• 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

• 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 

• 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 P_trend  < 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 P_trend  < 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%) 

• 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 

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

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?