Cervical-Cancer Screening - New Guidelines and the Balance between Benefits and Harms

Department of Obstetrics, Gynecology, and Reproductive Sciences,, University of California, San Francisco, USA.
New England Journal of Medicine (Impact Factor: 55.87). 11/2009; 361(26):2503-5. DOI: 10.1056/NEJMp0911380
Source: PubMed

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    • "Second, the change of guideline recommendations to less frequent screening and later starting age for cervical cancer (US Preventive Services Task Force, 2014; Saslow et al., 2012; Sawaya, 2009) and breast cancer (US Preventive Services Task Force, 2009) around the same time period may have in part offset any impact of the ACA provision. Third, cancer screening services are typically more complicated, more invasive , time-consuming, require more resources, and generally performed by specialists rather than primary care providers. "
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    ABSTRACT: An early provision of the Affordable Care Act (ACA) eliminated cost-sharing for a range of recommended preventive services. This provision took effect in September 2010, but little is known about its effect on preventive service use. We evaluated changes in the use of recommended preventive services from the 2009 (before the implementation of ACA cost sharing provision) and 2011/2012 (after the implementation) in the Medical Expenditure Panel Survey, a nationally representative household interview survey in the US. Specifically, we examined: blood pressure check, cholesterol check, flu vaccination, and cervical, breast, and colorectal cancer screening, controlling for demographic characteristics and stratifying by insurance type. There were 64,280 (21,310 before and 42,970 after the implementation of ACA cost-sharing provision) adults included in the analyses. Receipt of recent blood pressure check, cholesterol check and flu vaccination increased significantly from 2009 to 2011/2012, primarily in the privately insured population ages 18-64 years, with adjusted prevalence ratios (95% confidence intervals) 1.03 (1.01-1.05) for blood pressure check, 1.13 (1.09-1.18) for cholesterol check and 1.04 (1.00-1.08) for flu vaccination (all p-values <0.05). However, few changes were observed for cancer screening. We observed little change in the uninsured population. These early observations suggest positive benefits from the ACA policy of eliminating cost sharing for some preventive services. Future research is warranted to monitor and evaluate longer term effects of the ACA on access to care and health outcomes. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Jul 2015 · Preventive Medicine
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    • "The American Congress of Obstetricians and Gynecologists (ACOG) recommend that screening start at age 21, to be repeated once every 2 years until age 30 and then every 3 years until 65-70 [46]. Despite repeated efforts to standardize cytologic reporting guidelines and screening practice, there are knowledge gaps and disagreements over the management of patients, in particular those with ASCUS and low-grade lesions, care for women older than 65 years, and the effects of HPV immunization on screening initiation and intervals [47-51]. "
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    ABSTRACT: ABSTRACT: Human Papillomavirus vaccines are widely hailed as a sweeping pharmaceutical innovation for the universal benefit of all women. The implementation of the vaccines, however, is far from universal or equitable. Socio-economically marginalized women in emerging and developing, and many advanced economies alike, suffer a disproportionately large burden of cervical cancer. Despite the marketing of Human Papillomavirus vaccines as the solution to cervical cancer, the market authorization (licensing) of the vaccines has not translated into universal equitable access. Vaccine implementation for vulnerable girls and women faces multiple barriers that include high vaccine costs, inadequate delivery infrastructure, and lack of community engagement to generate awareness about cervical cancer and early screening tools. For Human Papillomavirus vaccines to work as a public health solution, the quality-assured delivery of cheaper vaccines must be integrated with strengthened capacity for community-based health education and screening.
    Full-text · Article · Jun 2011 · International Journal for Equity in Health
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