TOPLINE:

Among 670,003 commercially insured US adults, only 7.3% adhered to cervical cancer screening guidelines between 2013 and 2021; most were either overscreened (61.6%) or underscreened (31.1%).

METHODOLOGY:

• Evolving US cervical cancer screening guidelines may create confusion among clinicians and patients and lead to issues with guideline adherence.
• To assess guideline adherence, researchers analyzed claims data from 670,003 eligible individuals, of whom 315,249 (47.1%) received cytology only and 354,754 (52.9%) received co-testing with cytology and HPV testing.
• Definitions of adherence were adapted from the 2012 American College of Obstetricians and Gynecologists Cervical Cancer Screening Guideline for women aged 30-64 years: co-testing every 5 years or cytology every 3 years. Primary human papillomavirus (HPV) testing was excluded from modalities because the US Preventive Services Task Force did not recommend it until 2018.
• Researchers evaluated the adjusted predicted probabilities of overscreening and underscreening while controlling for age, education, household net worth, and Charlson Comorbidity Index.

TAKEAWAY:

• The rate of adherence to cervical screening guidelines was low: 7.3%. Overall, 61.6% of participants were overscreened and 31.1% were underscreened. The overall adjusted predicted probability for overscreening was 89.4% and for underscreening was 81.0%, with similar patterns observed across racial and ethnic groups.
• The predicted probability of overscreening was higher with co-testing vs cytology only (96.2% vs 82.4%) and was the highest among non-Hispanic Black participants (91.0%). Overscreening was also more common among younger age groups, those with a high Charlson Comorbidity Index, and those with higher socioeconomic status.
• The predicted probability of underscreening was higher with co-testing vs cytology only (93.1% vs 68.7%) and was highest among non-Hispanic Asian participants (82.7%). Older age, high comorbidity, and lower socioeconomic status were each associated with a higher predicted probability of underscreening.

IN PRACTICE:

The findings suggest that “targeted strategies are needed to improve adherence, de-implement unnecessary care, and address disparities in adoption of evolving screening guidelines,” the authors concluded.

SOURCE:

This study, led by Michelle B. Shin, PhD, MPH, School of Nursing, University of Washington in Seattle, was published online in JAMA Network Open.

LIMITATIONS:

Key limitations were the exclusion of uninsured populations, potential coding errors in the database, and imperfect race and ethnicity classification, which may have affected the generalizability of the findings.

DISCLOSURES:

This study was funded by the University of Washington Population Health Initiative and the University of Washington School of Nursing Research Intramural Funding Program. One author reported receiving nonfinancial support from Intuitive Surgical-Educational outside the submitted work. Another author disclosed receiving grants from the National Cancer Institute and the US CDC outside the submitted work. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.