Characterizing Cervical Cancer Screening in the US: Preparing for the Era of Self-Collection.

Abstract

Cervical cancer screening (CCS) is shifting from in-office to self-screening. The primary aim of this study is to define a baseline distribution of in-office CCS providers by specialty and the race/ethnicity and age of those screened. We extracted electronic health record data (Truveta-multiple health systems in 34 states) of individuals eligible for CCS aged 21 to 65, documented between January 1, 2017-December 31, 2022. Those with a hysterectomy before 2017, had any gynecological cancer at any time, or had evidence of CCS after the hysterectomy, except if there was a history of cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3) disease were excluded. We reported the total number of CCS and colposcopies per eligible patient and the specialty of the performing clinician (medical taxonomy). Among the 2,439,331 individuals included in the study, the average age was 42.9 (SD 11.7). There were 3,412,148 CCSs linked with 1 of 3 provider specialties: obstetrics & gynecology (OG), family medicine (FM), and general internal medicine (GIM). OG provided less than half of all CCS, dropping to 31.6% of those 50 to 65. While only 70.5% (1,718,914) of the population received at least 1 CCS during the study, the mean CCS per patient was 2.6 (SD 2.7). The rate of colposcopy after a CCS was 3.9%. Family and Internal Medicine clinicians provide the majority of CCS in the US (61.9%), particularly for people aged 50 to 65 (68.4%), when cervical cancer risk is the highest.