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. 2015 May;26(5):759-64.
doi: 10.1007/s10552-015-0549-9. Epub 2015 Mar 21.

Provider management of equivocal cervical cancer screening results among underserved women, 2009-2011: follow-up of atypical squamous cells of undetermined significance

Meg Watson  1 , Vicki Benard, Lavinia Lin, Tanner Rockwell, Janet Royalty
Affiliations

Provider management of equivocal cervical cancer screening results among underserved women, 2009-2011: follow-up of atypical squamous cells of undetermined significance

Meg Watson et al. Cancer Causes Control. 2015 May.

Erratum in

Abstract

Purpose: Reflex human papillomavirus (HPV) testing is the preferred triage option for most women diagnosed with atypical squamous cells of undetermined significance (ASC-US). This study was conducted to describe follow-up results of women with ASC-US Pap test results in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), focusing on HPV test use.

Methods: We examined the follow-up of 45,049 women in the NBCCEDP with ASC-US Pap tests during 2009-2011. Data on demographic characteristics, diagnostic procedures, and clinical outcomes were analyzed.

Results: NBCCEDP providers diagnosed 45,049 women (4.5 % of all Pap tests) with an ASC-US result. Of those, 28,271 (62.8 %) were followed with an HPV test, 3,883 (8.6 %) with a repeat Pap test, 6,592 (14.6 %) with colposcopy, and 6,303 were lost to follow-up (14.0 %). Women aged 40 and older were followed more often with an HPV test. White, black, and Asian/Pacific Islander women were followed more often with an HPV test after an ASC-US Pap compared to Hispanic and American Indian/Alaska Native (AI/AN) women. Among women with a positive HPV test on follow-up, almost 90 % continued with colposcopy as recommended. AI/AN women had the highest rates of HPV positivity (55.2 %) and of no follow-up (25.0 %).

Conclusion: This is the first analysis describing follow-up of ASC-US Pap test results in the NBCCEDP, providing a window into current management of ASC-US results. Findings raise concerns about persistent disparities among AI/AN women. During 2009-2011, nearly two-thirds of women with an ASC-US Pap test result were followed with an HPV reflex test.

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Figures

Fig. 1
Fig. 1
Management of women with atypical squamous cells of undetermined significance (ASC-US) on cytology (n = 45,049). Note of women who had a repeat cytology within 15 months, 26 (0.7 %) had unsatisfactory results and eight (0.2 %) had “other” results. Of HPV+ women who had a colposcopy, 133 (1.3 %) had “other” results. Of women who received a colposcopy without an HPV test, 205 (3.1 %) had “other” results
Fig. 2
Fig. 2
Percent of HPV-positive test results after follow-up of ASC-US Pap test, NBCCEDP, 2009–2011 (HPV positivity among those followed up with an HPV test)
See this image and copyright information in PMC

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