Cervical Cancer Screening Among Young Adult Women in the United States
ABSTRACT BACKGROUND: Cervical cancer screening guidelines have evolved significantly in the last decade for young adult women, with current recommendations promoting later initiation and longer intervals. METHODS: Using self-reported cross-sectional National Health Interview Survey (NHIS) 2000-2010 data, trends in Papanicolaou (Pap) testing among women aged 18-29 years were examined. NHIS 2010 data were used to investigate age at first Pap test (N=2,198), time since most recent Pap test (n=1,622), and predictors of Pap testing within the last 12 months (n=1,622). RESULTS: The percentage of 18-year-olds who reported ever having a Pap test significantly decreased from 49.9% in 2000 to 37.9% in 2010. Mean age at first Pap test in 2010 was significantly younger for non-Hispanic black women (16.9 years), women <high school education (16.9 years), women who received the HPV vaccine (17.1 years), and women who have ever given birth (17.3 years). The majority reported their last Pap test within the previous 12 months (73.1%). Usual source of healthcare (OR 2.31) and current birth control use (OR 1.64) significantly increased chances of having a Pap test within the previous 12 months. CONCLUSIONS: From 2000 to 2010 there was a gradual decline in Pap test initiation among 18-year-olds, however, in 2010 many women reported ≤12 months since last screening. Evidence-based guidelines should be promoted, as screening young adult women for cervical cancer more frequently than recommended can cause considerable harms. Impact: A baseline of cervical cancer screening among young adult women in the United States to assess adherence to evidence-based screening guidelines.
Full-textDOI: · Available from: Katherine B Roland, Aug 25, 2014
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ABSTRACT: OBJECTIVE: Cervical cancer screening using the human papillomavirus (HPV) test and Pap test together (co-testing) is an option for average-risk women ≥30 years of age. With normal co-test results, screening intervals can be extended. The study objective is to assess primary care provider practices, beliefs, facilitators and barriers to using the co-test and extending screening intervals among low-income women. METHOD: Data were collected from 98 providers in 15 Federally Qualified Health Center (FQHC) clinics in Illinois between August 2009 and March 2010 using a cross-sectional survey. RESULTS: 39% of providers reported using the co-test, and 25% would recommend a three-year screening interval for women with normal co-test results. Providers perceived greater encouragement for co-testing than for extending screening intervals with a normal co-test result. Barriers to extending screening intervals included concerns about patients not returning annually for other screenings (77%), patient concerns about missing cancer (62%), and liability (52%). CONCLUSION: Among FQHC providers in Illinois, few administered the co-test for screening and recommended appropriate intervals, possibly due to concerns over loss to follow-up and liability. Education regarding harms of too-frequent screening and false positives may be necessary to balance barriers to extending screening intervals.Preventive Medicine 04/2013; 57(5). DOI:10.1016/j.ypmed.2013.04.012 · 2.93 Impact Factor
- JAMA Internal Medicine 11/2013; 174(2). DOI:10.1001/jamainternmed.2013.12607 · 13.25 Impact Factor
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ABSTRACT: In December 2009, the American College of Obstetricians and Gynecologists recommended cervical cancer screening begin at age 21 for young women. In this study, we examine receipt of first lifetime Papanicolaou (Pap) test and predictors of over-screening among adolescents within a large urban ambulatory care network. We compared the proportion of first lifetime Pap test of adolescents aged 13-20years between June 2007-November 2009 (n=7700) and December 2009-June 2012 (n=9637) using electronic health records. We employed multivariable regression models to identify demographic and health care factors associated with receiving a first lifetime Pap test at age <21years in the post-guideline period (over-screening). The proportion of Pap tests declined from 19.3% to 4.2% (p <0.001) between the two periods. Multivariable logistic regression results showed receiving care from gynecology/obstetrics/family planning clinics compared to pediatric clinics, having more clinic encounters, and older age were associated with over-screening in the post-guideline period. We found that guideline adherence differed by clinic type, insurance status, and health care encounters. In the quickly evolving field of cervical cancer control, it is important to monitor practice trends as they relate to shifts in population-based guidelines, especially in high-risk populations.Preventive Medicine 03/2014; DOI:10.1016/j.ypmed.2014.03.010 · 2.93 Impact Factor