BACKGROUND: New guidelines for managing cervical precancer among women in the United States use risk directly to guide clinical actions for individuals who are being screened. These risk-based management guidelines have previously only been based on risks from a large integrated healthcare system. We present here data representative of women of low income without continuous insurance coverage to inform the 2019 guidelines and ensure applicability. OBJECTIVE: We examined the risks of high-grade precancer after human papillomavirus and cytology tests in underserved women and assessed the applicability of the 2019 guidelines to this population. STUDY DESIGN: We examined cervical cancer screening and follow-up data among 363,546 women enrolled in the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program from 2009 to 2017. We estimated the immediate (prevalent) risks of cervical intraepithelial lesion grade 3 or cancer by using prevalence-incidence mixture models. Risks were estimated for each combination of human papillomavirus and cytology result and were stratified by screening history. We compared these risks with published estimates used in new risk-based management guidelines. RESULTS: Women who were up-to-date with their screening, defined as being screened with cytology within the past 5 years, had immediate risks of cervical intraepithelial neoplasia grade 3 or higher similar to that of women at Kaiser Permanente Northern California, whose data were used to develop the management guidelines. However, women in the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program had greater immediate risks if they were never screened or not up-to-date with their screening. CONCLUSION: New cervical risk-based management guidelines are applicable for underinsured and uninsured women with a low income in the United States who are up-to-date with their screening. The increased risk observed here among women who received human papillomavirus-positive, high-grade cytology results, who were never screened, or who were not up-to-date with their cervical cancer screening, led to a recommendation in the management guidelines for immediate treatment among these women. Published by Elsevier Inc.
BACKGROUND: New guidelines for managing cervical precancer among women in the United States use risk directly to guide clinical actions for individuals who are being screened. These risk-based management guidelines have previously only been based on risks from a large integrated healthcare system. We present here data representative of women of low income without continuous insurance coverage to inform the 2019 guidelines and ensure applicability. OBJECTIVE: We examined the risks of high-grade precancer after human papillomavirus and cytology tests in underserved women and assessed the applicability of the 2019 guidelines to this population. STUDY DESIGN: We examined cervical cancer screening and follow-up data among 363,546 women enrolled in the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program from 2009 to 2017. We estimated the immediate (prevalent) risks of cervical intraepithelial lesion grade 3 or cancer by using prevalence-incidence mixture models. Risks were estimated for each combination of human papillomavirus and cytology result and were stratified by screening history. We compared these risks with published estimates used in new risk-based management guidelines. RESULTS: Women who were up-to-date with their screening, defined as being screened with cytology within the past 5 years, had immediate risks of cervical intraepithelial neoplasia grade 3 or higher similar to that of women at Kaiser Permanente Northern California, whose data were used to develop the management guidelines. However, women in the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program had greater immediate risks if they were never screened or not up-to-date with their screening. CONCLUSION: New cervical risk-based management guidelines are applicable for underinsured and uninsured women with a low income in the United States who are up-to-date with their screening. The increased risk observed here among women who received human papillomavirus-positive, high-grade cytology results, who were never screened, or who were not up-to-date with their cervical cancer screening, led to a recommendation in the management guidelines for immediate treatment among these women. Published by Elsevier Inc.
Entities:
Keywords:
HPV and cytology cotesting; cervical cancer screening; low-income women; risk-based management guidelines
Authors: L Stewart Massad; Mark H Einstein; Warner K Huh; Hormuzd A Katki; Walter K Kinney; Mark Schiffman; Diane Solomon; Nicolas Wentzensen; Herschel W Lawson Journal: Obstet Gynecol Date: 2013-04 Impact factor: 7.661
Authors: Li C Cheung; Qing Pan; Noorie Hyun; Mark Schiffman; Barbara Fetterman; Philip E Castle; Thomas Lorey; Hormuzd A Katki Journal: Stat Med Date: 2017-06-28 Impact factor: 2.373
Authors: Rebecca B Perkins; Richard S Guido; Philip E Castle; David Chelmow; Mark H Einstein; Francisco Garcia; Warner K Huh; Jane J Kim; Anna-Barbara Moscicki; Ritu Nayar; Mona Saraiya; George F Sawaya; Nicolas Wentzensen; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2020-04 Impact factor: 1.925
Authors: Susan J Curry; Alex H Krist; Douglas K Owens; Michael J Barry; Aaron B Caughey; Karina W Davidson; Chyke A Doubeni; John W Epling; Alex R Kemper; Martha Kubik; C Seth Landefeld; Carol M Mangione; Maureen G Phipps; Michael Silverstein; Melissa A Simon; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2018-08-21 Impact factor: 56.272
Authors: Nancy C Lee; Faye L Wong; Patricia M Jamison; Sandra F Jones; Louise Galaska; Kevin T Brady; Barbara Wethers; George-Ann Stokes-Townsend Journal: Cancer Date: 2014-08-15 Impact factor: 6.860
Authors: Li C Cheung; Didem Egemen; Xiaojian Chen; Hormuzd A Katki; Maria Demarco; Amy L Wiser; Rebecca B Perkins; Richard S Guido; Nicolas Wentzensen; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2020-04 Impact factor: 3.842
Authors: Didem Egemen; Li C Cheung; Xiaojian Chen; Maria Demarco; Rebecca B Perkins; Walter Kinney; Nancy Poitras; Brian Befano; Alexander Locke; Richard S Guido; Amy L Wiser; Julia C Gage; Hormuzd A Katki; Nicolas Wentzensen; Philip E Castle; Mark Schiffman; Thomas S Lorey Journal: J Low Genit Tract Dis Date: 2020-04 Impact factor: 3.842
Authors: Maria Demarco; Didem Egemen; Noorie Hyun; Xiaojian Chen; Anna-Barbara Moscicki; Li Cheung; Olivia Carter-Pokras; Anne Hammer; Julia C Gage; Megan A Clarke; Philip E Castle; Brian Befano; Jie Chen; Cher Dallal; Xin He; Kanan Desai; Thomas Lorey; Nancy Poitras; Tina R Raine-Bennett; Rebecca B Perkins; Nicolas Wentzensen; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2022-04-01 Impact factor: 3.842
Authors: Mona Saraiya; Jean Colbert; Geeta L Bhat; Rose Almonte; David W Winters; Sharon Sebastian; Michael O'Hanlon; Ginny Meadows; Michael R Nosal; Thomas B Richards; Maria Michaels; Julie S Townsend; Jacqueline W Miller; Rebecca B Perkins; George F Sawaya; Nicolas Wentzensen; Mary C White; Lisa C Richardson Journal: J Womens Health (Larchmt) Date: 2022-04 Impact factor: 3.017
Authors: Rebecca B Perkins; Rachael Adcock; Vicki Benard; Jack Cuzick; Alan Waxman; Jean Howe; Stephanie Melkonian; Janis Gonzales; Charles Wiggins; Cosette M Wheeler Journal: Prev Med Date: 2021-08-18 Impact factor: 4.018