Cervical Cancer Screening Rates in a Chart Review of Adolescent Patients at an Academic Institution before and after the Publication of the 2009 American College of Obstetricians and Gynecologists' Recommendations

Abstract

ObjectiveEvaluation of compliance with ACOG guidelines against screening for cervical cancer in women before age 21; identification of factors associated with lack of compliance with guidelines. MethodsA review of 799 charts of women age 14-21 seen for care at our institution in 2009-2010 to determine baseline cervical cytology rates, compliance with publication of 2009 ACOG guidelines recommending against testing in this age group. Clinical data was gathered to identify patient and physician characteristics associated with testing. ResultsThe baseline rate of cervical cytology testing for women age 14-21 in our chart review (20%, 2009) dropped significantly (10.8%, 2010, P < .005) after publication of new guidelines. Among those patients tested, factors associated with higher screening rates included: patients seen by obstetrician/gynecologist (59% patients tested 2009/38% 2010), who were sexually active (83%/88%) and seen for routine care (68%/95%). Other associated factors: prior screening (61% all patients tested), hormonal contraceptives (58%), private insurance (72%). Patients with history of previous cervical intraepithelial neoplasia had cytology testing done at high rates (72%). ConclusionThe rate of cervical cytology screening in women ages 14-21 was higher than expected given ACOG recommendations. There was a significant decrease in screening rates after publication of guidelines. Patient and physician characteristics were identified which were associated with an increased screening rate. There are no databases that track cervical cancer testing in this age group. This information can be utilized for physician and patient education in order to improve compliance.