Cervical cancer screening practices: Rates of underscreening, overscreening, and guideline-adherent screening in a national cohort (379)

Abstract

<b>Objectives:</b> To determine the proportions of women adherent to national guidelines, overscreened, or underscreened for cervical cancer after stratifying for high-risk conditions. <b>Methods:</b> The Marketscan database, a de-identified database containing information on approximately half of the employer-based insurance in the United States, was queried for elements relevant to cervical cancer screening among women of screening age (21-65) with six years of continuous enrollment in the database. The 6-year timeframe was chosen to allow for adequate assessment of the recommended 5-year screening interval. The database was queried for ICD-9, ICD-10, and CPT codes corresponding to high-risk conditions, screening tests, and diagnostic and treatment procedures. Women who had hysterectomies for benign indications were excluded. Average-risk women were considered adequately screened if they had Pap tests alone at 2.5-3.5 year intervals or HPV tests or co-tests at 4.5-5.5 year intervals. <b>Results:</b> A total of 1,800,125 women met the inclusion criteria. Among those, 329,062 (18.3%) met high-risk criteria. Among the 1,471,063 women who qualified for routine screening, 25% had no screening during the entirety of the 6-year observation period. A further 11% were underscreened, and 46% were overscreened. Only 18% of average-risk women received guideline adherent screening with any method. Guideline adherent screening was three times higher among women screened with co-testing compared with Pap testing alone (44% vs 15%). Rates of underscreening were highest among women screened with Pap testing alone. Rates of underscreening increased with age, with 35% of women aged 50-64 years having no testing during the entire 6-year period. <b>Conclusions:</b> The findings among this cohort of women with continuous private insurance coverage for six years raise several important points. First, nearly one in five women meet high-risk criteria and require repeat testing at 1-3 year intervals. Second, 25% of women were never screened during the entire 6-year period, and rates of non-screening were highest among women aged 50-64, who were approaching the age of screening exit. Third, high rates of both underscreening and overscreening were observed for women of all ages. Pap tests alone were associated with more overscreening and underscreening than HPV-only testing or co-testing.