Cervical Cancer Burden and Opportunities for Prevention in a Safety-Net Healthcare System

Abstract

Among engaged patients, strategies to increase screening and follow-up of abnormal screening tests could prevent over 80% of cervical cancer cases.

A population study of screening history and diagnostic outcomes of women with invasive cervical cancer

“…Findings from this population-based study are comparable to those from similar studies conducted in managed care health plan setting, a safety net system and state-wide evaluation that found proportions of women without screening of about 50%, 60%, and 64%, respectively. 6,7,11 Like similar studies, this study found that screened women had higher incomes and were more likely to be insured than unscreened women. Significant disparities in cervical cancer screening exist for women who live in poverty, have limited access to care, or are racial/ethnic minorities.…”

“…10 In this study, the dates in the medical records were used to classify women as "screened for cervical cancer" if they had a Pap test (with or without an HPV test) 6 months to 5 years before the date of diagnosis. This 6-month cutoff is a timeframe used by similar studies, 5,11 and assumes that Pap tests within 6 months would most likely represent follow-up testing to confirm abnormal results rather than screening. 10 Women were classified as unscreened if she had no screening in the 5-year timeframe or if she had a Pap test less than 6 months from her diagnosis.…”

“…20 The distributions of cervical cancer histologies by screening status and screening test in this study were like findings from previous studies. [5][6][7]11 It has been suggested that the proportion of new squamous cell carcinoma cases is likely to be lower in screened populations because precursors of squamous cell carcinoma are detected more easily by Pap test, the main method of screening. 21 We found that 70% of women in our study had squamous cell carcinoma; this proportion was higher for unscreened women (78%) than for screened women (57%).…”

“…Other studies investigating cervical cancer screening, follow-up, and diagnosis also found screening detection failures. [7][8][9][10] Not many studies have addressed adherence to follow-up of women with abnormal screening tests outside of insured populations 11 ; the CICC Study found that over onethird of women with abnormal test results did not receive adequate follow-up. Women whose test results required a repeat test (lowest urgency) or biopsy with more aggressive procedures in 1-3 months (highest urgency) were most likely to get adequate follow-up compared to women who needed biopsy in 3 months (moderate urgency).…”

“…We chose a 6-month cutoff for screening, assuming any such testing performed within 6 months of diagnosis could have been for diagnostic purposes, an assumption used in other studies. 5,7,11 In determining the definition for screening at 6 months, we examined other thresholds for defining screening (4 months and 8 months), but these changed the rate of screening only minimally (44% and 38%, respectively, vs. 40% at 6 months) and did not affect other findings. In addition, because this was a study of cervical cancer survivors, not including women who were deceased could bias our results to underreport the unscreened estimate.…”