Background Human papillomavirus vaccination may result in lowered intention to be screened for cervical cancer, potentially leading to gaps in screening coverage and avoidable cervical cancer diagnoses. Objective To examine the association between human papillomavirus vaccination and subsequent cervical cancer screening initiation and adherence to recommended screening intervals to detect gaps in screening coverage and inform future prevention efforts. Study Design A retrospective cohort study was conducted in two distinct cohorts of female members of Kaiser Permanente Southern California, a large integrated healthcare delivery system. Pap screening initiation was evaluated in women who reached age 21 years between 2010 and 2013. Adherence to recommended screening intervals was evaluated in women between ages 25–30 years in 2010. All women were followed to the end of 2013 for the evaluation of their screening behaviors. History of human papillomavirus vaccination and Pap screening were obtained from electronic medical records. Adherence to recommended screening intervals was measured as ≥85% vs. <85% of the observed “screening up-to-date” person-time. Multivariable Cox and logistic regression models were used to examine associations between vaccination history and screening initiation and interval adherence. Demographic characteristics, gynecological health history, healthcare utilization, and characteristics of women’s primary care providers were included as potential confounders in analyses. Results There were 27,352 and 41,328 women included in the screening initiation and screening interval adherence analyses, respectively. In comparison to unvaccinated women, adjusted hazard ratios [95% confidence intervals (CIs)] for screening initiation among human papillomavirus vaccinated women were 1.19 (1.11–1.28), 1.44 (1.34–1.53) and 1.57 (1.50–1.65), for 1, 2 and 3+ doses, respectively. Adjusted odds ratios (and CIs) for screening interval adherence were 0.93 (0.83–1.04), 1.73 (1.52–1.97) and 2.29 (2.05–2.56), for 1, 2 and 3+ dose, respectively. Conclusion Human papillomavirus vaccinated women in this community-based, integrated healthcare setting were more likely to be screened for cervical cancer than were unvaccinated women. Our findings underscore the need for targeted interventions among unvaccinated women, who may be disproportionally affected by cervical cancer despite the presence of population-based screening programs.

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OBJECTIVES: We lack reliable methods for identifying patients with chronic pancreatitis (CP) at increased risk for pancreatic cancer. We aimed to identify radiographic parameters associated with pancreatic cancer in this population. METHODS: We conducted a retrospective cohort study of patients with suspected CP within an integrated healthcare system in Southern California in 2006–2015. Patients were identified by a diagnostic code and confirmed by imaging findings (parenchymal calcification, ductal stones, glandular atrophy, pseudocyst, main duct dilatation, duct irregularity, abnormal side branch, or stricture) defined by the natural language processing of radiographic reports. We used Cox regression to determine the relationship of smoking, alcohol use, acute pancreatitis, diabetes, body mass index, and imaging features with the risk of incident pancreatic cancer at least 1 year after abnormal pancreas imaging. RESULTS: We identified 1,766 patients with a diagnostic code and an imaging feature for CP with a median follow-up of 4.5 years. There were 46 incident pancreatic cancer cases. Factors that predicted incident pancreatic cancer after 1-year of follow-up included obesity (hazard ratio 2.7, 95% confidence interval: 1.2–6.1) and duct dilatation (hazard ratio 10.5, 95% confidence limit: 4.0–27). Five-year incidence of pancreatic cancer in this population with duct dilatation was 6.3%. DISCUSSION: High incidence of pancreatic cancer in suspected patients with CP with pancreatic duct dilatation warrants regular surveillance for pancreatic cancer.

Study aim To develop and apply a natural language processing algorithm for characterization of patients diagnosed with chronic pancreatitis in a diverse integrated U.S. healthcare system. Methods Retrospective cohort study including patients initially diagnosed with chronic pancreatitis (CP) within a regional integrated healthcare system between January 1, 2006 and December 31, 2015. Imaging reports from these patients were extracted from the electronic medical record system and split into training, validation and implementation datasets. A natural language processing (NLP) algorithm was first developed through the training dataset to identify specific features (atrophy, calcification, pseudocyst, cyst and main duct dilatation) from free-text radiology reports. The validation dataset was applied to validate the performance by comparing against the manual chart review. The developed algorithm was then applied to the implementation dataset. We classified patients with calcification(s) or �2 radiographic features as advanced CP. We compared etiology, comorbid conditions, treatment parameters as well as survival between advanced CP and others diagnosed during the study period. Results 6,346 patients were diagnosed with CP during the study period with 58,085 radiology studies performed. For individual features, NLP yielded sensitivity from 88.7% to 95.3%, specificity from 98.2% to 100.0%. A total of 3,672 patients met cohort inclusion criteria: 1,330 (36.2%) had evidence of advanced CP. Patients with advanced CP had increased frequency of smoking (57.8% vs. 43.0%), diabetes (47.6% vs. 35.9%) and underweight body mass index (6.6% vs. 3.6%), all p<0.001. Mortality from pancreatic cancer was higher in advanced CP (15.3/1,000 person-year vs. 2.8/1,000, p<0.001). Underweight BMI (HR 1.6,

Less than half of the women insured for preventative services initiated screening at age 21 years. Strategies to improve adherence to screening initiation guidelines should consider a tailored approach for at-risk subgroups and addressing initiation challenges associated with male physicians.