Title X Health Centers Reducing Cervical Cancer Screening in Accordance With Guidelines

Among women treated at health centers receiving federal funding under Title X, the proportion receiving cervical cancer screening tests declined significantly from 2005 to 2015, according to new research. Study authors attributed these reductions to clinical guidelines that changed the recommendations for such screening.

Recent research examining the rates of services provided at 64 Title X-funded health centers from 2005 to 2015 was published in the Morbidity and Mortality Weekly Report. The Title X Family Planning Program provides funding for health centers to deliver contraceptive and other preventive care to a population that is heavily female and tends to be low-income, uninsured, younger, and racially and ethnically diverse.

Although cervical cancer screening is an important tool that can enable the early detection and treatment of cancer, research has found that underserved women, including lower-income and younger women, experience disparities in receiving such screening. Updates to guidelines that have raised the age of starting screening and lengthened the interval between tests have also complicated the task of assessing rates of cervical cancer screening.

According to the data provided by the 64 health centers in annual reports, the proportion of female Title X clients screened for cervical cancer declined gradually between 2005 and 2015. In 2005, 51% of such clients received a Pap test, whereas in 2015 the rate was 21%. Researchers observed large annual drops in 2010 (from 41% in the previous year to 35%) and in 2013 (from 27% to 23%).

They noted that these 1-year drops in the rate of women screened for cervical cancer corresponded to guideline updates issued the year prior. In 2009, the American College of Obstetricians and Gynecologists (ACOG) raised the recommended age for starting screening to 21 years. In 2012, ACOG, the US Preventive Services Task Force, and the American Cancer Society aligned their guidelines to agree on a starting age of 21 years and screening intervals of 3 or 5 years.

The study authors determined that the reductions in cervical cancer screening rates were not part of a trend of lower overall rates of providing preventive care at Title X-funded health centers. For instance, women 19 years and younger were not recommended to receive cervical cancer screening after 2009, but the proportion screened for chlamydia at these centers increased by 6 percentage points from 2009 to 2015, and the percentage using an effective method of contraception rose from 72% to 77% in this time period.

Therefore, the “decline in the percentage of Title X female clients screened for cervical cancer during 2005—2015 is consistent with newer screening guidelines,” the researchers wrote, which supports previous findings from national surveys collecting self-reported screening rates.

Whereas these data from the Family Planning Annual Reports provide an aggregate view of program-level trends in screening for cervical cancer, the Title X Family Planning Program plans to update the current system to collect patient- and encounter-level data. These types of data will allow program administrators to evaluate their adherence to screening recommendations and will enable the comparison of screening rates across socioeconomic and other patient-level characteristics.