cone biopsy, and ablation) in Medicare fee-for-service beneficiaries during January 1, 1999, to December 31, 2019, and estimate expenditures for services performed in 2019. Design, Setting, and Participants This population-based, cross-sectional analysis included health service use data across 21 years for women aged 65 to 114 years with Medicare fee-for-service coverage (15-16 million women per year). Data analysis was conducted between July 2021 and April 2022. Main Outcomes and Measures Proportion of testing modalities (cytology alone, cytology plus HPV testing [cotesting], HPV testing alone); annual use rate per 100 000 women of cytology and HPV testing, colposcopy, and cervical procedures from 1999 to 2019; Medicare expenditure for these services in 2019. Results There were 15 323 635 women 65 years and older with Medicare fee-for-service coverage in 1999 and 15 298 656 in 2019. In 2019, the mean (SD) age of study population was 76.2 (8.1) years, 5.1% were Hispanic, 0.5% were non-Hispanic American Indian/Alaska Native, 3.0% were non-Hispanic Asian/Pacific Islander, 7.4% were non-Hispanic Black, and 82.0% were non-Hispanic White. From 1999 to 2019, the percentage of women who received at least 1 cytology or HPV test decreased from 18.9% (2.9 million women) in 1999 to 8.5% (1.3 million women) in 2019, a reduction of 55.3%; use rates of colposcopy and cervical procedures decreased 43.2% and 64.4%, respectively. Trend analyses showed a 4.6% average annual reduction in use of cytology or HPV testing during 1999 to 2019 (P < .001). Use rates of colposcopy and cervical procedures decreased before 2015 then plateaued during 2015 to 2019. The total Medicare expenditure for all services rendered in 2019 was about $83.5 million. About 3% of women older than 80 years received at least 1 service at a cost of $7.4 million in 2019. Conclusions and Relevance The results of this cross-sectional study suggest that while annual use of cervical cancer screening-associated services in the Medicare fee-for-service population older than 65 years has decreased during the last 2 decades, more than 1.3 million women received these services in 2019 at substantial costs.
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Affiliation(s)
- Jin Qin
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hunter K. Holt
- Department of Family and Community Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Thomas B. Richards
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mona Saraiya
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - George F. Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
- UCSF Center for Healthcare Value, San Francisco, California
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Wang Q, He Y, Long F, Li C, Shen Z, Guo D, Zhaxi D, Bumu L, Hua Z, Sun Z, Jiang N, Han X, Li J, Yan K, Bai S, Tao M, Xu X, Xiao Z. Cervical cancer screening in high-altitude areas in China: A large cross-section study of 25,173 women in northern Tibet. Front Oncol 2022; 12:841547. [PMID: 36091127 PMCID: PMC9452642 DOI: 10.3389/fonc.2022.841547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Cervical cancer has become a worldwide concern owing to its high incidence and mortality rates. To date, high-altitude areas of Tibet have not benefited from any large-scale cervical cancer screening programs. Therefore, we initiated a screening program to investigate the prevalence of human papilloma virus (HPV) and HPV genotype distribution to reveal cervical cancer and its precursor which lead to morbidity among women in the city of Nagqu in northern Tib3et. Methods A total of 25,173 women were recruited to undergo HPV genotype tests between June and December 2019. Women infected with HPV 16 and/or 18 underwent colposcopy and histological examination. Women with other high-risk HPV type (hr-HPV) underwent cytological tests to determine whether to conduct further colposcopy and histological examination for diagnosis. HPV prevalence was calculated in the total population and further stratified according to various parameters, such as age group, area location (altitude level), and single or mixed infection status. The HPV genotype distribution was also investigated accordingly. Cervical lesions revealed by further colposcopic findings were also analyzed; high-grade and malignant lesion morbidities were calculated in total and in each county. Most data were collected and analyzed using descriptive and consistency check statistical methods, and a risk factor investigation for HPV infection was performed using logistic regression models. Results The total HPV infection rate among women in Nagqu was 13.42%. Of the 25,173 women in the study, 999 (3.97%) were HPV 16/18 positive, 2,379 (9.45%) were other hr-HPV-positive, and 21,795 (86.58%) were HPV-negative. The five most common HPV genotypes, accounting for more than 60% of all HPV infections in Nagqu people, were HPV 16, 58, 31, 18, and 52. Tibetan women younger than 20 years and older than 60 years were the two age groups with the highest rates of HPV infection, 26.7% and 19.8%, respectively. Among the HPV-positive women, 2,656 (78.33%) were infected with a single strain and 732 (21.67%) were infected with multiple strains (more than two genotypes). HPV prevalence increased in high-altitude areas (positive rate highest in Nyima with an altitude of 5,000 m, 23.9%) and decreased in relatively low-altitude areas (positive rate lowest in Lhari with an altitude of 4,000 m, 6.6%). Multiple analyses showed that age, parity, age at first delivery, and altitude of residence were independent factors facilitating HPV infection in Tibetan women. High-grade and malignant cervical lesions revealed by histological findings were different among living locations, with the highest rates in Xainza, Baingoin, and Nyainrong, these being 2.019%, 1.820%, and 1.116%, respectively, among women in these areas. Conclusion Our survey provides an overall perspective on HPV genotype infection and cervical lesions in women in northern Tibet. The data not only provide useful information for the treatment of cervical lesions but also has great value in terms of the primary and secondary prevention measures that can be taken for women living in these regions. Clinical Trial Registration www.chictr.org.cn, indentifier ChiCTR2000035061.
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Affiliation(s)
- Qimin Wang
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Pathology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yingying He
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Pathology, Dalian Maternal and Child Medical Group, Dalian, China
| | - Fang Long
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Obstetrics and Gynecology, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
| | - Chaoran Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Performance and Quality Management Department, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhuowei Shen
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dongxing Guo
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Obstetrics and Gynecology, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
| | - Duoji Zhaxi
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
| | - Lamu Bumu
- Department of Obstetrics and Gynecology, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
| | - Zhengyu Hua
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhigang Sun
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Jiang
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xu Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Keqing Yan
- Department of Pathology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Siqi Bai
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Muhan Tao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoguang Xu
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Neurosurgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Zhen Xiao, ; Xiaoguang Xu,
| | - Zhen Xiao
- Institute of High Altitude Medicine, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Obstetrics and Gynecology, People’s Hospital of Nagqu affiliated to Dalian Medical University, Nagqu, China
- *Correspondence: Zhen Xiao, ; Xiaoguang Xu,
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Seay J, Matsuno RK, Porter B, Tannenbaum K, Warner S, Wells N. Cervical cancer screening compliance among active duty service members in the US military. Prev Med Rep 2022; 26:101746. [PMID: 35256926 PMCID: PMC8897620 DOI: 10.1016/j.pmedr.2022.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/31/2022] [Accepted: 02/26/2022] [Indexed: 11/30/2022] Open
Abstract
Previous research suggests active duty service members (ADSM) experience higher rates of human papilloma virus infection and cervical dysplasia, which puts them at greater risk for cervical cancer. The current study examined crude rates and correlates of cervical cancer screening compliance in 2003–2015 among screening-eligible ADSM in the Millennium Cohort Study (MCS). Data were drawn from the MCS, Defense Manpower Data Center, and Military Health System Data Repository. Screening eligibility and compliance were calculated each year and initial analyses examined crude rates of compliance. Generalized estimating equations were calculated to determine whether sociodemographic, military, and mental/behavioral health covariates were associated with cervical cancer screening compliance. A majority of participants were 21–29 years old (79.4%), non-Hispanic White (60.6%), and enlisted (82.2%). Crude rates of cervical cancer screening compliance increased from 2003 (61.2%) to 2010 (83.1%), and then declined from 2010 to 2015 (59.8%). Older ADSM and those who had a history of deployment had lower odds of screening compliance. ADSM in the Air Force and those in healthcare occupations had higher odds of screening compliance. Study findings suggest that cervical cancer screening compliance is declining among ADSM. Interventions to improve screening should target groups with lower screening compliance.
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Wang J, Dong J, Zhou Y, Wang K, Pan M, Deng Z, Wang P, Du Y, Lu W. Performance of human papillomavirus (HPV) mRNA testing and HPV 16 and 18/45 genotyping combined with age stratification in the triaging of women with ASC-US cytology. Gynecol Oncol 2022; 164:607-614. [PMID: 34996586 DOI: 10.1016/j.ygyno.2021.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to assess the clinical performance of an HPV E6/E7 mRNA assay (Aptima HPV, AHPV) and AHPV 16 18/45 genotype assay (AHPV-GT) combined with age stratification for triaging women with atypical squamous cells of undetermined significance (ASC-US) cytology. METHODS In total, 3052 women >21 years old with ASC-US cytology underwent AHPV testing, and AHPV-positive samples were reflex-tested with the AHPV-GT test. All women were referred for colposcopy and then biopsy if indicated. The AHPV and AHPV-GT test performances and risk estimates by hrHPV status with age stratification were calculated. RESULTS Overall, 1599 women (52.4%) tested AHPV positive; of these women, 225 (7.4%), 101 (3.3%) and 1273 (41.7%) tested HPV 16+, HPV 18/45+ and other hrHPV-genotype-positive. When identifying CIN3+, the AHPV test had a 93.2% sensitivity and achieved a higher NPV (99.7% vs. 98.5%, P < 0.001) but a lower PPV (4.3% vs. 10.4%, P < 0.001) than the AHPV-GT test. The immediate risks of CIN3+ in AHPV+, other hrHPV+, and AHPV-GT+ women were 4.3%, 2.7%, and 10.4%, respectively. In the 21-24-year-old group, the immediate risks were 1.6%, 2.0% and 0.0%, which were below the 4.0% threshold for immediate colposcopy. The immediate colposcopy referral rate for AHPV-positive/ASC-US women 25 years or older was reduced from 51.7% to 10.5% by the AHPV-GT risk stratification method. CONCLUSIONS AHPV testing with age stratification is effective for triaging women with ASC-US cytology. AHPV-GT testing may be a proper risk stratification method for women with AHPV-positive ASC-US cytology.
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Affiliation(s)
- Jiajian Wang
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Jie Dong
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Yinjian Zhou
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Kaiyi Wang
- Department of Cervical Disease, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Min Pan
- Department of Cervical Disease, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Zaixing Deng
- Department of Pathology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Pengfei Wang
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Ying Du
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang Province, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China; Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
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Haas JS, Cheng D, Yu L, Atlas SJ, Clark C, Feldman S, Silver MI, Kamineni A, Chubak J, Pocobelli G, Tiro JA, Kobrin SC. Variation in the receipt of human papilloma virus co-testing for cervical screening: Individual, provider, facility and healthcare system characteristics. Prev Med 2022; 154:106871. [PMID: 34762966 PMCID: PMC8724456 DOI: 10.1016/j.ypmed.2021.106871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
Since 2012, cervical cancer screening guidelines allow for choice of screening test for women age 30-65 years (i.e., Pap every 3 years or Pap with human papillomavirus co-testing every 5 years). Intended to give patients and providers options, this flexibility reflects a trend in the growing complexity of screening guidelines. Our objective was to characterize variation in cervical screening at the individual, provider, clinic/facility, and healthcare system levels. The analysis included 296,924 individuals receiving screening from 3626 providers at 136 clinics/facilities in three healthcare systems, 2010 to 2017. Main outcome was receipt of co-testing vs. Pap alone. Co-testing was more common in one healthcare system before the 2012 guidelines (adjusted odds ratio (AOR) of co-testing at the other systems relative to this system 0.00 and 0.50) but was increasingly implemented over time in a second with declining uptake in the third (2017: AORs shifted to 7.32 and 0.01). Despite system-level differences, there was greater heterogeneity in receipt of co-testing associated with providers than clinics/facilities. In the three healthcare systems, providers in the highest quartile of co-testing use had an 8.35, 8.81, and 25.05-times greater odds of providing a co-test to women with the same characteristics relative to the lowest quartile. Similarly, clinics/ facilities in the highest quartile of co-testing use had a 4.20, 3.14, and 6.56-times greater odds of providing a co-test relative to the lowest quartile. Variation in screening test use is associated with health system, provider, and clinic/facility levels even after accounting for patient characteristics.
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Affiliation(s)
- Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - David Cheng
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Liyang Yu
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Cheryl Clark
- Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Michelle I Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, United States of America
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Gaia Pocobelli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Jasmin A Tiro
- Department of Population & Data Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Sarah C Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
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Silver MI, Anderson ML, Beaber EF, Haas JS, Kobrin S, Pocobelli G, Skinner CS, Tiro JA, Kamineni A. De-implementation of cervical cancer screening before age 21. Prev Med 2021; 153:106815. [PMID: 34599920 PMCID: PMC8802556 DOI: 10.1016/j.ypmed.2021.106815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 11/28/2022]
Abstract
In 2012, United States consensus guidelines were modified to recommend that cervical cancer screening not begin before age 21 and, since 2014, the Health Effectiveness Data and Information Set (HEDIS), a health plan quality measurement too, has included a measure for non-recommended cervical cancer screening among females ages 16-20. Our goal was to describe prevalence over time of cervical cancer screening before age 21 following the 2012 guideline change, and provide information to help understand how rapidly new guidelines may be disseminated and implemented into clinical practice. We used longitudinal clinical and administrative data from three diverse healthcare systems in the Population-based Research to Optimize the Screening Process (PROSPR II) consortium to examine annual trends in screening before age 21. We identified 55,316 average-risk, screening-eligible females ages 18-20 between 2011 and 2017. For each calendar year, we estimated the proportion of females who received a Papanicolaou (Pap) test. We observed a steady decline in the proportion of females under age 21 who received a Pap test, from an average of 8.3% in 2011 to <1% in 2017 across the sites. The observed steady decline suggests growing adherence to the 2012 consensus guidelines. This trend was consistent across diverse geographic regions, healthcare systems, and patient populations, strengthening the generalizability of the results; however, since we only had 1-2 years of study data prior to the consensus guidelines, we cannot discern whether screening under age 21 was already in decline. Nonetheless, these results provide data to compare with other guideline changes to de-implement non-recommended screening practices.
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Affiliation(s)
- Michelle I Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States of America.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Elisabeth F Beaber
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sarah Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
| | - Gaia Pocobelli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Simmons Comprehensive Cancer Center, Dallas, TX, United States of America
| | - Jasmin A Tiro
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Simmons Comprehensive Cancer Center, Dallas, TX, United States of America
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
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9
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Qin J, Shahangian S, Saraiya M, Holt H, Gagnon M, Sawaya GF. Trends in the use of cervical cancer screening tests in a large medical claims database, United States, 2013-2019. Gynecol Oncol 2021; 163:378-384. [PMID: 34507826 DOI: 10.1016/j.ygyno.2021.08.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine trends in the use of cervical cancer screening tests during 2013-2019 among commercially insured women. METHODS The study population included women of all ages with continuous enrollment each year in the IBM MarketScan commercial or Medicare supplemental databases and without known history of cervical cancer or precancer (range = 6.9-9.8 million women per year). Annual cervical cancer screening test use was examined by three modalities: cytology alone, cytology plus HPV testing (cotesting), and HPV testing alone. Trends were assessed using 2-sided Poisson regression. RESULTS Use of cytology alone decreased from 34.2% in 2013 to 26.4% in 2019 among women aged 21-29 years (P < .0001). Among women aged 30-64 years, use of cytology alone decreased from 18.9% in 2013 to 8.6% in 2019 (P < .0001), whereas cotesting use increased from 14.9% in 2013 to 19.3% in 2019 (P < .0001). Annual test use for HPV testing alone was below 0.5% in all age groups throughout the study period. Annually, 8.7%-13.6% of women aged 18-20 years received cervical cancer screening. There were persistent differences in screening test use by metropolitan residence and census regions despite similar temporal trends. CONCLUSIONS Temporal changes in the use of cervical cancer screening tests among commercially insured women track changes in clinical guidelines. Screening test use among individuals younger than 21 years shows that many young women are inappropriately screened for cervical cancer.
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Affiliation(s)
- Jin Qin
- Division of Cancer Prevention and Control, CDC, USA.
| | | | - Mona Saraiya
- Division of Cancer Prevention and Control, CDC, USA
| | - Hunter Holt
- Department of Family and Community Medicine, University of California, San Francisco, USA
| | | | - George F Sawaya
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA
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10
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Cuzick J, Du R, Adcock R, Kinney W, Joste N, McDonald RM, English K, Torres SM, Saslow D, Wheeler CM. Uptake of co-testing with HPV and cytology for cervical screening: A population-based evaluation in the United States. Gynecol Oncol 2021; 162:555-559. [PMID: 34253387 DOI: 10.1016/j.ygyno.2021.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Human papillomavirus (HPV) testing for cervical screening has been shown to increase the yield of precancerous disease and reduce the incidence of cervical cancer more than cytology alone. Here we document the state-wide uptake of co-testing with HPV and cytology in women aged 30-64 years as recommended by national and international bodies. METHODS Registry-based study of all screening cytology and HPV tests in New Mexico from 2008 to 2019 among women aged 21-64 years, with a focus on cytology negative tests to distinguish co-testing from reflex HPV testing to triage equivocal or mildly abnormal cytology. RESULTS A total of 1,704,055 cervical screening tests from 681,440 women aged 21-64 years in the state of New Mexico were identified. The proportion of screening tests which were co-tests rose from 5.6% in 2008 to 84.3% in 2019 among women aged 30-64 years with a marked change from the near exclusive use of the Hybrid Capture II HPV test, (a signal amplified test method) to the use of target amplified HPV tests. The largest increases were seen between 2013 and 2015, reflecting the introduction and adoption of new clinical guidelines. Increases in co-testing were also seen in younger women. CONCLUSIONS Co-testing is now well established in women aged 30-64 years, but smaller increases have also been seen at younger ages, although this is not currently recommended. The impact of co-testing on cervical disease outcomes and number of colposcopies and biopsies in routine population settings remain important, especially in young women.
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Affiliation(s)
- Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Ruofei Du
- University of New Mexico (UNM) Comprehensive Cancer Center, Department of Internal Medicine, Division of Molecular Medicine, Albuquerque, NM, USA
| | - Rachael Adcock
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Nancy Joste
- UNM Health Sciences Center (HSC), Department of Pathology, Albuquerque, NM, USA
| | - Ruth M McDonald
- UNM Health Sciences Center (HSC), Department of Pathology, Albuquerque, NM, USA; UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | | | | | - Cosette M Wheeler
- UNM Health Sciences Center (HSC), Department of Pathology, Albuquerque, NM, USA; UNM Comprehensive Cancer Center, Center for HPV Prevention, Albuquerque, NM, USA.
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Khan S, Chambers D, Neta G. Revisiting time to translation: implementation of evidence-based practices (EBPs) in cancer control. Cancer Causes Control 2021; 32:221-230. [PMID: 33392908 DOI: 10.1007/s10552-020-01376-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Previous studies estimate translation of research evidence into practice takes 17 years. However, this estimate is not specific to cancer control evidence-based practices (EBPs), nor do these studies evaluate variation in the translational process. We examined the translational pathway of cancer control EBPs. METHODS We selected five cancer control EBPs where data on uptake were readily available. Years from landmark publication to clinical guideline issuance to implementation, defined as 50% uptake, were measured. The translational pathway for each EBP was mapped and an average total time across EBPs was calculated. RESULTS Five cancer control EBPs were included: mammography, clinicians' advice to quit smoking, colorectal cancer screening, HPV co-testing, and HPV vaccination. Time from publication to implementation ranged from 13 to 21 years, averaging 15 years. Time from publication to guideline issuance ranged from 3 to 17 years, and from guideline issuance to implementation, - 4 to 12 years. Clinician's advice to quit smoking, HPV co-testing, and HPV vaccination were most rapidly implemented; colorectal cancer screening and mammography were slowest to implement. CONCLUSION The average time to implementation was 15 years for the five EBPs we evaluated, a marginal improvement from prior findings. Although newer EBPs such as HPV vaccination and HPV co-testing were faster to implement than other EBPs, continued efforts in implementation science to speed research to practice are needed.
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Affiliation(s)
- Shahnaz Khan
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, 20006, USA. .,Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA.
| | - David Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA
| | - Gila Neta
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA
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12
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Min CJ, Massad LS, Dick R, Powell MA, Kuroki LM. Assessing Physician Adherence to Guidelines for Cervical Cancer Screening and Management of Abnormal Screening Results. J Low Genit Tract Dis 2020; 24:337-342. [PMID: 32976292 PMCID: PMC7673488 DOI: 10.1097/lgt.0000000000000558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to survey obstetrician-gynecologists' cervical cancer screening practices and management of cervical abnormalities to ascertain adherence to guidelines. METHODS From January to July 2019, obstetrician-gynecologists at 5 St. Louis area hospitals were surveyed online about cervical cancer screening and management practices through 13 clinical vignettes. Survey scores and the American Society of Colposcopy and Cervical Pathology (ASCCP) app use were compared using Mann-Whitney tests. RESULTS When screening 30- to 65-year-old participants, 114 (98%) of the 116 total participants used co-testing, but only 71 (61%) screened at 5-year intervals. None used primary human papillomavirus (HPV) testing. For 21- to 29-year-old participants, 17 (15%) screened with annual cytology, whereas 14 (12%) used annual or every 3-year co-testing. Forty eight (41%) screened younger than 21 years, regardless of risk factors or only if immunocompromised. Eleven (9%) continued screening after total hysterectomy for benign indications. Only 2 (2%) responded to all clinical vignettes in adherence to guidelines. More than 30% of participants would pursue unnecessary HPV testing and/or loop electrosurgical excision procedure for persistent low-grade cytology. Fifty eight (48%) incorrectly reported hysterectomy as management for adenocarcinoma in situ on biopsy. Participants would undertreat young women with high-grade abnormalities including high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 3 (48, 41%) and high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 1 (65, 56%). Forty one (35%) reported exiting women from screening prematurely. The median score for participants using the ASCCP app was significantly greater than those who did not (79% vs 71%, p = .002). CONCLUSIONS Midwestern obstetrician-gynecologists' adherence to the guidelines for cervical cancer screening and management of abnormal results is suboptimal. Although co-testing for women aged 30-65 years has been broadly adopted, primary HPV testing has not. Physicians overscreen, overtreat low-grade lesions, and undertreat high-grade lesions in young women.
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Affiliation(s)
- Caroline J Min
- Department of Obstetrics and Gynecology, Washington University School of Medicine. St. Louis, MO
| | - L Stewart Massad
- Division of Gynecologic Oncology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, MO
| | - Rebecca Dick
- Department of Obstetrics and Gynecology, Washington University School of Medicine. St. Louis, MO
| | - Matthew A Powell
- Division of Gynecologic Oncology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, MO
| | - Lindsay M Kuroki
- Division of Gynecologic Oncology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, MO
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Malagón T, Mayrand MH, Ogilvie G, Gotlieb WH, Blake J, Bouchard C, Franco EL, Kulasingam S. Modeling the Balance of Benefits and Harms of Cervical Cancer Screening with Cytology and Human Papillomavirus Testing. Cancer Epidemiol Biomarkers Prev 2020; 29:1436-1446. [PMID: 32332032 DOI: 10.1158/1055-9965.epi-20-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Benefits of screening should outweigh its potential harms. We compared various metrics to assess the balance of benefits and harms of cervical cancer screening. METHODS We used a cervical cancer natural history Markov model calibrated to the Canadian context to simulate 100,000 unvaccinated women over a lifetime of screening with either cytology every 3 years or human papillomavirus (HPV) testing every 5 years. We estimated the balance of benefits and harms attributable to screening using various metrics, including colposcopies/life-year gained, and net lifetime quality-adjusted life-years (QALY) gained, a measure integrating women's health preferences. We present the average (minimum-maximum) model predictions. RESULTS Cytology-based screening led to 1,319,854 screening tests, 30,395 colposcopies, 13,504 life-years gained over a lifetime, 98 screening tests/life-year gained, 2.3 (1.6-3.3) colposcopies/life-year gained, and a net lifetime gain of 10,735 QALY (5,040-17,797). HPV-based screening with cytology triage in the same population would lead to 698,250 screening tests, 73,296 colposcopies, 15,066 life-years gained over a lifetime, 46 screening tests/life-year gained, 4.9 colposcopies/life-year gained (2.9-11.1), and a net lifetime gain of 11,690 QALY (4,409-18,742). HPV-based screening was predicted to prevent more cancers, but also incur more screening harms than cytology-based screening. CONCLUSIONS Metrics using colposcopies as the main harm outcome favored cytology-based screening, whereas metrics based on screening tests and health preferences tended to favor HPV-based screening strategies. IMPACT Whether HPV-based screening will improve the balance between benefits and harms of cervical cancer screening depends on how the balance between benefits and harms is assessed.
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Affiliation(s)
- Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada.
| | - Marie-Hélène Mayrand
- Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Université de Montréal et CRCHUM, Montreal, Quebec, Canada
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jennifer Blake
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
| | - Céline Bouchard
- Centre Hospitalier Universitaire de Québec, Québec City, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Han M, Li J, Austin M, Varma KR, Zhang H, Zhao C. Human Papillomavirus (HPV) 16 and 18/45 Genotyping-Directed Follow-up of Women With Messenger RNA HPV-Positive, Cytology-Negative Cervical Screening Test Results. Am J Clin Pathol 2020; 153:243-250. [PMID: 31603212 DOI: 10.1093/ajcp/aqz156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES In this study, we sought to correlate genotype test results for human papillomavirus (HPV) types 16, 18, and 45 with histopathologic follow-up diagnoses in patients with messenger RNA (mRNA) high-risk HPV-positive, cytology-negative results. METHODS We identified 1,157 patients with mRNA HPV-positive, cytology-negative cervical screening test results between June 2015 and June 2018. Reflex HPV 16/18/45 genotype results were documented in 1,018 women aged 30 years or older, 318 of whom had follow-up within 18 months. RESULTS Histopathologic findings of cervical intraepithelial neoplasia 2 or worse (CIN2+) were diagnosed in 14 of 122 (11.5%) patients positive for HPV 16/18/45 vs in seven of 196 (3.6%) HPV 16/18/45-negative patients. Three patients with high-risk HPV-positive, cytology-negative cervical screening test results were diagnosed with stage I cervical adenocarcinomas following early colposcopic referral and biopsy after HPV 16/18/45-positive genotype results. CONCLUSIONS Immediate reflex HPV 16/18/45 genotyping of mRNA HPV-positive, cytology-negative patients led to early colposcopic referral and histopathologic diagnoses of three difficult-to-detect, low-stage, cervical adenocarcinomas and significantly increased overall early detection of CIN2+ lesions.
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Affiliation(s)
- Min Han
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Marshall Austin
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kavita R Varma
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Huina Zhang
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
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15
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McClung NM, Gargano JW, Park IU, Whitney E, Abdullah N, Ehlers S, Bennett NM, Scahill M, Niccolai LM, Brackney M, Griffin MR, Pemmaraju M, Querec TD, Cleveland AA, Unger ER, Markowitz LE. Estimated Number of Cases of High-Grade Cervical Lesions Diagnosed Among Women - United States, 2008 and 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:337-343. [PMID: 30998672 PMCID: PMC6476057 DOI: 10.15585/mmwr.mm6815a1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Horn J, Denecke A, Luyten A, Rothe B, Reinecke-Lüthge A, Mikolajczyk R, Petry KU. Reduction of cervical cancer incidence within a primary HPV screening pilot project (WOLPHSCREEN) in Wolfsburg, Germany. Br J Cancer 2019; 120:1015-1022. [PMID: 30988395 PMCID: PMC6734660 DOI: 10.1038/s41416-019-0453-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Randomised controlled trials showed human papillomavirus (HPV)-based screening leads to a significant reduction in cervical cancer incidence compared with cytology-based screening only. Methods Non-hysterectomised participants ≥30 years underwent co-testing with Papanicolaou (Pap) smear and HR-HPV testing (Hybrid Capture 2; HC2). Women with normal findings had their next screening round after 5 years, and HC2+ and Pap abnormal cases were immediately referred for colposcopy, while cases with discordant findings had repeat testing after 12 months with referral to colposcopy in cases with persistent positive findings. Results Twenty-six thousand six hundred and twenty-four women were recruited between February 2006 and December 2016. Two hundred and seventy-four CIN3+ cases were diagnosed (270 HPV+, 4 HPV−), including 31 invasive cervical cancers (29 HPV+, 2 HPV−). No CIN3+ was detected in HPV− women with abnormal cytology. We observed a significant decline in the 5-year incidence of CIN3+ (from 0.96% [95% CI 0.85–1.09%] to 0.16% [95% CI 0.10–0.25%]; p < 0.0001) and cervical cancer (from 0.10% [95% CI 0.07%–0.15%] to 0.025% [95% CI 0.01–0.08%]; p = 0.01) between the first and subsequent rounds. Approximately 90% (246/274) of CIN3+ cases were diagnosed at first colposcopy. Conclusions The decline in disease rates with 5-yearly co-testing seems mainly attributable to HPV testing since no CIN3+ occurred in HPV−/Pap+ women.
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Affiliation(s)
- Johannes Horn
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Agnieszka Denecke
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | | | - Beate Rothe
- Central Laboratory, Klinikum Wolfsburg, Wolfsburg, Germany
| | | | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.,German Centre for Infection Research, Site Braunschweig-Hannover, Germany
| | - Karl Ulrich Petry
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany.
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17
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MacLaughlin KL, Jacobson RM, Radecki Breitkopf C, Wilson PM, Jacobson DJ, Fan C, St Sauver JL, Rutten LJF. Trends Over Time in Pap and Pap-HPV Cotesting for Cervical Cancer Screening. J Womens Health (Larchmt) 2019; 28:244-249. [PMID: 30614380 DOI: 10.1089/jwh.2018.7380] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 2012, updated cervical cancer screening recommendations were released with consensus on Papanicolaou (Pap) testing every 3 years for women age 21-65 years or Pap-human papillomavirus (HPV) cotesting at 5-year intervals for women age 30-65 years. Primary study aims: Assess current use of Pap-HPV cotesting and describe local population trends over time in Pap and Pap-HPV cotesting. Secondary aim: Assess sociodemographic factors correlating with screening. METHODS We assessed Rochester Epidemiology Project data for Pap and Pap-HPV cotesting among women age 16 years and older living in Olmsted County, Minnesota, yearly from 2005 (study population n = 47,203) through 2016 (study population n = 49,510). We calculated 3-year (Pap) and 5-year (Pap-HPV) moving prevalence rates of screening as proportion of eligible population. Multivariable logistic regression was used to assess factors potentially associated with screening. RESULTS In 2016, 64.6% of 27,418 eligible 30- to 65-year-old women were up to date with cervical cancer screening; 60.8% had received Pap-HPV cotest screening. Significant declines in Pap completion rates over time were observed in all age groups, including an unexpected decline in 21- to 29-year-old women. Coincident with decreasing Pap screening rates, Pap-HPV cotesting significantly increased among women age 30-65 years, from 10.0% in 2007 to 60.8% in 2016. CONCLUSIONS This suggests increasing adoption of 2012 screening recommendations in the 30- to 65-year-old population. However, decline in Pap screening among 21- to 29-year-old women is concerning. Disparities by race, ethnicity, smoking status, and comorbidity level were observed. Results suggest need for multilevel patient and clinician interventions to increase cervical cancer screening adherence.
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Affiliation(s)
| | - Robert M Jacobson
- 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,3 Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.,4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Patrick M Wilson
- 4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Debra J Jacobson
- 4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Chun Fan
- 4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L St Sauver
- 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Lila J Finney Rutten
- 2 Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,4 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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18
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Llanos AAM, Tsui J, Rotter D, Toler L, Stroup AM. Factors associated with high-risk human papillomavirus test utilization and infection: a population-based study of uninsured and underinsured women. BMC WOMENS HEALTH 2018; 18:162. [PMID: 30285820 PMCID: PMC6171187 DOI: 10.1186/s12905-018-0656-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/26/2018] [Indexed: 02/02/2023]
Abstract
Background Current cervical cancer screening guidelines recommend a Pap test every 3 years for women age 21–65 years, or for women 30–65 years who want to lengthen the screening interval, a combination of Pap test and high-risk human papilloma virus testing (co-testing) every 5 years. Little population-based data are available on human papilloma virus test utilization and human papilloma virus infection rates. The objective of this study was to examine the patient-level, cervical cancer screening, and area-level factors associated with human papilloma virus testing and infection among a diverse sample of uninsured and underinsured women enrolled in the New Jersey Cancer Early Education and Detection (NJCEED) Program. Methods We used data for a sample of 50,510 uninsured/underinsured women, age ≥ 29 years, who screened for cervical cancer through NJCEED between January 1, 2009 and December 31, 2015. Multivariable logistic regression models were used to estimate associations between ever having a human papilloma virus test or a positive test result, and individual- (age, race/ethnicity, birthplace) and area-level covariates (% below federal poverty level, % minority, % uninsured), and number of screening visits. Results Only 26.6% (13,440) of the sample had at least one human papilloma virus test. Among women who underwent testing, 13.3% (1792) tested positive for human papilloma virus. Most women who were positive for human papilloma virus (99.4%) had their first test as a co-test. Human papilloma virus test utilization and infection were significantly associated with age, race/ethnicity, birthplace (country), and residential area-level poverty. Rates of human papilloma virus testing and infection also differed significantly across counties in the state of New Jersey. Conclusions These findings suggest that despite access to no-cost cervical cancer screening for eligible women, human papilloma virus test utilization was relatively low among diverse, uninsured and underinsured women in New Jersey, and test utilization and infection were associated with individual-level and area-level factors.
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Affiliation(s)
- Adana A M Llanos
- Department of Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Room 211, Piscataway, NJ, 08854, USA. .,Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Jennifer Tsui
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - David Rotter
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Lindsey Toler
- Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Antoinette M Stroup
- Department of Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Room 211, Piscataway, NJ, 08854, USA.,Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ, USA
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