BACKGROUND AND PURPOSE:

• The province of Ontario (Canada) changed their cervical cancer screening guidelines in 2012
  • Annual Pap within 3 years of sexual activity was changed to every 3 years for women ≥21 years of age
•  Zur et al. (Journal of Obstetrics and Gynecology Canada, 2020) sought to determine if changing Pap guidelines from 1 to 3 years impacted STI screening rates in younger women

METHODS:

• Retrospective cohort study
• Participants
  • Women aged 19 to 25
  • Care provided by family health team
• Exposures
  • Annual Pap test: women who presented between May 1, 2009 and April 30, 2012
  • Triennial Pap test: women who presented between Nov 1, 2012 and Oct 31, 2015
• Power analysis
  • >90% power and an alpha of <0.05
  • Pre-guideline testing rate of 90%
  • 175 patients in each group required to detect a 15% difference
• Primary outcome
  • Proportion of patients screened for CT/GC at any point during the 3-year study period
• Secondary outcomes
  • Number of patient visits that included any STI screening
  • Number of screening tests for GC, CT, syphilis, hepatitis B, hepatitis C, HIV
  • Positive STI results
  • Method of screening used (cervical swab, urine nucleic acid amplification test [NAAT], serum [HIV, hepatitis B, hepatitis C, and VDRL])

RESULTS:

• 600 women
• There were no statistically significant differences in the two groups for the following
  • Age | Number of physician appointments | History of STIs
• There was a significant decrease in the number of visits (mean) at which STI screening was performed after the recommendations were changed in 2012 (P=0.001)
  • Annual Pap test group: 1.21 visits/patient
  • Triennial Pap test group: 0.82 visits/patient
• There was a decrease in the proportion of patient screened for STIs over 3 years (P=0.007)
  • Annual Pap test group: 66.8%
  • Triennial Pap test group: 52.8%
• For STI screening methods, there was a
  • Significant decrease in the use of endocervical culture (P<0.001)
    • Annual Pap test group: 1.06 tests/patient
    • Triennial Pap test group: 0.57 tests/patient
  • Nonsignificant increase in the use of urine NAAT (P=0.07)
    • Annual Pap test group: 0.09 tests/patient
    • Triennial Pap test group: 0.17 tests/patient
  • Nonsignificant increase in the use of serum STI screening (P=0.16)
    • Annual Pap test group: 0.37 tests/patient
    • Triennial Pap test group: 0.47 tests/patient

CONCLUSION:

• A change in cervical cancer screening guidelines, from once annually to once every three years, was associated with a decrease in STI screening in younger women
• The authors conclude

…we observed a decrease in STI screening even though there was no difference in number of physician visits over 3 years

This implies that it is not the frequency of physician visits but rather the nature of the visit that matters

This may be due to the ease with which a sensitive topic such as sexual health can be broached or the additional time and resources needed to perform an STI assessment when a pelvic examination is not otherwise indicated 

Learn More – Primary Sources:

Unintended Consequences: The Impact of Cervical Cancer Screening Guidelines on Rates of STI Screening in Primary Care

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