Trends in Cervical Cancer Screening in California's Family Planning Program

Bocanegra, Heike Thiel de; Navarro, Sandy; Nonzee, Narissa J.; Vangala, Sitaram; Zhou, Xinkai; Chang, Charlene; Moscicki, Anna‐Barbara

doi:10.1097/lgt.0000000000000376

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…Nonadherence to regular screening as individuals approach the age for cessation of screening 56 is of particular importance and may reduce the benefits. Failure to initiate screening near the recommended starting age may similarly reduce screening benefits 57 …”

Section: Methodsmentioning

confidence: 99%

Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society

Fontham

Wolf

Church

et al. 2020

CA A Cancer J Clinicians

616

546

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The American Cancer Society (ACS) recommends that individuals with a cervix initiate cervical cancer screening at age 25 years and undergo primary human papillomavirus (HPV) testing every 5 years through age 65 years (preferred); if primary HPV testing is not available, then individuals aged 25 to 65 years should be screened with cotesting (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years (acceptable) (strong recommendation). The ACS recommends that individuals aged >65 years who have no history of cervical intraepithelial neoplasia grade 2 or more severe disease within the past 25 years, and who have documented adequate negative prior screening in the prior 10 years, discontinue all cervical cancer screening (qualified recommendation). These new screening recommendations differ in 4 important respects compared with the 2012 recommendations: 1) The preferred screening strategy is primary HPV testing every 5 years, with cotesting and cytology alone acceptable where access to US Food and Drug Administration-approved primary HPV testing is not yet available; 2) the recommended age to start screening is 25 years rather than 21 years; 3) primary HPV testing, as well as cotesting or cytology alone when primary testing is not available, is recommended starting at age 25 years rather than age 30 years; and 4) the guideline is transitional, ie, options for screening with cotesting or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Evidence related to other relevant issues was reviewed, and no changes were made to recommendations for screening intervals, age or criteria for screening cessation, screening based on vaccination status, or screening after hysterectomy. Follow-up for individuals who screen positive for HPV and/or cytology should be in accordance with the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.

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Section: Methodsmentioning

confidence: 99%

Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society

Fontham

Wolf

Church

et al. 2020

CA A Cancer J Clinicians

616

546

View full text Add to dashboard Cite

show abstract

“… 4 In addition, screening rates seem to be falling precipitously in this age group. 5 Therefore, arguments can be made for continuing to advocate screening among women aged 21 to 24 years so that they make cervical screening part of their normal well woman care and facilitate prevention of cancers among women aged 25 to 29 years related to underscreening. In this forum, we address the question of when to begin screening in the US, considering both the epidemiology and natural history of disease and the practical limitations of the US healthcare setting.…”

Section: Moderator Statementmentioning

confidence: 99%

“…11 There are now disturbing data that cervical cancer screening has been decreasing among all women, but specifically young women. 5 Although screening is recommended at 3-year intervals (36 months), a recent study using Family Pact claims that data showed that the percent of women aged 21 to 29 years having at least a single screen within 42 months decreased from approximately 75% in 2012 to less than 50% in 2015, 5 indicating that increasing the screening interval from 1 to 3 years has resulted in high rates of underscreening in women younger than 30 years. In contrast, screening rates for chlamydia did not change in women aged 20 to 24 years, suggesting that women continue to have contact with the health care system but are not receiving the recommended cervical cancer screening.…”

Section: Sidementioning

confidence: 99%

“…In addition, many young women do not adhere to cervical cancer screening recommendations. 5 This elevates their risk of developing cervical cancer, because “underscreened” and “unscreened” women are at greatest risk of developing cervical cancer. The current low vaccination rates and lack of immunization registries for vaccine verification do not confer enough protection to support “not screening” in the 21 to 24 age group.…”

Section: Sidementioning

confidence: 99%

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Should Cervical Cancer Screening be Performed Before the Age of 25 Years?

Moscicki

Perkins

Saville

et al. 2018

J Low Genit Tract Dis

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“…Clinicians may therefore be less likely to adhere to recommended lengthier screening intervals due to concerns about patients' perceptions or their own beliefs. The implementation of less frequent testing intervals and less invasive follow up of abnormal cervical cytology results is complicated by the fact that some population groups have inadequate screening rates even with the new guidelines (at least one Pap test in the past three years) which continues the development of tools that aim to increase cervical cancer testing [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Impact of an Educational Tool on Young Women’s Knowledge of Cervical Cancer Screening Recommendations

Bocanegra

Dehlendorf

Kuppermann

et al. 2021

Preprint

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Purpose Current cervical cancer screening guidelines recommend 3-year screening intervals, in contrast to the previous recommendation of annual screening, to prevent over screening and overtreatment. We evaluated the impact of viewing a tablet-based educational tool prior to seeing a clinician on young women’s knowledge and understanding of cervical cancer screening, HPV vaccination follow-up of abnormal pap smears, and comfort in communicating with their providers. Methods This cross-sectional study was part of a cluster randomized study of fourteen primary care clinics from January 2015 to December 2016. We developed the cervical cancer education tool in English and Spanish using a community-based approach that included formative work and cognitive interviewing. Clinics were randomized to use the intervention (tablet-based patient education tool) or to participate as a control group. We administered surveys to a convenience sample of 229 English-or Spanish-speaking women aged 19 to 35 years in these clinics. We used descriptive analyses and logistic regression models with cluster-robust standard errors to compare differences among the two groups. Results Compared to women seen in control clinics, women seen in intervention clinics demonstrated greater knowledge regarding human papilloma virus (HPV (p = .004) and understanding (p < .001) of cervical cancer screening. Comfort in communicating with providers was not statistically different (p = .053). Women in the intervention group felt that the tool helped them understand that an abnormal Pap smear does not require immediate treatment (61.5%). Conclusion Innovative online patient education that is offered prior to patients’ interaction with their clinicians can improve their knowledge about cervical cancer prevention and treatment.

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Trends in Cervical Cancer Screening in California's Family Planning Program

Cited by 4 publications

References 16 publications

Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society

Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society

Should Cervical Cancer Screening be Performed Before the Age of 25 Years?

Impact of an Educational Tool on Young Women’s Knowledge of Cervical Cancer Screening Recommendations

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