Overview of Centers for Disease Control and Prevention's Case Investigation of Cervical Cancer Study

Abstract

Background: Despite advances in cervical cancer screening, a significant number of women in the United States have not received adequate screening. Studies have suggested that approximately half of the women who developed cervical cancer were not adequately screened. The Centers for Disease Control and Prevention (CDC) Case Investigation of Cervical Cancer (CICC) Study took a unique approach to reconstruct the time before a woman's cervical cancer diagnosis and understand the facilitators and barriers to screening and care. This article provides an overview of the study. Methods: This study included all cervical cancer survivors diagnosed with invasive cervical cancer aged 21 years and older in three U.S. states from 2014-2016. The study design consisted of three different data collection methods, including comprehensive registry data, a mailed survey, and medical chart abstraction. This overview compares the characteristics of cervical cancer survivors in the three states by study participation and eligibility status. Results: Registries identified 2,748 women diagnosed with invasive cervical cancer. Of these, 1,730 participants were eligible for participation, 28% (n = 481) enrolled in the study and 23% (n = 400) consented to the medical chart abstraction. Conclusion: The CICC Study is unique in that it addresses, with medical record verification, the medical history of woman 5 years before their cervical cancer diagnosis as well as provides information from the woman on her health care behaviors. This study provides data on a general population of cervical cancer survivors in three states that could be used to guide interventions to increase cervical cancer screening.

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

“…Details of the study are reported elsewhere. 4 Study packets were mailed containing questionnaires and requests for consent to collect data from medical records. Of the 1,730 eligible women, 28% (n = 481) enrolled in the study and 23% (n = 400) consented to chart abstraction.…”

“…Additional information on response rate has been reported. 4 Of the women who consented, charts were available for 376 (94%). Abstractors were asked to evaluate the completeness of the data they were able to obtain for each woman based on requests made and the responses.…”

“…However, the chart abstraction protocol included a process for assessing the completeness of the medical records obtained by the study staff. 4 Sensitivity analyses were conducted that included only cases where medical records were judged to be complete. We tested the potential impact of missing data due to failure to obtain complete medical records by excluding the 125 observations with suspected incomplete data and re-testing all logistic models.…”

“…2 However, each year approximately 13,000 women are diagnosed with and more than 4,000 women die from cervical cancer, 3 and cervical cancer disproportionally affects women who are Hispanic, Black, or from low socioeconomic backgrounds. 4 Previous studies have suggested that approximately half of the women who developed cervical cancer in the United States were not adequately screened. 5,6 A new statewide population-based study conducted in New Mexico found that 64% of the women with cervical cancer had not been screened.…”

“…The Centers for Disease Control and Prevention (CDC) Case Investigation of Cervical Cancer (CICC) Study took a unique approach to reconstruct the time before a woman's cervical cancer diagnosis, combining her screening history with diagnosis information and sociodemographic factors to understand her prognosis and outcomes. 4 This paper aims to answer the following questions: (a) What proportion of cervical cancer survivors were screened during the five years prior to diagnosis? What factors predicted screening?…”