Guideline adherent colposcopy completion following abnormal cervical cancer screening.
Authors: Patel Anisha V. , Tong Guangyu , Jones Beth A. , Hernandez-Ramirez Raul U. , Tang Wanyi , Megiel Sarah , Foster Jamie , Girgis Abigail , Spiegelman Donna , Sheth Sangini S 
Published: June 2023

e17510

Background: Cervical cancer (CC) prevention relies upon timely management of abnormal screening results. Established recommended follow-up intervals for colposcopy after abnormal CC screening results exist for high-grade and low-grade abnormalities. Despite these guidelines, CC incidence is disproportionately higher in Black and Hispanic/Latino women in the US. Differential follow-up of abnormal screening results and delays in diagnosis may contribute to these disparities despite well-defined CC prevention measures. We investigated factors associated with guideline adherent colposcopy scheduling and attendance. Methods: Clinical and demographic medical record data was collected for patients with abnormal CC screening results from 2/2021 to 1/2022 at a large urban OB/GYN clinic in Connecticut. Timely colposcopy was defined as completion within 8 weeks from final CC screening result for high-grade abnormalities and 90 days for low-grade abnormalities. Clinical and demographic characteristics of patients needing colposcopy were examined. Association between these factors and completion of guideline adherent colposcopy was evaluated using univariate and multivariate regression. Colposcopy scheduling and attendance outcomes were compared by Pap grade using univariate regression and the Mann Whitney U test. Results: Overall, most of the 248 patients needing colposcopy identified as Black or Hispanic, spoke English, were publicly insured, had a low-grade Pap abnormality, and never smoked; half had received at least one dose of HPV vaccine. Among them, 215 (87%) received colposcopy ever and 190 (77%) received colposcopy within the guideline recommend interval. Race/ethnicity, preferred language, insurance status, pap grade, and smoking status were not significantly associated with receipt of timely colposcopy. In multivariate analysis only pregnancy was significantly associated with colposcopy receipt within the guideline recommended interval (RR=1.37, 95% CI: 1.11–1.69, p=0.004). There was no difference in receipt of colposcopy by pap grade. Scheduling of an initial colposcopy appointment was significantly lower among women with low-grade vs. high-grade CC screening abnormalities (94% vs. 100%, RR=1.03, 95% CI: 1.01–1.04, p<0.001). Patients with low-grade vs. high-grade abnormalities experienced similar numbers of no shows or cancellations for colposcopy appointments, with a maximum of 4 no shows or cancellations in each group. Conclusions: Evaluation of abnormal CC screening with colposcopy within guideline adherent time intervals can reduce diagnostic delays. Except for pregnancy, when there is increased interaction with healthcare, no other factors were associated with timely receipt of colposcopy. Further research on factors associated with receipt of colposcopy can contribute to implementation strategies to improve rates of timely follow-up for CC prevention.