Trends Over Time in Pap and Pap-HPV Cotesting for Cervical Cancer Screening

Abstract

Background: In 2012, updated cervical cancer screening recommendations were released with consensus on Papanicolaou (Pap) testing every 3 years for women age 21-65 years or Pap-human papillomavirus (HPV) cotesting at 5-year intervals for women age 30-65 years. Primary study aims: Assess current use of Pap-HPV cotesting and describe local population trends over time in Pap and Pap-HPV cotesting. Secondary aim: Assess sociodemographic factors correlating with screening. Methods: We assessed Rochester Epidemiology Project data for Pap and Pap-HPV cotesting among women age 16 years and older living in Olmsted County, Minnesota, yearly from 2005 (study population n = 47,203) through 2016 (study population n = 49,510). We calculated 3-year (Pap) and 5-year (Pap-HPV) moving prevalence rates of screening as proportion of eligible population. Multivariable logistic regression was used to assess factors potentially associated with screening. Results: In 2016, 64.6% of 27,418 eligible 30-to 65-year-old women were up to date with cervical cancer screening; 60.8% had received Pap-HPV cotest screening. Significant declines in Pap completion rates over time were observed in all age groups, including an unexpected decline in 21-to 29-year-old women. Coincident with decreasing Pap screening rates, Pap-HPV cotesting significantly increased among women age 30-65 years, from 10.0% in 2007 to 60.8% in 2016. Conclusions: This suggests increasing adoption of 2012 screening recommendations in the 30-to 65-year-old population. However, decline in Pap screening among 21-to 29-year-old women is concerning. Disparities by race, ethnicity, smoking status, and comorbidity level were observed. Results suggest need for multilevel patient and clinician interventions to increase cervical cancer screening adherence.

Impact of knowledge and attitude on the utilization rate of cervical cancer screening tests among Ethiopian women: A systematic review and meta-analysis

“…However, the result is lower than a finding from European countries that the coverage of cervical cancer screening tests ranges from 10% to 79% [81]. Consistent with the European report, a study in Minnesota, United States of America, showed that 60.8% of women had received Pap-HPV co-test screening with a significant increment among women aged 30-65 years, from 10.0% in 2007 to 60.8% in 2016 [82]. It is also lower than other findings across the literature: Kenya, 16.4% [83], India, 29.8% [84], South Africa, 52% [85], and China, 20.7% [86].…”

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

“…Despite recommendations against annual cervical cancer screening from major guideline developing groups, and many years since annual cytology screening was recommended, it is reported that annual cytology testing still is common 160,161 . Likewise, adoption of the 2012 preferred strategy of cotesting for women aged 30 to 65 years had been slow, although recent reports show an upward trend in cotesting among individuals aged 30 to 65 years, 24,25,162 which varied geographically, from 27.5% in Utah to 49.9% in the District of Columbia 163 . Not only is guideline adherence an enduring challenge; but, as noted previously, concerns about lack of universal access to preferred screening tests overall, and more so outside of urban and academic settings, have been borne out by national surveys of laboratories 22,134 …”

Impact of COVID-19 on cervical cancer screening: Challenges and opportunities to improving resilience and reduce disparities

“…Currently, there are notable disparities regarding screening approaches offered to different populations. Black and Hispanic women are more likely than white women to be screened with cervical cytology alone than with HPV alone or co-testing ( MacLaughlin et al, 2019 ). Since a negative cervical cytology result provides less reassurance against the development of cancer than HPV testing or co-testing ( Castle et al, 2018 ), screening needs to be repeated more often to provide equivalent protection ( Curry et al, 2018 ).…”