Cervical cancer screening and follow‐up in 4 geographically diverse US health care systems, 1998 through 2007

Abstract

Background Cervical cancer screening and follow-up guidelines have changed considerably in recent years, but to the authors' knowledge few published reports exist to estimate the impact of these changes in community-based settings. The authors examined the patterns and results of cervical cancer testing and follow-up over a decade in 4 geographically diverse US health care systems to inform future evaluation of changes resulting from increased uptake of the human papillomavirus (HPV) vaccination. Methods The authors studied women aged 21 to 65 years who were members of one of these health systems at any time between1998 and 2007. Data were collected and standardized across sites, based on receipt of Papanicolaou (Pap) and HPV tests, HPV vaccination, cervical biopsies, and treatment of cervical dysplasia. Annual rates (per 1000 person-years) of Pap testing, HPV testing, and cervical biopsy and treatment procedures were calculated. Screening intervals and trends in the results of screening Pap tests and cervical biopsies also were examined. Results Pap testing rates decreased (from 483 per 1000 person-years in 2000 to 412 per 1000 person-years in 2007) and HPV testing rates increased over the study period. Screening frequency varied across health care systems, and many women continued to receive annual testing. All 4 sites moved to less frequent screening over the study period without marked changes in the overall use of cervical biopsy or treatment. Conclusions Despite differences over time and across health plans in rates of cervical cancer testing and follow-up cervical procedures, the authors found no notable differences in Pap test results, diagnostic or treatment procedure rates, or pathological outcomes. This finding suggests that the longer screening intervals did not lead to more procedures or more cancer diagnoses.

Harms of cervical cancer screening in the United States and the Netherlands

“…A possible cause of the increase in abnormal tests might be the increase in liquid based cytology in the NL from 65% in 2007 to nearly 100% by 2011(40). In the US, cytology was already 100% liquid-based in 2007 in SEARCH (16). The US National Health Interview Survey data show a small 1% relative decrease per year between 2008 and 2013 in the percent of women 25–64 having a Pap test within the past 3 years (39,40).…”

“…In 2007 and the following years, HPV testing still played a minor role. In the US, HPV co-testing increased in New Mexico from 5% in 2007 to 19% in 2013 (55), and in SEARCH from no HPV testing in 2002 to about 7% in 2007(16). In the NL, HPV testing was only done in trials and in some cases of triage, counting for a few percent of all tests.…”

“…SEARCH was created by a National Cancer Institute-funded research project conducted in four integrated health care systems in the states of Hawaii, Massachusetts, Oregon and Washington affiliated with the Health Care Systems Research Network. The SEARCH database links cytology, biopsy, histology, treatment, and health plan membership data (15,16). Since it is the most comprehensive US population-based database on cervical cancer screening and follow-up, we used it as a baseline for our analysis.…”

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

“…Preventive Services Task Force, 2014) and well-utilized (Sabatino et al, 2015; Weinmann et al, 2015) in the United States (US) for the prevention of cervical cancer. However, performing Papanicolaou (Pap) smears in women ≥65 years of age has limited benefit, and can result in potential harm from false positive results and subsequent invasive procedures (Mandelblatt et al, 2002; Sawaya et al, 2000a; Sawaya et al, 2000b; Van Wijngaarden and Duncan, 1993).…”

Impact of Widespread Cervical Cancer Screening

“…47,48 While racial breakdown of participants in the ATHENA HPV trial was comparable to that of the United States population as a whole, 49,50 subsequent studies indicate that HPV test utilization patterns have thus far and will likely continue to differ by practice setting and population demographics. 51,52 The changing landscape of cervical cancer screening will likely present challenges in terms of equal access to the increasing number of possible screening approaches. 53,54 Therefore, it is necessary that we continue to monitor rates of cervical cancer screening and the impact of screening on cancer rates in the current and future eras, especially for at risk populations such as minorities and women of lower socioeconomic status.…”