Use of cervical cancer screening among insured women: the extent of missed opportunities

Chattopadhyay, Sajal K.; Ebrahim, Shahul H.; Tao, Guoyu; McKenna, Matthew T.

doi:10.1016/j.healthpol.2004.11.012

Cited by 12 publications

(9 citation statements)

References 29 publications

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“…The overall proportion of women receiving Pap screening within KPNW each year was observed to be similar to that in a large U.S. claims-based study of women from across the U.S [102,106]. For modeling purposes, two adjustments were made to annual age-specific routine cervical cancer screening rates reported for KPNW.…”

Section: Resultsmentioning

confidence: 67%

“…Two large U.S. studies utilizing automated cervical cytology [47] and medical claims [102] databases revealed annual proportions of privately insured women receiving cervical cancer screening that were lower than those estimated from nationally representative self-reported data for all women (privately insured, publicly insured and uninsured) [104]. We therefore chose to estimate Pap screening utilization among screened women using validated cytology data from the Kaiser Permanente Northwest (KPNW) health plan [47] and to estimate the proportion of women who are never screened during their lifetimes from data sources that include the uninsured and publicly insured.…”

Section: Resultsmentioning

confidence: 99%

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Epidemiologic natural history and clinical management of Human Papillomavirus (HPV) Disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model

2009

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BackgroundNatural history models of human papillomavirus (HPV) infection and disease have been used in a number of policy evaluations of technologies to prevent and screen for HPV disease (e.g., cervical cancer, anogenital warts), sometimes with wide variation in values for epidemiologic and clinical inputs. The objectives of this study are to: (1) Provide an updated critical and systematic review of the evidence base to support epidemiologic and clinical modeling of key HPV disease-related parameters in the context of an HPV multi-type disease transmission model which we have applied within a U.S. population context; (2) Identify areas where additional studies are particularly needed.MethodsConsistent with our and other prior HPV natural history models, the literature review was confined to cervical disease and genital warts. Between October 2005 and January 2006, data were gathered from the published English language medical literature through a search of the PubMed database and references were examined from prior HPV natural history models and review papers. Study design and data quality from individual studies were compared and analyses meeting pre-defined criteria were selected.ResultsPublished data meeting review eligibility criteria were most plentiful for natural history parameters relating to the progression and regression of cervical intraepithelial neoplasia (CIN) without HPV typing, and data concerning the natural history of HPV disease due to specific HPV types were often lacking. Epidemiologic evidence to support age-dependency in the risk of progression and regression of HPV disease was found to be weak, and an alternative hypothesis concerning the time-dependence of transition rates is explored. No data were found on the duration of immunity following HPV infection. In the area of clinical management, data were observed to be lacking on the proportion of clinically manifest anogenital warts that are treated and the proportion of cervical cancer cases that become symptomatic by stage.ConclusionKnowledge of the natural history of HPV disease has been considerably enhanced over the past two decades, through the publication of an increasing number of relevant studies. However, considerable opportunity remains for advancing our understanding of HPV natural history and the quality of associated models, particularly with respect to examining HPV age- and type-specific outcomes, and acquired immunity following infection.

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Section: Resultsmentioning

confidence: 67%

Section: Resultsmentioning

confidence: 99%

Epidemiologic natural history and clinical management of Human Papillomavirus (HPV) Disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model

2009

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“…We appreciate the contribution by Chattopadhyay et al [1], in the August 2005 issue of Health Policy, describing cervical cancer screening utilization among insured U.S. women. The widespread availability of Pap screening has been credited with reducing the rate of cervical cancer in the U.S. by approximately 75% [2].…”

Section: Dear Editormentioning

confidence: 99%

“…This study is also one of the few recent U.S. analyses to monitor population cervical cancer screening trends using administrative data on utilization [1,9]. National surveys of Pap screening behavior rely on self-reported data from women [10,11], which have generally been shown to overestimate the rate [12,13] and recency [14] of cervical cancer screening.…”

Section: Dear Editormentioning

confidence: 99%

“…In the first paragraph of their discussion, Chattopadhyay et al cite our study within the Kaiser Permanente Northwest health plan [9] and report that in that analysis "only 31.2% of women received a Pap screening in 1998" [1]. We wish to clarify that while the Chattopadhyay study included women aged 21-64 years and excluded those with hysterectomy during the 3-year study period, our analysis evaluated screening utilization among female enrollees of all ages (range 0-108 years) regardless of hysterectomy status.…”

Section: Dear Editormentioning

confidence: 99%

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Response to “Use of cervical cancer screening among insured women: the extent of missed opportunities” [Health Policy 73 (2005) 194–201]

Insinga¹,

Glass

Rush

2006

Health Policy

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Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

et al. 2021

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IMPORTANCEMost clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. OBJECTIVE To understand rates and factors associated with outpatient low-value cancer screenings. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed the receipt of low-value cancer screening and associated factors among 5 993 010 veterans. Four measures of low-value cancer screening defined by validated recommendations of practices to avoid were constructed using administrative data. Patients with cancer screenings in 2017 at Veterans Health Administration primary care clinics were included. Excluded patients had recent symptoms or historic high-risk diagnoses that may affect test appropriateness (eg, melena preceding colonoscopy). Data were analyzed from December 23, 2019, to June 21, 2021. EXPOSURES Receipt of cancer screening test. MAIN OUTCOMES AND MEASURES Low-value screenings were defined as occurring for averagerisk patients outside of guideline-recommended ages or if the 1-year mortality risk estimated using a previously validated score was at least 50%. Factors evaluated in multivariable regression models included patient, clinician, and clinic characteristics and patient-centered medical home domain performance for team-based care, access, and continuity previously developed from administrative and survey data. RESULTS Of 5 993 010 veterans (mean [SD] age, 63.1 [16.8] years; 5 496 976 men [91.7%]; 1 027 836 non-Hispanic Black [17.2%] and 4 539 341 non-Hispanic White [75.7%] race and ethnicity) enrolled in primary care, 903 612 of 4 647 479 men of average risk (19.4%) underwent prostate cancer screening; 299 765 of 5 770 622 patients of average risk (5.2%) underwent colorectal cancer screening; 21 930 of 469 045 women of average risk (4.7%) underwent breast cancer screening; and 65 511 of 458 086 women of average risk (14.3%) underwent cervical cancer screening. Of patients screened, low-value testing was rare for 3 cancers, with receipt of a low-value test in 633 of 21 930 of women screened for breast cancer (2.9%), 630 of 65 511 of women screened for cervical cancer (1.0%), and 6790 of 299 765 of patients screened for colorectal cancer (2.3%). However, 350 705 of 4 647 479 of screened men (7.5%) received a low-value prostate cancer test. Patient race and ethnicity, sociodemographic factors, and illness burden were significantly associated with likelihood of receipt of low-value tests among screened patients. No single patient-, clinician-, or clinic-level factor explained the receipt of a low-value test across cancer screening cohorts.

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Use of cervical cancer screening among insured women: the extent of missed opportunities

Cited by 12 publications

References 29 publications

Epidemiologic natural history and clinical management of Human Papillomavirus (HPV) Disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model

Epidemiologic natural history and clinical management of Human Papillomavirus (HPV) Disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model

Response to “Use of cervical cancer screening among insured women: the extent of missed opportunities” [Health Policy 73 (2005) 194–201]

Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

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