• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Has There Been a Change in Cervical Cancer Underscreening Since Release of 2012 Guidelines?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE: 

  • HPV testing for cervical screening is part of routine cervical cancer screening for women in the US between practice in the United States in women between 30 and 64 years 
  • Cotesting  
    • 2004: First recommended every 3 years
    • 2012: Every 5 years was recommended  
  • HPV testing alone (“primary HPV testing”)  
    • Recently included in guidelines every 5 years  
  • Triennial cytology-only screening  
    • Remains an option due to unavailability of HPV or reimbursement issues  
  • Castle et al. (JNCI, 2021) examined cervical screening uptake for women aged 25 to 64 years to determine adherence to screening recommendations since the 2012 consensus guidelines were released

METHODS: 

  • Retrospective study 
    • Data derived from New Mexico HPV Pap Registry (NMHPVPR) 
  • Population 
    • 25 to 64 years  
    • Prior negative cervical cancer screening in the registry, either co-test or cytology alone (T−1) 
    • Underwent a second screening (T0) in 2013, 2016, or 2019 
  • Exposures 
    • Second screening (T0) method 
      • Screening with co-testing 
      • Screening with cytology alone 
  • Study design 
    • Linear regression used to test if there was a trend in percent screened as interval lengthened 
    • The primary outcome was also assessed by age group and by screening year 
  • Primary outcome 
    • Percentage of population screened 

RESULTS: 

  • T0 screens in 
    • 2013: 91,651 
    • 2016: 71,300 
    • 2019: 57,532 
  • Of all women screened in 2019 
    • 65.2% had a negative co-test within the last 3 years (95% CI, 64.6 to 65.7%) 
  • Over time, more women were screened at intervals longer than those recommended 
    • Percentages of women screened with a prior negative co-test more than 5 years and up to 7 years ago (2-sided Ptrend  < 0.001) 
      • In 2013: 2.6% (95% CI, 2.2 to 2.9%) 
      • In 2016: 2.1% (95% CI, 1.9 to 2.2%) 
      • In 2019: 6.5% (95% CI, 6.2 to 6.8%) 
    • Percentages of women screened with a prior negative cytology more than 5 years and up to 7 years ago (2-sided Ptrend  < 0.001) 
      • In 2013: 3.8% (95% CI, 3.7 to 3.9%) 
      • In 2016: 9.0% (95% CI, 8.7 to 9.3%) 
      • In 2019: 14.9% (95% CI, 14.4 to 15.4%)  
  • From 2008 to 2019 
    • There was an increase in the median screening interval from approximately 1.5 years in 2008 to approximately 3.4 years in 2019 
  • In 2019, a minority of women aged 30 to 64 underwent co-testing or cytology at the recommended interval 
    • Co-testing: 12.7% (95% CI, 12.4 to 13.1%) 
    • Cytology: 27.7% (95% CI, 27.1 to 28.3%) 
  • Overscreening (screening to often) was also documented although percentage declined over the study time period 
    • Cotesting 
      • 2013: 94.4% (95% CI, 93.9% to 94.9%) 
      • 2019: 80.8% (95% CI, 80.3% to 81.2%) 
    • Cytology 
      • 2013: 65.1% (95% CI, 64.7% to 65.4%) 
      • 2019: 26.2% (95% CI = 25.5% to 26.8%) 

CONCLUSION: 

  • Between 2008 and 2019, the percentage of women undergoing cervical cancer screening decreased twofold for all age groups 
    • Overscreening was also documented but declined over this time period
  • Limitations include underestimating rates of underscreening women
    • New Mexico registry created in 2006 so study could only extend back by a maximum of 7 years
    • Current study only covered women with 1 screen or none at all | It did not account for women with very long screening intervals
  • The authors state that  

A new and alarming observation was the increasing percentage of women being screened at too long of an interval 

Most notable was the greater than fourfold increase in women being screened at an interval of more than 5 years and up to 7 years  

There was also an increasing trend in women being screened at an interval of more than 5 years and up to 7 years following a negative HPV cotest, which may increase the risk of cancer 

Learn More – Primary Sources: 

Adherence to National Guidelines on Cervical Screening: A Population-Based Evaluation From a Statewide Registry 

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

HPV Genotyping and Cytology for hrHPV: What Screening Combination is Best for CIN Detection?
HPV Testing vs PAP Smear: Results of the HPV FOCAL Trial
Why Have Cervical Cancer Screening Rates Decreased Over the Past Decade in the US?
What is the Most Efficient Method for Cervical Cancer Screening?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site