Timeliness of Cervical Cancer Diagnosis and Initiation of Treatment in the National Breast and Cervical Cancer Early Detection Program

Abstract

Objectives-To examine time intervals from cervical cancer screening to diagnosis and treatment initiation among low-income and uninsured women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) during two consecutive time periods.Methods-We analyzed NBCCEDP data for women with abnormal Pap tests (n = 100,167), from which 1,417 invasive cervical cancers were diagnosed. We examined two time intervals for this study: diagnostic interval (time from abnormal Pap test to the date of definitive diagnosis) and treatment initiation interval (time from definitive diagnosis to treatment initiation) for two time periods : 1996-2002 and 2003-2009. We compared median time intervals for diagnostic and treatment initiation using the Kruskal-Wallis test. Adjusted proportions (predicted marginals) were calculated using logistic regression to examine diagnosis and treatment within program benchmarks (≤ 60 days).Results-Median diagnostic intervals decreased overall by 6 days (54 vs. 48 days, p < 0.001). This decrease in the median diagnostic interval was noted for all variables examined. The median treatment initiation intervals remained stable over the two time periods.Conclusions-Women screened by the NBCCEDP receive diagnostic follow-up and initiate treatment within preestablished program guidelines.

Variation in Screening Abnormality Rates and Follow-Up of Breast, Cervical and Colorectal Cancer Screening within the PROSPR Consortium

“…Screening abnormality rates observed across PROSPR are consistent with prior studies, 12,[15][16][17][18][19][20][21][22] yet the cross-organ perspective highlights the higher abnormality rate for breast cancer screening (10.5 % of individuals screened) relative to colorectal cancer screening using FOBT/FIT (4.7 % of individuals screened) or cervical cancer screening (7.9 % of Other factors may contribute to variation in the observed organ-specific abnormality rates, including the mix of breast imaging modalities with different operating characteristics, the sensitivity of different types of fecal occult blood tests, and the subjectivity of radiologist and cervical cytology interpretations, as well as differences in laboratory processing procedures. While UPenn was an early adopter of digital breast tomosynthesis, their abnormality rate was intermediate, between the rates observed for Dartmouth-BWH and VT.…”

Comparing Breast Cancer Outcomes Between Medicaid and the Ohio Breast and Cervical Cancer Early Detection Program

“…Studies examining outcomes associated with the BCCEDP have generally yielded favorable results with regard to cancer stage at diagnosis, 14 timeliness of care, [15][16][17][18] and treatment patterns. 6,19 In contrast, an earlier study reporting unfavorable outcomes in BCCEDP participants indicated that 71% of women who received mammography through the BCCEDP were symptomatic, and more than 50% of the women were diagnosed with late-stage disease.…”

Age-specific trends in black–white disparities in cervical cancer incidence in the United States: 1975–2009

“…The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides funding to states for cervical cancer screening and treatment of uninsured and underinsured women contingent upon performance measures, including timely diagnosis and follow-up of women with abnormal cytology [20]. Despite improvements over time, the diagnosis interval (time between Pap testing and definitive diagnosis) across NBCCEDP sites remains somewhat longer for blacks compared to whites [21]. Another analysis found that black women had a higher percentage of no follow-up after two prior abnormal Pap tests [19].…”