Assessment of trends in cervical cancer screening rates using healthcare claims data: United States, 2003–2014

Watson, Meg; Benard, Vicki B.; Flagg, Elaine W.

doi:10.1016/j.pmedr.2018.01.010

Cited by 57 publications

(73 citation statements)

References 17 publications

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“…Self-reported data from national surveys may overestimate the screening use compared to data based on health-care claims. [53][54][55] Metasummaries of studies comparing self-reported mammogram vs documented screening history showed sensitivity to be between 93% and 95% and specificity to be approximately 62%; the validity and reliability of self-reported responses also varied across sociodemographic subgroups. 56,57 In addition, question wording may impact the accuracy of self-reported mammography.…”

Section: Limitationsmentioning

confidence: 99%

Factors associated with mammography use: A side‐by‐side comparison of results from two national surveys

Besculides

et al. 2020

Cancer Medicine

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Background Mammography use is affected by multiple factors that may change as public health interventions are implemented. We examined two nationally representative, population‐based surveys to seek consensus and identify inconsistencies in factors associated with mammography use in the entirety of the US population, and by black and white subgroups. Methods Self‐reported mammography use in the past year was extracted for 12 639 and 169 116 women aged 40‐74 years from the 2016 National Health Interview Survey (NHIS) and the 2016 Behavioral Risk Factor Surveillance System (BRFSS), respectively. We applied a random forest algorithm to identify the risk factors of mammography use and used a subset of them in multivariable survey logistic regressions to examine their associations with mammography use, reporting predictive margins and effect sizes. Results The weighted prevalence of past year mammography use was comparable across surveys: 54.31% overall, 54.50% in white, and 61.57% in black in NHIS and 53.24% overall, 56.97% in white, and 62.11% in black in BRFSS. Overall, mammography use was positively associated with black race, older age, higher income, and having health insurance, while negatively associated with having three or more children at home and residing in the Western region of the US. Overweight and moderate obesity were significantly associated with increased mammography use among black women (NHIS), while severe obesity was significantly associated with decreased mammography use among white women (BRFSS). Conclusion We found higher mammography use among black women than white women, a change in the historical trend. We also identified high parity as a risk factor for mammography use, which suggests a potential subpopulation to target with interventions aimed at increasing mammography use.

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Section: Limitationsmentioning

confidence: 99%

Factors associated with mammography use: A side‐by‐side comparison of results from two national surveys

Besculides

et al. 2020

Cancer Medicine

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“…The proportion of minority residents per ZCTA was calculated as the difference of 1 minus the proportion of non-Hispanic White (NHW) residents. Age-adjusted cervical cancer incidence and mortality rates by New Jersey county were obtained from the National Cancer Institute (NCI) State Cancer Profiles [ 14 ], which summarizes data from the latest SEER submission (December 2016).…”

Section: Methodsmentioning

confidence: 99%

“…Little population-based data exist on the utilization of and barriers/facilitators to HPV DNA testing in the US, particularly for minority and medically underserved women with a higher risk of developing cervical cancer. The limited population-based studies on HPV co-test utilization have generally demonstrated low utilization across various population subgroups (approximately ≤20% testing rates) [ 9 – 12 ]; however, more recent data suggest increased HPV co-test utilization by mid-2013 through 2014 in some populations (≥44% to as high as 78%) [ 13 , 14 ]. Recent analysis of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) have suggested a variety of provider-level factors (e.g., provider characteristics, practices, beliefs, etc.)…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Although rates of cervical cancer incidence in New Jersey has been declining dramatically from 1990 (15.0 per 100,000) to 2014 (7.5 per 100,000) at approximately 2.7% per year (95% CI -2.9, -2.4) [ 14 ], substantial variation exists in cervical cancer incidence within the state by geographic and population subgroups. For example, Hispanic women in New Jersey and women of all race/ethnicities residing in at least four counties within the state have cervical cancer incidence rates that are significantly higher than the US average [ 14 ]. The objective of this study was to examine the patient-, clinical-, and area-level factors associated with HR-HPV DNA testing and HR-HPV infection among a diverse sample of uninsured and underinsured women enrolled in the New Jersey Cancer Early Education and Detection (NJCEED) Program, which is part of the NBCCEDP.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with high-risk human papillomavirus test utilization and infection: a population-based study of uninsured and underinsured women

et al. 2018

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BackgroundCurrent 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.MethodsWe 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.ResultsOnly 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.ConclusionsThese 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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Use Trends and Recent Expenditures for Cervical Cancer Screening–Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years

et al. 2023

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ImportanceSince 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.ObjectiveTo 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 ParticipantsThis 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 MeasuresProportion 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.ResultsThere 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 &lt; .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 RelevanceThe 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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Assessment of trends in cervical cancer screening rates using healthcare claims data: United States, 2003–2014

Cited by 57 publications

References 17 publications

Factors associated with mammography use: A side‐by‐side comparison of results from two national surveys

Factors associated with mammography use: A side‐by‐side comparison of results from two national surveys

Factors associated with high-risk human papillomavirus test utilization and infection: a population-based study of uninsured and underinsured women

Use Trends and Recent Expenditures for Cervical Cancer Screening–Associated Services in Medicare Fee-for-Service Beneficiaries Older Than 65 Years

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