Provider management of equivocal cervical cancer screening results among underserved women, 2009–2011: follow-up of atypical squamous cells of undetermined significance
- 373 Downloads
Reflex human papillomavirus (HPV) testing is the preferred triage option for most women diagnosed with atypical squamous cells of undetermined significance (ASC-US). This study was conducted to describe follow-up results of women with ASC-US Pap test results in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), focusing on HPV test use.
We examined the follow-up of 45,049 women in the NBCCEDP with ASC-US Pap tests during 2009–2011. Data on demographic characteristics, diagnostic procedures, and clinical outcomes were analyzed.
NBCCEDP providers diagnosed 45,049 women (4.5 % of all Pap tests) with an ASC-US result. Of those, 28,271 (62.8 %) were followed with an HPV test, 3,883 (8.6 %) with a repeat Pap test, 6,592 (14.6 %) with colposcopy, and 6,303 were lost to follow-up (14.0 %). Women aged 40 and older were followed more often with an HPV test. White, black, and Asian/Pacific Islander women were followed more often with an HPV test after an ASC-US Pap compared to Hispanic and American Indian/Alaska Native (AI/AN) women. Among women with a positive HPV test on follow-up, almost 90 % continued with colposcopy as recommended. AI/AN women had the highest rates of HPV positivity (55.2 %) and of no follow-up (25.0 %).
This is the first analysis describing follow-up of ASC-US Pap test results in the NBCCEDP, providing a window into current management of ASC-US results. Findings raise concerns about persistent disparities among AI/AN women. During 2009–2011, nearly two-thirds of women with an ASC-US Pap test result were followed with an HPV reflex test.
KeywordsHPV testing ASC-US NBCCEDP Pap test
We would like to thank William Helsel and William Kammerer from Information Management Services, Inc. for their assistance with data analysis. This research was supported in part by an appointment (LL) to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and CDC.
Conflict of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- 2.American Cancer Society (2014) Finding cervical pre-cancers. http://www.cancer.org/cancer/cervicalcancer/moreinformation/cervicalcancerpreventionandearlydetection/cervical-cancer-prevention-and-early-detection-find-pre-cancer-changes. Accessed 12 Mar 2014
- 5.Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D, American Society for C, Cervical Pathology-sponsored Consensus C (2007) 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 197(4):346–355. doi: 10.1016/j.ajog.2007.07.047 PubMedCrossRefGoogle Scholar
- 6.Mullen J, Lantz P (2014) Overview of the National Breast and Cervical Cancer Early Detection Program. Cancer Causes Control. doi: 10.1007/s10552-015-0565-9
- 7.Gutman SI (2003) Premarket Approval of Digene Hybrid Capture 2 High-Risk HPV DNA Test. http://www.accessdata.fda.gov/cdrh_docs/pdf/p890064s009a.pdf
- 8.Ryerson AB, Benard VB, Major AC (2014) Summarizing the first 12 years of partnerships and progress against breast and cervical cancer 1991–2002 national report, vol 24 Mar 2014Google Scholar
- 9.Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER, Committee A-A-ACCG (2012) American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 62(3):147–172. doi: 10.3322/caac.21139 PubMedCentralPubMedCrossRefGoogle Scholar
- 10.Research Triangle Institute (2012) SUDAAN language manual, volumes 1 and 2, release 11. Research Triangle Institute, Research Triangle ParkGoogle Scholar
- 16.Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, Solomon D, Wentzensen N, Lawson HW, Conference ACG (2013) 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 17(5 Suppl 1):S1–S27. doi: 10.1097/LGT.0b013e318287d329 PubMedCrossRefGoogle Scholar