Patterns of cervical cancer screening follow-up in the era of prolonged screening intervals

Abstract

IntroductionLittle is known as to how prolonged screening recommendations for cervical cancer have affected compliance. ObjectiveWe examined compliance with repeat cervical cancer screening among U.S. women aged 30–64 who underwent index screening between 2013 and 2019. Study designThe IBM Watson Health MarketScan Database was used to identify commercially-insured women 30–64 years old who underwent cervical cancer screening from 2013 to 2019. The cohort was limited to women with continuous insurance 12 months before and ≥ 2 months after index testing. Patients with prior hysterectomy, more frequent surveillance needs, or a history of abnormal cytology, histology, or HPV test were excluded. Index screening included cytology, co-testing, or primary HPV testing. Cumulative incidence curves described screening intervals. Compliance was considered if repeat screening occurred 2.5–4 years after index cytology and 4.5–6 years after index co-testing. Cause-specific hazard models examined factors associated with compliance. ResultsOf 5,368,713 patients identified, co-testing was performed in 2,873,070 (53.5%), cytology in 2,422,480 (45.1%), and primary HPV testing in 73,163 (1.4%). The cumulative incidence of repeat screening among all women by seven years was 81.9%. Of those who underwent repeat screening, 85.7% with index cytology and 96.6% with index co-testing were rescreened early. Only, 12.2% with index cytology had appropriate rescreening and 2.1% had delayed rescreening. Among the index co-testing group, 3.2% had appropriate rescreening and 0.3% had delayed rescreening. ConclusionAppropriate cervical cancer follow-up screening is highly variable. The cumulative incidence rate of repeat screening was 81.9% and among women rescreened, the vast majority are tested earlier than recommended by current guidelines.