Current consensus recommendations are to not initiate cervical cancer screening for immunocompetent adolescent females prior to age 21 years. This is in part due to very low rate of 0.8 per 100,000 new cervical cancer cases diagnosed among women ages 20 to 24 years. Timely HPV vaccination further decreases incidence of cervical cancer to 4 cases per 100,000 persons by the age of 28 years. Screening prior to age 21 has demonstrated no clear benefit in cancer risk reduction or outcomes. Additionally, unindicated screening among adolescents can lead to patient harm and increasing cost to the healthcare system.
It is important to assess the rates of overutilization of cervical cancer screening and to identify areas where improvements have occurred and where further opportunities exist. The objective of this study is to assess the trends over time and the practice and provider factors associated with unindicated cervical cancer screening tests in adolescent females within the largest healthcare system in the state.
Cross-sectional data from patients ages 13-20 years who underwent cervical cancer screening between January 1, 2012, and December 31, 2018, across a large multi-hospital health system were reviewed. All cervical cancer screening results were included. The incidence rate (IR) of unindicated screening was analyzed over 6-month intervals using Poisson regression analysis.
The study included data from 118 providers and 794 women. Among the 900 screening results, most (90%) were unindicated; 87% with unindicated cytology testing alone and 14% with unindicated HPV testing. Screening tests were collected from patients ages 13-20 years, many of whom had multiple unindicated cytology tests, with 25 patients having 3 tests or more before the age of 21. The majority of results of cytology testing were negative for intraepithelial lesion or malignancy (77%). Of note, 52 invasive diagnostic or therapeutic procedures (49 colposcopies and 3 conizations) were performed, of which 45 (87%) followed an unindicated screening test. Between 2012 and 2018, the IR of unindicated cytology decreased by 33% (12.6 to 8.5 unindicated cytology per 1,000 encounters). The IR of unindicated screening was lower in the academic than in the community setting (IRR = 0.43, P<.01). Even with decreases in the overall rates of unindicated screening throughout the study period, there were still 58 unindicated screening tests performed in the final year of this study.
Despite significant reductions in unindicated screening for women <21 years of age, there remain areas for improvement. Our data reflects practices of guideline non-adherence up to seven years after the 2012 guideline. Now, with a new series of changes to the guidelines, which may be even more challenging for patients and providers, it is more important than ever to utilize evidence-based strategies to improve guideline dissemination and adherence.

Copyright © 2021. Published by Elsevier Inc.