Reaves Sydney, Hall Katherine C, Stewart Mary W, Wentzensen Nicolas, Ferrell Christina, Risley Carolann, Wells Jimmie, Rives Rhonda, Bobo Fajada, Daniels Jon, Farrington Kathy, Morgan Jody C, Clarke Megan A
University of Mississippi Medical Center, School of Nursing.
Mississippi State University, School of Nursing.
Res Sq. 2024 Feb 13:rs.3.rs-3943646. doi: 10.21203/rs.3.rs-3943646/v1.
Cervical screening is used to detect and treat precancers to prevent invasive cancers. However, successful prevention also requires adequate follow-up and treatment of individuals with abnormal screening results. The aim was to investigate demographics, clinical characteristics, and follow-up status for individuals needing colposcopy after an abnormal screening result.
The STRIDES (udying isk to mprove ispariti) cohort comprises individuals undergoing cervical cancer screening and management at a Mississippi Health Department or University of Mississippi clinic. Follow-up status, demographics, and clinical data were assessed from electronic health records and, if necessary, patient navigation on individuals identified as needing a colposcopy after an abnormal screening.
Of the 1,458 individuals requiring colposcopy, 43.0% had the procedure within 4 months, 16.4% had a delayed procedure, and 39.5% had no documented follow-up, with significant predictors of follow-up identified as age and cytology diagnosis. Based on age, individuals 30 + were more likely to follow up with a colposcopy compared to individuals < 30 years (49% and 38.7%, respectively; p < .001). Individuals with cytology diagnoses of LSIL (52.9%), ASC-H (51.4%), and HSIL (62.3%) had higher percentages of adherence to follow-up colposcopy guidelines (p < .001).
Despite high cervical cancer screening rates among Mississippians, a substantial portion did not have adequate next-step intervention. However, it is encouraging that highest risk individuals were more likely to have a colposcopy. Regardless, continuing to understand the underlying causes for incomplete follow-up is crucial for timely secondary targeted interventions to reduce cervical cancer burden, promote awareness, and improve health outcomes.
宫颈癌筛查用于检测和治疗癌前病变以预防浸润性癌症。然而，成功的预防还需要对筛查结果异常的个体进行充分的随访和治疗。本研究旨在调查筛查结果异常后需要进行阴道镜检查的个体的人口统计学特征、临床特征及随访情况。
STRIDES（改善差异研究风险）队列包括在密西西比州卫生部或密西西比大学诊所接受宫颈癌筛查和管理的个体。通过电子健康记录评估随访情况、人口统计学特征和临床数据，必要时对筛查结果异常后被确定需要进行阴道镜检查的个体进行患者导航。
在1458名需要进行阴道镜检查的个体中，43.0%在4个月内接受了该检查，16.4%的检查延迟，39.5%没有记录在案的随访情况，随访的显著预测因素为年龄和细胞学诊断。按年龄划分，30岁及以上的个体比30岁以下的个体更有可能接受阴道镜检查（分别为49%和38.7%；p<0.001）。细胞学诊断为低度鳞状上皮内病变（LSIL，52.9%）、非典型鳞状细胞不排除高度病变（ASC-H，51.4%）和高度鳞状上皮内病变（HSIL，62.3%）的个体遵循阴道镜检查随访指南的比例更高（p<0.001）。
尽管密西西比州的宫颈癌筛查率很高，但很大一部分人没有得到充分的下一步干预。然而，令人鼓舞的是，高危个体更有可能接受阴道镜检查。无论如何，持续了解随访不完整的潜在原因对于及时进行二级靶向干预以减轻宫颈癌负担、提高认识和改善健康结局至关重要。
