The number of women up to date on screening for cervical cancer may be far below what national data suggest, a new study found.
In a Minnesota database, 64.6% of women ages 30 to 65 were current on their recommended cervical cancer screening in 2016, while just 53.8% of 21- to 29-year-olds were up to date, reported Kathy MacLaughlin, MD, and colleagues of the Mayo Clinic in Rochester, Minnesota in the Journal of Women’s Health.
“We need to fix this relatively quickly or we are going to start seeing problems down the line,” MacLaughlin told MedPage Today. “We know that screening works for helping prevent cervical cancer and for early detection of lesions that can be treated for preventing cervical cancer, but screening isn’t just a one-time event, it works because it is done repeatedly over time.”
MacLaughlin’s group used the Rochester Epidemiology Project database to determine the yearly screening rates from 2005 to 2016 for more than 47,000 women living in Olmsted County, Minnesota.
The objective was to compare the rates of Papanicolaou (Pap) and Pap-HPV combination testing in light of 2012 national screening recommendations from multiple organizations that called for Pap testing every 3 years for women ages 21 to 65, or combination testing at 5-year intervals for women ages 30 to 65.
Among those in the 30-65 age group who were up to date with cervical cancer screening, 60.8% had been screened with the Pap-HPV combination test within 5 years, and 3.9% with the Pap test within 3 years. For those in the 21-29 age group, these rates were reversed, at 6.5% and 47.3%, respectively.
“Acceptance of the Pap-HPV combination test, which was available for 30- to 65-year-old women at 5-year intervals, increased significantly,” said McLaughlin. “That was a positive finding.”
“However, what surprised and concerned us were the actual screening rates in 2016,” she said, pointing out that both age groups were below the 81% self-reported screening rate published in the 2015 National Health Interview Survey, and well below the Healthy People 2020 goal of 93%.
The study also revealed racial disparities in screening rates. Black women were 50% less likely than white women to be up to date with their screening, while Asian women were almost 30% less likely. However, the Olmsted County population is less ethnically diverse than the U.S. population as a whole, which limits the generalizability.
Why are screening rates this low?
“Although guidelines are evidence-based — and we fully support the 3- and 5-year intervals — I think it is challenging for any person to remember to have something done at such an infrequent interval, compared with other screening tests that might be suggested annually, such as a mammogram.” said MacLaughlin. “We are losing touch with these women, or not doing as good a job as we need to in reminding them because it is a long interval between screenings.”
MacLaughlin said that healthcare providers need to be more proactive in reaching out to patients to make sure they are being screened on a timely basis. For example, she suggested that providers could set up Pap clinics with more convenient evening and weekend hours, or provide screening at urgent care clinics.
“Overall, cervical cancer screening has been a huge success story,” MacLaughlin said. “The rates of diagnosis and deaths have dropped by 60% or more since Pap screening started back in the 1950s. So we’re concerned that since only a little more than half to two-thirds of women are having regular screening, that could have consequences down the road in terms of cervical abnormalities, and pre-cancerous changes.”
“We don’t want to lose the positive progress we have gained,” she said.
One co-author reported serving on external safety review committees overseeing post-licensure Gardasil safety studies, which are funded by Merck.