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Single Health System Adherence to 2012 Cervical Cancer Screening Guidelines at Extremes of Age and Posthysterectomy

Teoh, Deanna MD; Isaksson Vogel, Rachel PhD; Hultman, Gretchen MPH; Monu, Minnu MD; Downs, Levi MD; Geller, Melissa A. MD, MS; Le, Chap PhD; Melton-Meaux, Genevieve MD, PhD; Kulasingam, Shalini PhD

doi: 10.1097/AOG.0000000000001895
Contents: Original Research

OBJECTIVE: To estimate the proportion of guideline nonadherent Pap tests in women aged younger than 21 years and older than 65 years and posthysterectomy in a single large health system. Secondary objectives were to describe temporal trends and patient and health care provider characteristics associated with screening in these groups.

METHODS: A retrospective cross-sectional chart review was performed at Fairview Health Services and University of Minnesota Physicians. Reasons for testing and patient and health care provider information were collected. Tests were designated as indicated or nonindicated per the 2012 cervical cancer screening guidelines. Point estimates and descriptive statistics were calculated. Patient and health care provider characteristics were compared between indicated and nonindicated groups using χ2 and Wilcoxon rank-sum tests.

RESULTS: A total of 3,920 Pap tests were performed between September 9, 2012, and August 31, 2014. A total of 257 (51%; 95% confidence interval [CI] 46.1–54.9%) of tests in the younger than 21 years group, 536 (40%; 95% CI 37.7–43.1%) in the older than 65 years group, and 605 (29%; 95% CI 27.1–31.0%) in the posthysterectomy group were not indicated. White race in the older than 65 years group was the only patient characteristic associated with receipt of a nonindicated Pap test (P=.007). Health care provider characteristics associated with nonindicated Pap tests varied by screening group. Temporal trends showed a decrease in the proportion of nonindicated tests in the younger than 21 years group but an increase in the posthysterectomy group.

CONCLUSION: For women aged younger than 21 years and older than 65 years and posthysterectomy, 35% of Pap tests performed in our health system were not guideline-adherent. There were no patient or health care provider characteristics associated with guideline nonadherent screening across all groups.

In the health system studied, nonindicated cervical cancer screening continues in substantial numbers of women aged younger than 21 years and older than 65 years and posthysterectomy.

Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Biostatistics & Bioinformatics, Masonic Cancer Center, the Institute for Health Informatics, the School of Public Health, Division of Biostatistics, the Department of Surgery, Division of Colon & Rectal Surgery, and the Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.

Corresponding author: Deanna Teoh, MD, Mayo Mail Code 395, 420 Delaware Street SE, Minneapolis, MN 55455; email: dkteoh@umn.edu.

The Masonic Cancer Center Women's Health Scholar is sponsored by the University of Minnesota Masonic Cancer Center, a comprehensive cancer center designated by the National Cancer Institute and administrated by the University of Minnesota Deborah E. Powell Center for Women's Health. Research is supported by the Building Interdisciplinary Research Careers in Women's Health Grant (# K12HD055887) and administered by the University of Minnesota Deborah E. Powell Center for Women's Health. This award is cofunded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Office of Research on Women's Health. This award is also funded by the Office of the Director, National Institutes of Health, National Institute of Mental Health, and the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the office views of the cofunders. Also supported by National Institutes of Health grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota, and the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114.

Presented at the American Society for Colposcopy and Cervical Pathology annual meeting, April 13–16, 2016, New Orleans, Louisiana; and at the 2016 BIRCWH (Building Interdisciplinary Research Careers in Women's Health) meeting, June 7, 2016, Bethesda, Maryland.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal’s requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.