Variation in cervical cancer screening test utilization and results in a United States-based program

BACKGROUND

Little is known about cervical cancer screening strategy utilization (cytology alone, cytology plus high-risk human papillomavirus [HPV] testing [cotesting], primary HPV testing) and test results in the United States.

METHODS

Data from the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program were analyzed for 199,578 persons aged 21-65 years screened from 2019 to 2020. Screening test utilization and results were stratified by demographic characteristics and geographic region. Age-standardized pooled HPV test positivity and genotyping test positivity were estimated within cytology result categories.

RESULTS

Primary HPV testing was performed in 592 persons (0.3%). Among the remaining 176,290 persons aged 30-65 years, cotesting was utilized in 72.1% (95% confidence interval [CI] 71.9-72.3%), and cytology alone was utilized in 27.9% (95% CI 27.7-28.1%). Utilization of cytology alone varied by geographic region, ranging from 18.3% (95% CI 17.4-19.1%) to 49.0% (95% CI 48.4-49.6%). HPV genotyping test utilization among those with positive pooled HPV test results was 33.9%. In persons aged ≥30 years, variations in age-adjusted test results by region were observed for pooled HPV-positive test results and for HPV genotyping-positive test results.

CONCLUSIONS

Cervical cancer screening strategy utilization and test results vary substantially by geographic region within a national screening program. Variation in utilization may be due to regional differences in screening test availability or the preferences of healthcare systems, screened persons and/or clinicians. Test result variations may reflect differing risk factors for HPV infections by geographic region.

The association between YouTube use and knowledge of human papillomavirus-related cancers

Objective

To examine the association between YouTube usage and HPV-related cancer knowledge (cervical, anal, oral and penile).

Study design

Cross-sectional study using data from the Health Information National Trends survey conducted between 2017 and 2020 (N = 16,092). Logistic regression was used to analyze the independent effect of YouTube use on cancer knowledge, controlling for sociodemographic characteristics.

Results

Respondents' knowledge of HPV-related cancers varied: 49.9% about cervical, 18% anal, 20.1% oral and 20.4% penile cancers. YouTube use was associated with increased knowledge for all cancers (cervical: OR 2.66, 95% CI 2.04, 3.46; anal: OR 1.83, 95% CI 1.32, 2.53; oral: OR 1.89, 95% CI 1.37, 2.61; penile OR 2.00, 95% CI 1.44, 2.77) in models adjusted for all covariates. Other independent predictors of HPV-related cancer knowledge included female gender, younger age, a higher income, and higher education.

Conclusions

YouTube could play an important role in educating people about HPV-related cancers and should also target other populations, such as males and those with less formal education.

Innovation

The study provides novel insights into the potential of YouTube as an educational tool for promoting cancer knowledge with the goal of cancer prevention.

Avoiding Low-Value Care and Patient Financial Harm in Cervical Cancer Screening

The provision of low-value care remains a significant concern in healthcare. The negative impacts resulting from low-value cervical cancer screenings are extensive at the population level and can lead to harms and substantial out-of-pocket expenses for patients. Inattention to the financial implications of screening poses a serious threat to low-income populations that depend on affordable screening services, and it may exacerbate existing healthcare disparities and inequities. Identifying and implementing strategies that promote high-value care and reduce patient out-of-pocket expenses are important to ensure that all people, regardless of their socioeconomic status, have access to effective and affordable preventive care. See related article by Rockwell et al., p. 385.

Towards an absolute bilirubin threshold for preoperative biliary decompression in patients undergoing whipple

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Background: There is no consensus as to when preoperative biliary decompression is indicated in patients with obstructive jaundice prior to pancreatoduodenectomy. The purpose of this study is to identify a bilirubin level whereby biliary decompression provides clear benefit despite potential drawbacks. Methods: Serial logistic regression analyses were undertaken to identify the bilirubin threshold upon which biliary decompression was associated with significant improvement in overall complications, mayor complications (Clavien-Dindo ≥ 3), length of stay, readmission rates and mortality. Results: Biliary decompression independently predicted a higher incidence of overall complications in patients presenting with bilirubin ≤ 10mg/dl, (p = 0.02). For patients with bilirubin > 10mg/dl - < 15mg/dl, there were no differences in complications, mortality, length of stay or readmissions. Biliary decompression in patients with bilirubin ≥ 15mg/dl independently predicted fewer overall (72% vs 100%), and mayor complications (11 % vs 50%), p < 0.05, and lower readmission rates (27.7% vs 62.5%), p = 0.02. Patients not undergoing biliary decompression underwent resection on average two weeks sooner than those having decompression (4.7 days vs 17.2 days), p = 0.01, with no significant change in bilirubin levels between presentation and surgery. Patients with bilirubin < 15mg/dl at presentation, who underwent biliary decompression, had a bilirubin decrease of more than 50% ( 6.3mg/dl to 2.5mg/dl), and the time to resection increased by more than one week (28 days vs 20.4 days), p < 0.001. Conclusions: All patients presenting with bilirubin ≥ 15mg/dl should undergo preoperative biliary decompression to minimize the risk of complications and readmissions. Patients presenting with bilirubin ≤ 10 mg/dl should forego stent placement to avoid stent related complications without clear benefit. The decision to stent between > 10mg/dl to < 15 mg/dl should be made on a case by case basis, taking into account anticipated bilirubin level at the time of surgery.