Assessing Management of Abnormal Cervical Cancer Screening Results and Concordance with Guideline Recommendations in Three US Healthcare Settings.

Autor:	Cheng D; Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.; Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Rieu-Werden ML; Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Lykken JM; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas., Werner CL; Department of Obstetrics and Gynecology, University of Southwestern Medical Center, Dallas, Texas.; Parkland Health, Dallas, Texas., Feldman S; Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Silver MI; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri., Atlas SJ; Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Tiro JA; Department of Public Health Sciences, University of Chicago-Biological Sciences Division, Chicago, Illinois., Haas JS; Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Kamineni A; Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Jazyk:	angličtina
Zdroj:	Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology [Cancer Epidemiol Biomarkers Prev] 2024 Jul 01; Vol. 33 (7), pp. 912-922.
DOI:	10.1158/1055-9965.EPI-23-1564
Abstrakt:	Background: Follow-up of abnormal results is essential to cervical cancer screening, but data on adherence to follow-up are limited. We describe patterns of follow-up after screening abnormalities and identify predictors of guideline-concordant follow-up. Methods: We identified the index screening abnormality (positive human papillomavirus test or atypical squamous cells of undetermined significance or more severe cytology) among women of ages 25 to 65 years at three US healthcare systems during 2010 to 2019. We estimated the cumulative incidence of surveillance testing, colposcopy, or treatment after the index abnormality and initial colposcopy. Logistic regressions were fit to identify predictors of guideline-concordant follow-up according to contemporaneous guidelines. Results: Among 43,007 patients with an index abnormality, the cumulative incidence of any follow-up was 49.6% by 4 years for those with atypical squamous cells of undetermined significance/human papillomavirus-negative and higher for abnormalities warranting immediate colposcopy. The 1-year cumulative incidence of any follow-up after colposcopy was 70% for patients with normal results or cervical intraepithelial neoplasia I and 90% for patients with cervical intraepithelial neoplasia II+. Rates of concordant follow-up after screening and colposcopy were 52% and 47%, respectively. Discordant follow-up was associated with factors including age, race/ethnicity, overweight/obese body mass index, and specific types of public payor coverage or being uninsured. Conclusions: Adherence to the recommended follow-up of cytologic and histopathologic abnormalities is inconsistent in clinical practice. Concordance was poor for mild abnormalities and improved, although suboptimal, for more severe abnormalities. Impact: There remain gaps in the cervical cancer screening process in clinical practice. Further study is needed to understand the barriers to the appropriate management of cervical abnormalities. (©2024 American Association for Cancer Research.)
Databáze:	MEDLINE
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