Variation in cervical cancer screening test utilization and results in a United States-based program.

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.

Changes in Screening Test Volume in the National Breast and Cervical Cancer Early Detection Program during the COVID-19 Pandemic, 2020-2022.

INTRODUCTION: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) observed significant declines in screening volume early in the COVID-19 pandemic, January-June 2020, with variation by race/ethnicity and geography. We aimed to determine how screening in the NBCCEDP recovered from these early declines as it is important for monitoring the long-term impact on women served by the program. METHODS: Extending the previous analyses, we compared monthly breast (BC) and cervical cancer (CVC) screening volume in the NBCCEDP during 2020-2022, to five-year, pre-COVID-19 pandemic averages (2015-2019), and calculated percent change. Results were stratified by race/ethnicity and rurality groups. We employed multiple one-way ANOVA tests, which included multiple comparisons, to test for significant differences between groups. RESULTS: By December 2022, NBCCEDP breast and cervical cancer screening volumes had not fully recovered to pre-COVID-19 5-year averages, and recovery in breast cancer screening volume was slower than that of cervical cancer. Both BC and CVC screening among women in metro areas showed the smallest average monthly deficits (-8.8% BC and -4.9% CVC) compared to monthly pre-COVID-19 pandemic 5-year averages, and screening among women in rural areas showed the greatest deficits (-37.3% BC and -26.7% CVC). BC and CVC screening among Hispanic women showed the greatest improvements compared to the pre-COVID-19 averages (8.2% BC and 9.5% CVC), and cervical cancer screening among non-Hispanic Asian and Pacific Islander women showed the greatest deficits (-41.4% CVC). CONCLUSION: For increased intervention efforts, NBCCEDP recipients can focus on populations demonstrating greatest deficits in screening volume.