Provider management of equivocal cervical cancer screening results among underserved women, 2009–2011: follow-up of atypical squamous cells of undetermined significance

• DOI: 10.1007/s10552-015-0549-9
• Publication Date: 2015-03-20T06:06:19Z
• Authors: Meg Watson; Vicki Benard; Lavinia Lin; Tanner Rockwell; Janet Royalty
• Keywords: Adult; Vaginal Smears; Papillomavirus Infections; Uterine Cervical Neoplasms; Middle Aged; Uterine Cervical Dysplasia; Vulnerable Populations; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Colposcopy; Pregnancy; Atypical Squamous Cells of the Cervix; Humans; Female; Papillomaviridae; Early Detection of Cancer; Follow-Up Studies; Papanicolaou Test

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.