Adherence to National Guidelines on Cervical Screening: A Population-Based Evaluation from a Statewide Registry

Abstract

In 2012, national recommendations for cervical-cancer screening of women aged 30-64 years were quinquennial human papillomavirus and cytology co-testing or triennial cytology. Data from a state-wide surveillance program in New Mexico demonstrated 65.2% (95% confidence interval [95%CI]= 64.6%% to 65.7%) of women screened in 2019 had negative co-test within the last 3 years. Percentages of women screened in 2013, 2016, and 2019 with a prior negative co-test more than 5 and up to 7 years ago were 2.6% (95% CI = 2.2% to 2.9%), 2.1% (95% CI = 1.9% to 2.2%), and 6.5% (95% CI = 6.2% to 6.8%), respectively (2-sided P trend<.001). Percentages of women screened in 2013, 2016, and 2019 with a prior negative cytology more than 5 and up to 7 years ago were 3.8% (95% CI = 3.7% to 3.9%), 9.0% (95% CI = 8.7% to 9.3%), and 14.9% (95% CI = 14.4% to 15.4%), respectively (2-sided P trend<.001). Thus, in 2019, only 12.7% (95% CI = 12.4% to 13.1%) of the 30,215 women aged 30-64 years underwent co-testing and 27.7% (95% CI = 27.1% to 28.3%) of the 18,733 underwent cytology at the recommended interval. The observed under- and over-screening could result in increases in cervical-cancer incidence and harms and costs, respectively.

Figure 1.

Cervical cancer screening use and median screening intervals for women living in New Mexico. Shown are the A) Percentage of women screened and B) Median screening intervals for women aged 25-64 years living in New Mexico undergoing cervical screening by age group and year (irrespective of screening modality). Panels A and B include 600 987 individual women with screening cytology across the period of 2008-2019. Percentages of women included in A use age-specific denominators from the US Census (https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-detail.html). C) Percentage of women aged 30-64 years who had an index (T₀) screen (irrespective of screening modality or result; cytology alone or cotesting) in 2013, 2016, or 2019 following an antecedent (T₋₁) negative cotest (negative HPV and negative cytology) 1, 2, 3, 4, and over than 5-7 years before the index screen. D) Percentage of women aged 30-64 years who had an index (T₀) screen (irrespective of screening modality or result; cytology alone or cotesting) in 2013, 2016, or 2019 following an antecedent (T₋₁) negative cytology 1, 2, 3, 4, and over than 5-7 years before the index screen. The denominators for panels C (antecedent negative cotest) and D (antecedent negative cytology) are shown in Table 1 and Supplementary Table 1 (available online), respectively. Screening intervals are defined by the time between the index screen and the antecedent screen, that is, T₀ to T₋₁. Exclusions defining screening tests are detailed in the Supplementary Methods (available online).