Adhering to Cervical Cancer Screening Guidelines: Are We Getting It Right?

Ever since the cervical cancer screening guidelines were updated in 2012, clinicians have been slow to implement the recommended changes. In a retrospective cross-sectional study, researchers examined adherence to recommendations for average-risk screening initiation (age 21) and termination (age 65 if adequate previous screening or after total hysterectomy) during the 2 years following publication of the guidelines. An electronic database was used to identify Pap smears performed in 3920 women seen in >40 primary care centers in a single healthcare system in Minnesota. Charts with nonindicated Pap smears were manually reviewed for specific screening indications (e.g., immunosuppression, history of high-grade dysplasia). Initiation of screening at age ≥20.5 was deemed appropriate.

A total of 509 women younger than 21 had at least 1 Pap smear; of these, 257 (50.5%) were not indicated. In the >65-year-old group, 1327 women underwent at least 1 Pap smear; of these, 536 (40.4%) were not indicated. The most common reason for inappropriate screening in this older group was “health maintenance,” while reasons for indicated screening included inadequate previous screening and history of abnormal cervical cytology. Posthysterectomy, 2084 women had at least 1 Pap test (605 [29%] inappropriately), most commonly for “health maintenance.” Over the 2-year study period, the proportion of nonindicated Pap tests declined in the <21-year-old group, increased in the posthysterectomy group, and remained stable in the >65-year-old group.