Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA.
Family Planning Research Program, Department of Obstetrics & Gynecology, University of California, Irvine, CA.
J Low Genit Tract Dis. 2018 Jul;22(3):171-177. doi: 10.1097/LGT.0000000000000376.
Guidelines recommend 3-year cervical cancer screening intervals to avoid unnecessary invasive procedures; however, regular testing remains critical. We evaluated trends in cervical cancer screening among low-income women receiving family planning-related services and their association with patient and provider characteristics.
Using claims and enrollment data from California's publicly funded family planning program, we identified 540,026 women with a clinician visit at 216 sites between 2011 and 2015. We calculated guideline adherent cervical cancer testing rates for 6-month periods among women aged 21 to 24, 25 to 29, and 30 to 64 years. We also calculated guideline adherent chlamydia testing for women aged 21 to 24 years.
Having a 3-year cervical cancer screening test declined for all age groups. The odds of cervical cancer screening declined for women aged 21 to 24 years by an estimated 11% every 6 months (odds ratio [OR] = 0.90, 95% confidence interval [CI] = 0.89-0.90), a significantly greater decline than for the other age groups. Among women aged 21 to 29 years, the decrease was significantly larger for Latina (ratio of ORs = 0.95, 95% CI = 0.95-0.96) and Spanish-speaking (ratio of ORs = 0.95, 95% CI = 0.95-0.96) women compared with non-Latina and non-Spanish-speaking women. A smaller decline was seen for chlamydia screening.
Changes in screening interval guidelines are associated with overall decreased screening. This trend was strongest among women aged 21 to 24 years, even as they continued to be screened appropriately for chlamydia, suggesting many missed opportunities. Efforts to reduce unnecessary cervical cancer screening should be monitored to maintain appropriate screening rates to avoid advanced-stage diagnoses and higher health care costs.
指南建议宫颈癌筛查间隔 3 年，以避免不必要的侵入性操作；然而，定期检查仍然至关重要。我们评估了在接受计划生育相关服务的低收入妇女中宫颈癌筛查的趋势及其与患者和提供者特征的关系。
使用来自加利福尼亚州公共资助计划生育计划的索赔和登记数据，我们在 2011 年至 2015 年间在 216 个地点确定了 540,026 名接受临床医生就诊的女性。我们计算了年龄在 21 至 24、25 至 29 和 30 至 64 岁的女性每 6 个月进行一次符合指南的宫颈癌检测率。我们还计算了年龄在 21 至 24 岁的女性符合指南的衣原体检测率。
所有年龄段的 3 年宫颈癌筛查检测率均下降。年龄在 21 至 24 岁的女性宫颈癌筛查的可能性每 6 个月下降约 11%（比值比[OR] = 0.90，95%置信区间[CI] = 0.89-0.90），下降幅度明显大于其他年龄组。在年龄在 21 至 29 岁的女性中，与非拉丁裔和非西班牙语女性相比，拉丁裔（OR 比值=0.95，95%CI=0.95-0.96）和讲西班牙语的（OR 比值=0.95，95%CI=0.95-0.96）女性的下降幅度更大。衣原体筛查的下降幅度较小。
筛查间隔指南的变化与整体筛查率下降有关。这一趋势在 21 至 24 岁的女性中最为明显，尽管她们仍继续适当地筛查衣原体，表明错过了许多机会。应监测减少不必要的宫颈癌筛查的努力，以维持适当的筛查率，避免晚期诊断和更高的医疗保健费用。
