Q&A: Cervical cancer screening follow-up rates 'surprisingly low'
Key takeaways:
- Cervical cancer screening and follow-up rates for abnormal results were below 80% coverage targets.
- The study also revealed disparities by race and ethnicity.
Cervical cancer screening rates are low across the board, but disparities for Black patients persist, according to researchers.
Jennifer C. Spencer, PhD, an assistant professor in the department of population health and department of internal medicine at the University of Texas at Austin’s Dell Medical School, and colleagues published a study in the American Journal of Preventive Medicine that examined care across three diverse health care settings.
The researchers found that, among 188,415 patients, 62.8% received cervical cancer screening during the 3-year study period. Both screening and follow-up rates for abnormal results were below 80% coverage targets.
Additionally, they found disparities by race and ethnicity. A total of 53.2% of Black patients were screened, compared with 63.5% of white patients. About 65% of Hispanic patients and 66.5% of Asian/Pacific Islander patients were screened.
The lower screening rates for Black patients was attenuated after controlling for site of care and insurance, which the researchers wrote underscores the role of systemic inequity.
Healio spoke with Spencer to learn more about the findings and their clinical implications, what physicians can do to improve cervical screenings and more.
Healio: Will you describe the importance of your findings?
Spencer: We understand that there are important disparities in cervical cancer outcomes by race and ethnicity — Black, Hispanic and Native American women all have higher incidence and mortality from cervical cancer. It’s important to understand why it’s higher and what we can do about it, and one of the things we think is driving a lot of that difference is screening and treatment. Past studies of screening typically rely on self-report, which is really hard because it’s not always easy to remember when your last cervical cancer screening was, and we know people over-report behaviors like screening on surveys. So, the chance to use health record data from multiple centers was really exciting; we can get a maybe better measure of screening and understand what disparities exist, and we can see what happens after screening when the screen finds something abnormal.
Our findings showed pretty small differences within each of the practices that we looked at for cervical cancer screening rates. Across all practices, Hispanic patients were slightly more likely to be screened than white patients, but other groups were generally similar to white patients. But we found that there were important differences across practices, with one practice as high as 71% of eligible patients up to date with screening and another at only 59%. And, because there are differences in where patients are getting care by race and ethnicity, this resulted in only around half of eligible Black patients getting a screen, compared to nearly two-thirds of eligible white, Hispanic and Asian patients. There were also differences in which practices screened with Pap-only screening vs. co-testing with HPV tests — and those resulted in white and Asian patients being twice as likely as Black patients and three times as likely as Hispanic patients to receive a co-test. Finally, Hispanic patients were slightly more likely to follow up from an abnormal screening compared to white patients, but follow up was pretty low for all groups.
Healio: What are the clinical implications of your findings?
Spencer: Clinically, I think there are a couple takeaways. There are still a lot of folks at all sites who are not up to date with screening, so identifying and screening those folks is important! Addressing screening at community health centers and other places that are often under-resourced and serve a disproportionate share of minoritized individuals is probably an important strategy for closing gaps and reducing disparities. And everywhere should be putting more effort into getting folks who have high risk HPV or high-risk abnormalities on a Pap smear to come back for testing. We saw that was low across the board and it’s essential for screening to have a positive impact.
Healio: What does your study add to existing research?
Spencer: Two major things. One, we are able to use health record data and look across multiple health systems. A few studies have looked at health record data, but being able to look across systems is a rare opportunity and allows us to see how the differences in care across systems vs. within systems is driving disparities, or in the case of Hispanic populations that their higher screening rates within clinics is muted by distribution of care across clinics. Two, the focus is so much on screening that we miss the role of follow up. It’s really important for screening and we find it’s surprisingly low across all three clinics.
Healio: What can physicians do to improve cervical cancer screenings?
Spencer: It’s important for providers to offer screening to patients when they are in the office and to emphasize the importance of returning if the test results indicate a need for follow up. Practices can think about what they can implement to facilitate access and action — like patient or provider-facing reminders, informational materials and navigation to help patients make it all the way through the process of screening, follow up and treatment as necessary.
Healio: Is there anything else you’d like to add?
Spencer: I do just want to mention the limitation of the study, which is that we’re using data from health care practices, and missing from that data is one of the most important groups: folks who never or very rarely go to a doctor. They are missed by this study and it’s important for future work to understand how to reach out, not just to the folks falling through the cracks within the system, but those who aren’t engaged in the system at all.