Underscreening, overscreening, and guideline-adherent cervical cancer screening in a national cohort

Abstract

ObjectiveTo explore rates of under- and overscreening for cervical cancer among a national cohort. MethodsThe MarketScan database, a national administrative database of employee-sponsored insurance, was queried for elements relevant to cervical cancer screening among women aged 21–65 with 6 years of continuous enrollment (2015–2019). Average-risk women were defined as those without high-risk medical conditions or abnormal screening histories, and without evidence of hysterectomy with removal of the cervix for benign indications. 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. Logistic regressions were used to predict the odds of receiving guideline-adherent screening, underscreening, and overscreening. ResultsAmong 1,872,809 eligible patients, 1,471,063 (78.5%) qualified for routine screening. Of these, only 18.1% received guideline-adherent screening, and 25.4% were unscreened during the 6-year period. Younger women (aged 21–39) were more likely to be overscreened [OR 1.46]. Older women (aged 50–64) were more likely to be underscreened or unscreened during the study period [OR 2.54]. Guideline-adherent screening was highest with HPV testing alone (80%) followed by co-testing (44%), and lowest with cytology alone (15%). A total of 329,062 women in this general population sample (18%) met high-risk criteria that required increased frequency of screening. ConclusionsHigh rates of both underscreening and overscreening indicate a need for additional strategies to improve guideline-adherent care.Clinical trial registration: N/A.