Cervical cancer screening among women ≥70years of age in the United States—A referral problem or patient choice

Abstract

Objective Clinical guidelines recommend that women with a history of adequate screening and not otherwise at high risk may discontinue cervical cancer screening after 65 years of age. However, screening remains common among US women over 65 years old. This study was conducted to examine whether overutilization was attributable to provider’s recommendation or patient choice. Method This cross-sectional study used data from 1752 female participants (70+ years) from the 2013 National Health Interview Survey (NHIS). We quantitatively assessed the proportions of provider-recommended and patient self-initiated Pap smears. Results Among female respondents, 40.8% had a Pap smear within the past 3 years, 19.4% had a Pap smear in the last year, and 39.7% reported receiving a recommendation for a Pap smear from their provider in the past year. Among women who received a recommendation to obtain a Pap smear, 39.8% did so within the past 12 months compared to 5.9% of women who did not receive a recommendation (adjusted odds ratio 10.5, 95% confidence interval 7.39–15.0). About 70% of women who visited an obstetrician/gynecologist and reported receiving a recommendation to have a Pap smear did so in the past year, while 32.3% of women who visited an obstetrician/ gynecologist but did not receive a recommendation obtained one. Conclusion Pap smears were common among women ≥70 years of age. Health care providers may need additional education on current guidelines regarding indications for Pap smears in this age group to help reduce screening of patients who may not benefit.

Characteristics Associated with Low-Value Cancer Screening Among Office-Based Physician Visits by Older Adults in the USA

“…28 Physician specialty was associated with low-value cancer screening, although findings varied by screening type. As observed previously, 15,29 higher odds of cervical and breast cancer low-value screening were found for visits to an obstetrician/gynecologist relative to family/general practice physicians. When considering breast cancer screening for patients aged ≥75 years, the American College of Obstetrics and Gynecology recommends a shared decision-making approach that takes into account the patient's health status and life expectancy.…”

Cervical cancer (over)screening in Belgium and Switzerland: trends and social inequalities

“…Firstly, a strength of the research lies in having operationalized CCS overuse in a 2-fold manner. Apart from screening outside of the recommended age-range, which had already been established in the literature as an indicator of overuse, 14,17 this study has also addressed CCS overuse in terms of screening frequency at the population level, and combined both approaches. This 2-fold operationalization of overuse is an innovative approach in survey-based research, as it has only been previously included in research where data on individual health records were available.…”

“…4 In the first form of CCS overuse, women within screening-eligible age undergo CCS too frequently. [8][9][10][11][12][13] In the second form, past research had identified both women below the recommended age 14,15 and women above the recommended age [16][17][18] for screening. CCS overuse entails several detrimental aspects, such as low cost-effectiveness at population level, 4,19 heterogeneous quality, 20 psychological distress 21 and false positives due to over-diagnosis.…”

Human Papillomavirus Vaccination and Pap Smear Uptake Among Young Women in the United States: Role of Provider and Patient

“…We also included whether participants had visited an obstetrician/gynecologist (OB/GYN), a nurse practitioner/physician assistant/midwife, or other healthcare provider (e.g., general doctor, therapist, and medical specialist) in the past 12 months, as visiting an OB/ GYN was associated with Pap smear use. [20][21][22] We compared prevalence of Pap testing in the past 3 years or in the past year between vaccinated women and unvaccinated women from NHIS 2013 to 2015 and assessed the role of providers and patients in the initiation of Pap testing. We used Pap smear utilization in the past year as an outcome of interest, because this study aimed to examine the effect of providers' recommendations for Pap smears in the past year on uptake of Pap smear by vaccination status.…”

“…These include women who are recommended not to receive Pap testing, such as those over 65 years with adequate prior screening and no history of precancerous cervical lesions and those who have had a total hysterectomy for noncancerous conditions. 21,22 On the other hand, about 20%-25% of screening services are requested by the patients themselves among women. 21,22 In this study, we assessed differences in provider's recommendation for Pap testing and patient-initiated Pap testing between vaccinated and unvaccinated women, using data from the National Health Interview Survey (NHIS) 2013-2015.…”