Assessment of trends in cervical cancer screening rates using healthcare claims data: United States, 2003-2014

Abstract

Improved understanding of the natural history of cervical cancer has led to changes in screening recommendations, including the addition of the human papillomavirus (HPV) testing as an option in routine screening. Most studies of screening trends have used national self-reported survey data. To better understand recent trends in cervical cancer screening, including cytology (Papanicolaou, or Pap, tests) and human papillomavirus co-tests (HPV + Pap test), we used healthcare claims data to examine screening practices and trends. We analyzed screening among commercially-insured females ages 18-65 during 2005-2014 who were continuously enrolled during three or more contiguous calendar years, to identify those who received cervical cancer screening with a Pap test or co-test. We examined screening prevalence by age group and year. During the latter years of our study period, screening prevalence (regardless of screening method) declined significantly for women in all age groups examined. Despite declines in overall screening, the prevalence of co-testing increased in all age groups except those aged 18-20. In 2014, women aged 30-39 had the highest overall screening uptake (77.5%) and the highest use of co-testing (44.4%); this group also had the lowest overall declines in screening over the time period (-4.5%). These screening measures from healthcare claims were lower than self-reported screening from national surveys of the general population. More research to explore the reasons for these differences is needed to ensure that women are receiving appropriate screening, and to better understand why screening prevalence is declining among this population of commercially insured women.

Keywords: Cervical cancer; Cervical cancer screening; Claims data; HPV test.

Fig. 1

Trends in three-year cervical cancer screening status by age group among privately insured continuous enrollees aged 18–65 years, 2005–2014. Analysis restricted to women who were continuously enrolled for at least 3 years.

Fig. 2

Trends in cervical cancer screening with HPV co-testing by age group among privately insured continuous enrollees aged 18–65 years, 2005–2014. Analysis restricted to women who were continuously enrolled for at least 3 years.