Factors associated with timely colposcopy following an abnormal cervical cancer test result

• Published in: Preventive medicine 2022-11, Vol.164, p.107307-107307, Article 107307
• Main Authors: Feldman, Sarah, Lykken, Jacquelyn M., Haas, Jennifer S., Werner, Claudia L., Kobrin, Sarah C., Tiro, Jasmin A., Chubak, Jessica, Kamineni, Aruna
• Format: Article
• Language: English
• Subjects: Abnormal pap management; Adult; Aged; Cervical cancer screening; Colposcopy; Early Detection of Cancer; Female; Guideline implementation; Humans; Mass Screening; Middle Aged; Papanicolaou Test; Pregnancy; Timely follow-up; Uterine Cervical Dysplasia - diagnosis; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - prevention & control; Vaginal Smears; Young Adult
• ISSN: 0091-7435; 1096-0260; 1096-0260
• DOI: 10.1016/j.ypmed.2022.107307

Successful cervical cancer prevention requires screening and appropriate management of abnormal test results. Management includes diagnostic evaluation and treatment, if indicated, based on cervical cancer risk after most abnormal test results. There is little guidance on the optimal timing of diagnostic evaluation, and few data exist on factors associated with timely management. We quantified time-to-colposcopy within 12 months of an abnormal cervical cancer screening or surveillance test result from 2010 to 2018 across three diverse healthcare systems and described factors associated with timely colposcopy. Among 21–65 year-old patients with an abnormal test result for which colposcopy was indicated (n = 28,706), we calculated the proportion who received a colposcopy within 12 months of the abnormal test and used Kaplan-Meier methods to estimate the probability of colposcopy within 12 months. Across all systems, 75.3% of patients received a colposcopy within 12 months, with site-specific estimates ranging from 70.0 to 83.0%. We fit mixed-effects multivariable logistic regression models to identify factors associated with receipt of colposcopy within 12 months. The healthcare system and cytology result severity were the most important factors associated with of timely colposcopy. We observed that sites with more centralized processes had higher proportions of colposcopy completion, and patients with high-grade results were more consistently evaluated earlier than patients with low-grade results. Patient age also affected receipt of timely colposcopy, though this association differed by healthcare system and result severity. These data suggest opportunities for system-level interventions to improve management of abnormal cervical cancer test results. •Multi-level analysis of timely colposcopy following abnormal cervical cancer tests.•Healthcare system was strongly associated receipt of timely colposcopy.•High-grade abnormalities were positively associated with timely colposcopy.•Demonstrates need for new interventions to improve follow-up across diverse systems.