Cervical cytology screening among low-income, minority adolescents in New York City following the 2009 ACOG guidelines

Reducing overuse of cervical cancer screening: A systematic review

Overuse of clinical preventive services increases healthcare costs and may deprive underserved patients of necessary care. Up to 45% of cervical cancer screening is overuse. We conducted a systematic review of correlates of overuse of cervical cancer screening and interventions to reduce overuse. The search identified 25 studies (20 observational; 5 intervention). Correlates varied by the type of overuse measured (i.e., too frequent, before/after recommended age to start or stop screening, after hysterectomy), the most common correlates of overuse related to patient age (n = 7), OBGYN practice or provider (n = 5), location (n = 4), and marital status (n = 4). Six observational studies reported a decrease in overuse over time. Screening overuse decreased in all intervention studies, which used before-after designs with no control or comparison groups. Observational studies suggest potential targets for de-escalating overuse. Randomized clinical trials are needed to establish best practices for reducing overuse.

Cervical Cancer Screening and Follow-Up Procedures in Women Age <21 Years Following New Screening Guidelines

PURPOSE

The 2009 American College of Obstetricians and Gynecologists guidelines recommended no cervical cancer screening before age 21 years. We examined changes in screening, diagnostic, and treatment procedures for cervical dysplasia after guideline introduction, and cost implications.

METHODS

We studied Davidson County women aged 18-20 years, enrolled in Tennessee Medicaid, 2006-2014. We identified those with at least one Papanicolaou (Pap) test, human papillomavirus detection test, colposcopy, or excisional dysplasia treatment annually via Current Procedural Terminology coding. We used rate ratios with 95% confidence intervals to compare annual changes in procedure and treatment rates from 2014 to 2006. We counted total outcomes to estimate annual costs based on 2014 average procedural costs.

RESULTS

From 2006 to 2014, about 3,800 Davidson County women aged 18-20 years were enrolled in Medicaid annually. From 2006 to 2014, there were declines in Pap tests from 55.6 to 15.2 per 100 women (rate ratio .27, 95% confidence interval .25-.3); human papillomavirus tests from 13.8 to 5.9 per 100 (.42, .36-.5); colposcopy from 9.4 to 1.1 per 100 (.12, .08-.17); and dysplasia treatment from 1.1 to 0 per 100. The estimated cost of screening and procedures fell from $53 to $8 per enrolled woman, not accounting for changes in visits or complications associated with these procedures.

CONCLUSIONS

The 2009 screening guidelines were associated with major declines in screening, diagnostic, and treatment procedures for cervical dysplasia. Minimum estimated procedure and treatment costs saved were $45 per enrolled woman age 18-20 years.