RESUMO
Hysterectomy protects against cervical cancer when the cervix is removed. However, measures of cervical cancer incidence often fail to exclude women with a hysterectomy from the population-at-risk denominator, underestimating and distorting disease burden. In this study, we estimated hysterectomy prevalence from the Behavioral Risk Factor Surveillance System surveys to remove the women who were not at risk of cervical cancer from the denominator and combined these estimates with the US Cancer Statistics data. From these data, we calculated age-specific and age-standardized incidence rates for women aged >30 years from 2001-2019, adjusted for hysterectomy prevalence. We calculated the difference between unadjusted and adjusted incidence rates and examined trends by histology, age, race and ethnicity, and geographic region using joinpoint regression. The hysterectomy-adjusted cervical cancer incidence rate from 2001-2019 was 16.7 per 100 000 women-34.6% higher than the unadjusted rate. After adjustment, incidence rates were higher by approximately 55% among Black women, 56% among those living in the East South Central division, and 90% among women aged 70-79 and ≥80 years. These findings underscore the importance of adjusting for hysterectomy prevalence to avoid underestimating cervical cancer incidence rates and masking disparities by age, race, and geographic region. This article is part of a Special Collection on Gynecological Cancers.
Assuntos
Histerectomia , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/epidemiologia , Histerectomia/estatística & dados numéricos , Estados Unidos/epidemiologia , Incidência , Pessoa de Meia-Idade , Adulto , Idoso , Prevalência , Idoso de 80 Anos ou mais , Sistema de Vigilância de Fator de Risco Comportamental , Fatores EtáriosRESUMO
BACKGROUND: Little is known about cervical cancer screening strategy utilization (cytology alone, cytology plus high-risk human papillomavirus [HPV] testing [cotesting], primary HPV testing) and test results in the United States. METHODS: Data from the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program were analyzed for 199,578 persons aged 21-65 years screened from 2019 to 2020. Screening test utilization and results were stratified by demographic characteristics and geographic region. Age-standardized pooled HPV test positivity and genotyping test positivity were estimated within cytology result categories. RESULTS: Primary HPV testing was performed in 592 persons (0.3%). Among the remaining 176,290 persons aged 30-65 years, cotesting was utilized in 72.1% (95% confidence interval [CI] 71.9-72.3%), and cytology alone was utilized in 27.9% (95% CI 27.7-28.1%). Utilization of cytology alone varied by geographic region, ranging from 18.3% (95% CI 17.4-19.1%) to 49.0% (95% CI 48.4-49.6%). HPV genotyping test utilization among those with positive pooled HPV test results was 33.9%. In persons aged ≥30 years, variations in age-adjusted test results by region were observed for pooled HPV-positive test results and for HPV genotyping-positive test results. CONCLUSIONS: Cervical cancer screening strategy utilization and test results vary substantially by geographic region within a national screening program. Variation in utilization may be due to regional differences in screening test availability or the preferences of healthcare systems, screened persons and/or clinicians. Test result variations may reflect differing risk factors for HPV infections by geographic region.
Assuntos
Detecção Precoce de Câncer , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Humanos , Feminino , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Neoplasias do Colo do Útero/epidemiologia , Pessoa de Meia-Idade , Adulto , Detecção Precoce de Câncer/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Estados Unidos/epidemiologia , Idoso , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Infecções por Papillomavirus/epidemiologia , Adulto Jovem , Esfregaço Vaginal/estatística & dados numéricos , Papillomaviridae/isolamento & purificação , Papillomaviridae/genéticaRESUMO
ABSTRACT: This Research Letter summarizes all updates to the 2019 Guidelines through September 2023, including: endorsement of the 2021 Opportunistic Infections guidelines for HIV+ or immunosuppressed patients; clarification of use of human papillomavirus testing alone for patients undergoing observation for cervical intraepithelial neoplasia 2; revision of unsatisfactory cytology management; clarification that 2012 guidelines should be followed for patients aged 25 years and older screened with cytology only; management of patients for whom colposcopy was recommended but not completed; clarification that after treatment for cervical intraepithelial neoplasia 2+, 3 negative human papillomavirus tests or cotests at 6, 18, and 30 months are recommended before the patient can return to a 3-year testing interval; and clarification of postcolposcopy management of minimally abnormal results.
Assuntos
Infecções por Papillomavirus , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Feminino , Gravidez , Humanos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia , Consenso , Gestão de Riscos , Colposcopia , Esfregaço Vaginal , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , PapillomaviridaeRESUMO
BACKGROUND: Abnormal uterine bleeding (AUB) is a common but understudied gynaecological problem, and data are lacking on emergency department (ED) visits and associated ED-to-inpatient admissions for AUB. This project aims to further understanding of the burden of AUB on patients and the healthcare system by establishing the number and characteristics of women with AUB in the ED and evaluating predictors of AUB-related inpatient hospitalisation in the USA. METHODS: This is a cross-sectional study of women presenting to the ED with non-malignant AUB in the 2016 US Nationwide Emergency Department Sample (NEDS). Clinical, demographic and hospital system factors were evaluated. χ2 and Mann-Whitney tests were used to compare the proportion of visits with each characteristic, resulting in inpatient admission versus discharge from the ED. Multivariable logistic regression models were used to analyse predictors of AUB in the ED and of AUB-related hospitalisations. RESULTS: There were 1.03 million AUB-related visits in the 2016 NEDS, of which 11.2% resulted in inpatient admission. Clinical as well as demographic and hospital system factors influenced ED disposition. Women with AUB tended to be of reproductive age, be underinsured, live in lower income and urban areas, and present to urban and public hospitals. However, older age, higher income, better insurance, presentation to private hospitals and rural residence predicted inpatient admission. CONCLUSIONS: Our study highlights the ED as an essential place of care for women with AUB while also demonstrating the importance of access to outpatient gynaecology services as some AUB-related ED visits may be preventable with outpatient care. The significant demographic and hospital system differences, as well as expected clinical differences, between women with AUB admitted to inpatient and women discharged from the ED imply structural biases impacting AUB-related ED care and add to the deepening understanding of health disparities.
Assuntos
Hospitalização , Pacientes Internados , Humanos , Feminino , Estados Unidos/epidemiologia , Estudos Transversais , Serviço Hospitalar de Emergência , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/terapiaRESUMO
BACKGROUND: Concern regarding pelvic examinations may be more common among women experiencing intimate partner violence. OBJECTIVE: We examined women's attitudes towards pelvic examination with history of intimate partner violence (pressured to have sex, or verbal, or physical abuse). DESIGN: Secondary analysis of data from a cluster randomized trial on contraceptive access. PARTICIPANTS: Women aged 18-25 were recruited at 40 reproductive health centers across the USA (2011-2013). MAIN MEASURES: Delays in clinic visits for contraception and preference to avoid pelvic examinations, by history of ever experiencing pressured sex, verbal, or physical abuse from a sexual partner, reported by frequency (never, rarely, sometimes, often). We used multivariable logistic regression with generalized estimating equations for clustered data. KEY RESULTS: A total of 1490 women were included. Ever experiencing pressured sex was reported by 32.4% of participants, with 16.5% reporting it rarely, 12.1% reporting it sometimes, and 3.8% reporting it often. Ever experiencing verbal abuse was reported by 19.4% and physical abuse by 10.2% of participants. Overall, 13.2% of participants reported ever having delayed going to the clinic for contraception to avoid having a pelvic examination, and 38.2% reported a preference to avoid pelvic examinations. In multivariable analysis, women reporting that they experienced pressured sex often had significantly higher odds of delaying a clinic visit for birth control (aOR 3.10 95% CI 1.39-6.84) and for reporting a preference to avoid pelvic examinations (aOR 2.91 95% CI 1.57-5.40). We found no associations between delay of clinic visits or preferences to avoid a pelvic examination and verbal or physical abuse. CONCLUSIONS: History of pressured sex from an intimate partner is common. Among women who have experienced pressured sex, concern regarding pelvic examinations is a potential barrier to contraception. Communicating that routine pelvic examinations are no longer recommended by professional societies could potentially reduce barriers and increase preventive healthcare visits.
Assuntos
Exame Ginecológico , Violência por Parceiro Íntimo , Adolescente , Adulto , Anticoncepção , Estudos Transversais , Feminino , Humanos , Comportamento Sexual , Parceiros Sexuais , Adulto JovemRESUMO
OBJECTIVE: To examine trends in the use of cervical cancer screening tests during 2013-2019 among commercially insured women. METHODS: The study population included women of all ages with continuous enrollment each year in the IBM MarketScan commercial or Medicare supplemental databases and without known history of cervical cancer or precancer (range = 6.9-9.8 million women per year). Annual cervical cancer screening test use was examined by three modalities: cytology alone, cytology plus HPV testing (cotesting), and HPV testing alone. Trends were assessed using 2-sided Poisson regression. RESULTS: Use of cytology alone decreased from 34.2% in 2013 to 26.4% in 2019 among women aged 21-29 years (P < .0001). Among women aged 30-64 years, use of cytology alone decreased from 18.9% in 2013 to 8.6% in 2019 (P < .0001), whereas cotesting use increased from 14.9% in 2013 to 19.3% in 2019 (P < .0001). Annual test use for HPV testing alone was below 0.5% in all age groups throughout the study period. Annually, 8.7%-13.6% of women aged 18-20 years received cervical cancer screening. There were persistent differences in screening test use by metropolitan residence and census regions despite similar temporal trends. CONCLUSIONS: Temporal changes in the use of cervical cancer screening tests among commercially insured women track changes in clinical guidelines. Screening test use among individuals younger than 21 years shows that many young women are inappropriately screened for cervical cancer.
Assuntos
Detecção Precoce de Câncer/tendências , Medicare/tendências , Infecções por Papillomavirus/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Alphapapillomavirus/isolamento & purificação , Colo do Útero/patologia , Colo do Útero/virologia , Bases de Dados Factuais/estatística & dados numéricos , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/normas , Teste de Papanicolaou/estatística & dados numéricos , Teste de Papanicolaou/tendências , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Guias de Prática Clínica como Assunto , Estados Unidos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/normas , Esfregaço Vaginal/estatística & dados numéricos , Esfregaço Vaginal/tendências , Adulto JovemRESUMO
The expeditious diagnosis and treatment of high-grade cervical precancers are fundamental to cervical cancer prevention. However, during the COVID-19 pandemic healthcare systems have at times restricted in-person visits to those deemed urgent. Professional societies provided some guidance to clinicians regarding ways in which traditional cervical cancer screening might be modified, but many gaps remained. To address these gaps, leaders of screening programs at an academic medical center and an urban safety net hospital in California formed a rapid-action committee to provide guidance to its practitioners. Patients were divided into 6 categories corresponding to various stages in the screening process and ranked by risk of underlying high-grade cervical precancer and cancer. Tiers corresponding to the intensity of the local pandemic were constructed, and clinical delays were lengthened for the lowest-risk patients as tiers escalated. The final product was a management grid designed to escalate and de-escalate with changes in the local epidemiology of the COVID-19 pandemic. While this effort resulted in substantial delays in clinical screening services as mandated by the healthcare systems, the population effects of delaying on both cervical cancer outcomes as well as the beneficial effects related to decreasing transmission of severe acute respiratory coronavirus 2 have yet to be elucidated.
Assuntos
COVID-19 , Neoplasias do Colo do Útero , Centros Médicos Acadêmicos , California , Detecção Precoce de Câncer , Feminino , Humanos , Pandemias , SARS-CoV-2 , Provedores de Redes de Segurança , Neoplasias do Colo do Útero/diagnósticoRESUMO
Social media has become a valuable tool for disseminating cancer prevention information. However, the design of messages for achieving wide dissemination remains poorly understood. We conducted a multi-method study to identify the effects of sender type (individuals or organizations) and content type (personal experiences or factual information) on promoting the spread of cervical cancer prevention messages over social media. First, we used observational Twitter data to examine correlations between sender type and content type with retweet activity. Then, to confirm the causal impact of message properties, we constructed 900 experimental tweets according to a 2 (sender type) by 2 (content type) factorial design and tested their probabilities of being shared in an online platform. A total of 782 female participants were randomly assigned to 87 independent 9-person online groups and each received a unique message feed of 100 tweets drawn from the 4 experimental cells over 5â¯days. We conducted both tweet-level and group-level analyses to examine the causal effects of tweet properties on influencing sharing behaviors. Personal experience tweets and organizational senders were associated with more retweets. However, the experimental study revealed that informational tweets were shared significantly more (19%, 95% CI: 11 to 27) than personal experience tweets; and organizational senders were shared significantly more (10%, 95% CI: 3 to 18) than individual senders. While rare personal experience messages can achieve large success, they are generally unsuccessful; however, there is a reproducible causal effect of messages that use organizational senders and factual information for achieving greater peer-to-peer dissemination.
Assuntos
Informação de Saúde ao Consumidor , Detecção Precoce de Câncer , Disseminação de Informação , Mídias Sociais/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Feminino , Promoção da Saúde , Humanos , Projetos de PesquisaRESUMO
Introduction: Many high value care educational interventions have focused on shaping clinical decision-making for individual patients. Few have investigated how trainees integrate cost information into recommendations within a public health context. Methods: Third-year medical students at the University of California San Francisco participated in a small group on benefits and harms of breast cancer screening. We randomly assigned half of small groups to view estimated total costs of different screening strategies. Students selected a screening strategy for coverage by a publicly funded program and one they would recommend to a hypothetical patient. We used the chi-square test for independence and chi-square test for trend to compare proportions. Results: A total of 267 third-year medical students participated. Exposure to costs was associated with selection of significantly less intensive screening strategies for coverage by a publicly funded program (p < 0.05). We found no significant differences in perspectives that involved recommendations for individual patients. Discussion: Students weigh cost considerations more heavily when making decisions about populations, rather than individual hypothetical patients. We suggest that it may be easier for students to relate cost considerations to populations. Initial curricular activities can be framed from this perspective with subsequent activities focusing on individual patient care.
Assuntos
Mamografia/economia , Mamografia/métodos , Uso Excessivo dos Serviços de Saúde/prevenção & controle , Estudantes de Medicina/psicologia , Custos e Análise de Custo , Tomada de Decisões , HumanosRESUMO
Importance: Ovarian cancer is relatively rare but the fifth-leading cause of cancer mortality among United States women. Objective: To systematically review evidence on benefits and harms of ovarian cancer screening among average-risk women to inform the United States Preventive Services Task Force. Data Sources: MEDLINE, PubMed, Cochrane Collaboration Registry of Controlled Trials; studies published in English from January 1, 2003, through January 31, 2017; ongoing surveillance in targeted publications through November 22, 2017. Study Selection: Randomized clinical trials of ovarian cancer screening in average-risk women that reported mortality or quality-of-life outcomes. Interventions included transvaginal ultrasound, cancer antigen 125 (CA-125) testing, or their combination. Comparators were usual care or no screening. Data Extraction and Synthesis: Independent critical appraisal and data abstraction by 2 reviewers. Meta-analytic pooling of results was not conducted because of the small number of studies and heterogeneity of interventions. Main Outcomes and Measures: Ovarian cancer mortality, false-positive screening results and surgery, surgical complications, and psychological effects of screening. Results: Four trials (N = 293â¯587) were included; of these, 3 (n = 293â¯038) assessed ovarian cancer mortality, and 1 (n = 549) reported only on psychological outcomes. Evaluated screening interventions included transvaginal ultrasound alone, transvaginal ultrasound plus CA-125 testing, and CA-125 testing alone. Test positivity for CA-125 was defined by a fixed serum level cutpoint or by a proprietary risk algorithm based on CA-125 level, change in CA-125 level over time, and age (risk of ovarian cancer algorithm [ROCA]). No trial found a significant difference in ovarian cancer mortality with screening. In the 2 large screening trials (PLCO and UKCTOCS, n = 271â¯103), there was not a statistically significant difference in complete intention-to-screen analyses of ovarian, fallopian, and peritoneal cancer cases associated with screening (PLCO: rate ratio, 1.18 [95% CI, 0.82-1.71]; UKCTOCS: hazard ratio [HR], 0.91 [95% CI, 0.76-1.09] for transvaginal ultrasound and HR, 0.89 [95% CI, 0.74-1.08] for CA-125 ROCA). Within these 2 trials, screening led to surgery for suspected ovarian cancer in 1% of women without cancer for CA-125 ROCA and in 3% for transvaginal ultrasound with or without CA-125 screening, with major complications occurring among 3% to 15% of surgery. Evidence on psychological harms was limited but nonsignificant except in the case of repeat follow-up scans and tests, which increased the risk of psychological morbidity in a subsample of UKCTOCS participants based on the General Health Questionnaire 12 (score ≥4) (odds ratio, 1.28 [95% CI, 1.18-1.39]). Conclusions and Relevance: In randomized trials conducted among average-risk, asymptomatic women, ovarian cancer mortality did not significantly differ between screened women and those with no screening or in usual care. Screening harms included surgery (with major surgical complications) in women found to not have cancer. Further research is needed to identify effective approaches for reducing ovarian cancer incidence and mortality.
Assuntos
Detecção Precoce de Câncer , Programas de Rastreamento , Neoplasias Ovarianas/diagnóstico , Doenças Assintomáticas , Antígeno Ca-125/sangue , Detecção Precoce de Câncer/métodos , Reações Falso-Positivas , Feminino , Humanos , Programas de Rastreamento/efeitos adversos , Neoplasias Ovarianas/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , UltrassonografiaRESUMO
BACKGROUND: The American Congress of Obstetricians and Gynecologists recommends that a pelvic examination be offered to asymptomatic women after an informed discussion with their provider. Although the adverse health outcomes that the examination averts were not delineated, the organization stated that it helps establish open communication between patients and physicians. Recent surveys have focused on obstetrician-gynecologists' attitudes and beliefs about the examination, but the perspectives of women have not been well-characterized. OBJECTIVE: The purpose of this study was to better understand women's beliefs about the purpose and value of routine pelvic examinations. STUDY DESIGN: We completed structured interviews with 262 women who were 21-65 years old who agreed to participate in a 50-minute interview about cervical cancer screening. Recruitment took place in outpatient women's clinics at a public hospital and an academic medical center in San Francisco, CA. Women were shown an illustration of a bimanual pelvic examination and asked a series of closed-ended questions: if they knew why it was performed, if it reassured them of their health, and if they believed it helped establish open communication with their provider. Women were asked an open-ended question about their perception of the examination's purpose. Multivariable logistic regression analysis was used to identify demographic predictors of responses. RESULTS: Approximately one-half of the participants (56%) stated that they knew the examination's purpose. The most frequently cited reason was assurance of normalcy. Most of participants (82%) believed that the examination reassured them of their health. Approximately two-thirds of the participants (62%) believed that the examination helps establish open communication with their provider. In multivariate analyses, older age (≥45 years) independently predicted a higher likelihood of a belief that they knew the examination's purpose (odds ratio, 2.9; 95% confidence interval, 1.5-5.6) and a belief that it facilitates open communication (odds ratio, 2.1; 95% confidence interval, 1.1-3.9). Non-white race also was associated with a belief that the examination helps facilitate open communication between patients and providers (odds ratio, 1.9; 95% confidence interval, 1.1-3.1). CONCLUSION: Approximately one-half of the women who participated in our study reported not knowing the purpose of the pelvic examination, yet most of them believed it to be of some value, especially reassurance of health. To achieve shared, informed decision-making, clinicians will need to communicate better to their patients the examination's purpose.
Assuntos
Exame Ginecológico , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Idoso , Atitude Frente a Saúde , Comunicação , Feminino , Doenças dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/diagnóstico , Humanos , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Relações Médico-Paciente , São Francisco , Inquéritos e Questionários , Neoplasias do Colo do Útero/prevenção & controle , Saúde da MulherRESUMO
BACKGROUND: The American College of Physicians strongly recommends against performing pelvic examinations in asymptomatic, nonpregnant women, citing evidence of harm (false-positive testing, unnecessary surgery) and no evidence of benefit. In contrast, the American Congress of Obstetricians and Gynecologists recommends pelvic examinations in asymptomatic women beginning at age 21 years, citing expert opinion. OBJECTIVE: We sought to evaluate if providing women with professional societies' conflicting statements about pelvic examinations (recommendations and rationales) would influence their desire for a routine examination. STUDY DESIGN: We recruited 452 women ages 21-65 years from 2 women's clinics to participate in a 50-minute face-to-face interview about cervical cancer screening that included a 2-phase study related to pelvic examinations. In the first phase, 262 women were asked about their desire for the examination without being provided information about professional societies' recommendations. In the second phase, 190 women were randomized to review summaries of the American College of Physicians or American Congress of Obstetricians and Gynecologists statement followed by an interview. RESULTS: First-phase participants served as the referent: 79% (208/262) indicated they would want a routine examination if given a choice. In the second phase, a similar percentage of women randomized to the American Congress of Obstetricians and Gynecologists summary had this desire (82%: 80/97; adjusted odds ratio, 1.37; 95% confidence interval, 0.69-2.70). Women randomized to the American College of Physicians summary, however, were less likely to indicate they would opt for an examination (39%: 36/93; adjusted odds ratio, 0.12; 95% confidence interval, 0.06-0.21). Overall, 94% (179/190) believed the potential benefits and harms should be discussed prior to the examination. CONCLUSION: Providing women with a professional society's recommendation advising against routine pelvic examinations substantially reduced their desire to have one. Educational materials are needed to ensure women's informed preferences and values are reflected in decisions about pelvic examinations.
Assuntos
Exame Ginecológico/normas , Preferência do Paciente , Sociedades Médicas , Adulto , Idoso , Tomada de Decisões , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Adulto JovemRESUMO
DESCRIPTION: The purpose of this best practice advice article is to describe the indications for screening for cervical cancer in asymptomatic, average-risk women aged 21 years or older. METHODS: The evidence reviewed in this work is a distillation of relevant publications (including systematic reviews) used to support current guidelines. BEST PRACTICE ADVICE 1: Clinicians should not screen average-risk women younger than 21 years for cervical cancer. BEST PRACTICE ADVICE 2: Clinicians should start screening average-risk women for cervical cancer at age 21 years once every 3 years with cytology (cytologic tests without human papillomavirus [HPV] tests). BEST PRACTICE ADVICE 3: Clinicians should not screen average-risk women for cervical cancer with cytology more often than once every 3 years. BEST PRACTICE ADVICE 4: Clinicians may use a combination of cytology and HPV testing once every 5 years in average-risk women aged 30 years or older who prefer screening less often than every 3 years. BEST PRACTICE ADVICE 5: Clinicians should not perform HPV testing in average-risk women younger than 30 years. BEST PRACTICE ADVICE 6: Clinicians should stop screening average-risk women older than 65 years for cervical cancer if they have had 3 consecutive negative cytology results or 2 consecutive negative cytology plus HPV test results within 10 years, with the most recent test performed within 5 years. BEST PRACTICE ADVICE 7: Clinicians should not screen average-risk women of any age for cervical cancer if they have had a hysterectomy with removal of the cervix.
Assuntos
Detecção Precoce de Câncer , Programas de Rastreamento , Neoplasias do Colo do Útero/diagnóstico , Adulto , Fatores Etários , Detecção Precoce de Câncer/efeitos adversos , Detecção Precoce de Câncer/estatística & dados numéricos , Medicina Baseada em Evidências , Feminino , Testes de DNA para Papilomavírus Humano/estatística & dados numéricos , Humanos , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Fatores de Risco , Procedimentos Desnecessários/economia , Esfregaço Vaginal/estatística & dados numéricos , Adulto JovemAssuntos
Colposcopia/métodos , Detecção Precoce de Câncer/métodos , Gestão de Riscos/métodos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Consenso , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Medição de Risco , Sociedades Médicas , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal , Adulto JovemAssuntos
Colo do Útero/patologia , Detecção Precoce de Câncer , Neoplasias do Colo do Útero/terapia , Algoritmos , Feminino , Humanos , Infecções por Papillomavirus/diagnóstico , Guias de Prática Clínica como Assunto , Neoplasias do Colo do Útero/diagnóstico , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/terapiaRESUMO
OBJECTIVE: The primary cervical cancer screening strategy for women over age 30 is high-risk human papillomavirus (HPV) testing combined with Papanicolaou (Pap) testing (cotesting) every 5 years. This combination strategy is a preventive service that is required by the Affordable Care Act to be covered with no cost-sharing by most health insurance plans. The cotesting recommendation was made based entirely on prospective data from an insured population that may have a lower proportion of women with HPV positive and Pap negative results (ie, discordant results). The discordant group represents a very difficult group to manage. If the frequency of discordant results among underserved women is higher, health care providers may perceive the cotesting strategy to be a less favorable screening strategy than traditional Pap testing every 3 years. STUDY DESIGN: The Centers for Disease Control and Prevention's Cervical Cancer Study was conducted at 15 clinics in 6 federally qualified health centers across Illinois. Providers at these clinics were given the option of cotesting for routine cervical cancer screening. Type-specific HPV detection was performed on residual extracts using linear array. RESULTS: Pap test results were abnormal in 6.0% and HPV was positive in 7.2% of the underserved women screened in this study (mean age, 45.1 years). HPV prevalence decreased with age, from 10.3% among 30- to 39-year-olds to 4.5% among 50- to 60-year-olds. About 5% of the women had a combination of a positive HPV test and normal Pap test results; HPV 16/18 was identified in 14% of discordant women. CONCLUSION: The rate of discordant results among underserved women was similar to those reported throughout the US in a variety of populations. Typing for HPV 16/18 appears to assist in the management in a small proportion of women with discordant results.
Assuntos
Teste de Papanicolaou , Infecções por Papillomavirus/diagnóstico , Pobreza , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal , Populações Vulneráveis , Adulto , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Illinois , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Estudos Prospectivos , Neoplasias do Colo do Útero/virologia , Displasia do Colo do Útero/virologiaRESUMO
OBJECTIVE: With newer recommendations for less frequent cervical cancer screening, longer intervals between routine gynecologic examinations might also be considered. METHODS: A nationally representative mailed survey of U.S. obstetrician-gynecologists (n=521, response rate 62%) was conducted in 2010-11. Clinicians were asked their views on annual gynecologic examinations and on the consequences of extending the interval from annually to every 3 years for asymptomatic patients. RESULTS: Over two-thirds considered annual gynecologic examination very important for women in their reproductive years (69%); fewer consider it very important for women in menopause (55%). Most anticipated that shifting examinations to every 3 years would result in lower patient satisfaction (78%), contraceptive provision (74%), and patient health and well-being (74%). Decreases in clinic volume (93%) and financial reimbursement (78%) were also expected. Anticipated effects of longer intervals varied by provider characteristics, geography, and practice setting. CONCLUSION: Obstetrician-gynecologists in the U.S. believed that longer intervals between routine examinations would have negative repercussions for patients and medical practice, but there were differences by region, practice, and personal characteristics. Redefining annual gynecologic visits as contraceptive counseling and health maintenance visits could address financial and patient volume concerns, and perspectives from patients and other providers might reveal possible benefits of less frequent gynecologic examinations.
Assuntos
Exame Ginecológico/estatística & dados numéricos , Ginecologia/normas , Conhecimentos, Atitudes e Prática em Saúde , Obstetrícia/normas , Médicos/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Feminino , Ginecologia/métodos , Pesquisas sobre Atenção à Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obstetrícia/métodos , Satisfação do Paciente , Médicos/estatística & dados numéricos , Serviços Preventivos de Saúde/economia , Saúde Reprodutiva , Inquéritos e Questionários , Fatores de Tempo , Estados Unidos , Neoplasias do Colo do Útero/diagnósticoAssuntos
Detecção Precoce de Câncer/normas , Teste de Papanicolaou/normas , Papillomaviridae/isolamento & purificação , Guias de Prática Clínica como Assunto , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/normas , Adulto , Colposcopia , Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Feminino , Humanos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Background: Tubal sterilization is more commonly utilized by racial/ethnic minority groups and has been implicated in underscreening for cervical cancer. The objective is to determine if prior tubal sterilization is a risk factor for cervical cancer underscreening. Methods: National Survey of Family Growth dataset from 2015 to 2019 used for analysis; data were weighted to represent the 72 million women in the U.S. population aged 22-49. Chi-square tests, Fisher exact tests, and logistic regression were used for analysis. The primary predictor variable was tubal sterilization which was categorized into no previous sterilization, sterilization completed <5 years ago, and sterilization completed ≥5 years ago. The outcome variable was underscreened versus not underscreened. Other predictor variables included age, household income as a percent of federal poverty level, previous live birth, primary care provider, and insurance status. Results: Prevalence of tubal sterilization completed 5 or more years ago was 12.5% and varied by most measured characteristics in univariate analyses. Approximately 8% of women were underscreened for cervical cancer. In multivariable analyses, women with a tubal sterilization 5 or more years ago had 2.64 times the odds (95% confidence interval = 1.75-4.00) of being underscreened for cervical cancer compared with women who did not have a tubal sterilization. Conclusions: Approximately 4.3 million women ages 22-49 in the United States are potentially underscreened for cervical cancer and women with previous tubal ligation ≥5 years ago are more likely to be underscreened. These results may inform the need for culturally sensitive public health messages informing people who have had these procedures about the need for continued screening.