Abstract
Background/Aims Cervical cancer screening is performed to detect pre-cancerous cervical intraepithelial neoplasia or invasive cancerous cervical lesions prior to the onset of symptoms so they can be removed before the cancer has developed or spread. With the addition of high-risk human papillomavirus (HPV) testing to the long-established Papanicolaou (Pap) smear, national and health plan screening guidelines have been regularly updated in recent years. Guidelines on screening frequency and follow-up protocols have also changed over time and will likely continue to do so as HPV vaccination becomes more widespread. Here we describe patterns and results of cervical cancer testing and follow-up over a 10-year period within four geographically-dispersed U.S. managed care organizations.
Methods Using data collected by the SEARCH: Screening Effectiveness And Research in Community-Based Healthcare project, we analyzed electronic medical record data on all women aged 20–65 during the period 1998–2007 across four HMORN sites. We created standardized files for Pap smear dates and results; cervical histology dates, types, and results; and HPV test dates and results. We also collected Virtual Data Warehouse data on HPV vaccinations, and selected diagnosis and procedure codes. We calculated rates of Pap testing, HPV testing, colposcopy, and cervical histology (biopsy and treatment). We also calculated rates for Pap testing we classified as “screening.” Among women who had Pap tests in 2002 and 2007 and no abnormal test directly preceding the index test, we examined patterns of screening frequency. We also examined frequencies and trends in the results of “screening” Pap testing and cervical histology.
Results Overall, annual Pap testing rates decreased and HPV testing rates dramatically increased over the 10 years, while rates of colposcopy, cervical histology, and cervical treatment did not display obvious patterns. Trends varied by age group and health plan. Pap screening frequency differed by health plan; overall, in 2007 a higher proportion of subjects had longer screening intervals (2 years or greater) than in 2002. Information on patterns of Pap and histology results will be presented.
Discussion Evaluating trends in cervical cancer testing and follow-up may highlight opportunities to optimize cervical cancer screening delivery in community-based settings.
