Cervical Cancer Screening Rates "Unacceptably Low," Researchers Find

As January marks Cervical Health Awareness Month, healthcare stakeholders are emphasizing the importance of screening for the disease, which has reduced the incidence of cervical cancer death by more than 60% since its introduction in the 1950s. However, the percentage of women who get screened for cervical cancer may be far lower than national data suggest, according to Mayo Clinic researchers.

As of 2012, cancer screening guidelines recommend Papanicolaou (Pap) testing every 3 years for women aged 21 to 65 years or Pap—human papilloma virus (HPV) testing every 5 years for women aged 30 to 65 years.

Publishing their study results in Journal of Women’s Health, researchers obtained data from the Rochester Epidemiology Project for women 16 years and older living in Olmstead, Minnesota, from 2005 to 2016 and found that screening rates for all eligible women were well below the Healthy People 2020 goals. The findings contradict self-reported data from the 2015 National Health Interview Study, in which 81% of women reported compliance.

In 2016, less than two-thirds (64.6%) of the 27,4178 women aged 30 to 65 years were up to date with cervical cancer screening, most of whom (60.8%) were screened with a Pap—HPV cotest within 5 years. Among women aged 21 to 29 years, about half (53.8%) were adherent to screening, with the majority screened with Pap tests (47.3%).

“Total Pap and Pap—HPV cotest screening rates in 2016 for adolescent girls and women age 16 to less than 21 years and more than 65 years were appropriately low, 2.1% and 8.8%, respectively, and were consistent with recommendations against screening women in those age groups,” the researchers noted.

Looking across the study period, there were significant declines in Pap test rates in all age groups but significant increases in Pap—HPV cotesting. While Pap testing rates decreased from 62.8% in 2005 to 47.3% in 2016 among women aged 21 to 29 years, rates dropped from 67.5% to just 3.9% among women aged 30 to 65 years. However, during the same time period, cotesting rates varied significantly for women aged 21 to 29 years but consistently remained under 10%. Among women aged 30 to 65 years, there was a significant increase in cotesting between 2007 and 2016, jumping from 10% to 60.8%, which suggests increasing adoption of 2012 screening recommendations.

The researchers also observed troubling disparities across racial/ethnic groups. “African-American women were 50% less likely to be up-to-date on cervical cancer screening than white women in 2016,” said Kathy MacLaughlin, MD, family medicine specialist, Mayo Clinic, and the study’s lead author, in a statement. “Asian women were nearly 30% less likely than white women to be current on screening. These racial disparities are especially concerning.”

According to MacLaughlin, clinicians must start thinking outside the box on ways to best reach these women to ensure they are receiving these life-saving screening tests.

Reference

MacLaughlin K, Jacobson R, Breitkopf C, et al. Trends over time in Pap and Pap—HPV cotesting for cervical cancer screening [published online January 7, 2019]. J Womens Health. doi: 10.1089/jwh.2018.7380.