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MMWR: Cervical Cancer Screening Among Women Aged 18–30 Years

January 4, 2013 / 61(51);1038-1042
Screening women for cervical cancer can save lives. However, among young women, cervical cancer is relatively rare (1,2), and too-frequent screening can lead to high costs and adverse events associated with overtreatment (3). Before 2012, cervical cancer screening guidelines of the American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS), and U.S. Preventive Services Task Force (USPSTF) differed on age to start and how often to get screened for cervical cancer. (4). In 2012, however, all three organizations recommended that 1) screening by Papanicolau (Pap) test should not be used for women aged <21 years, regardless of initiation of sexual activity, and 2) a screening interval of 3 years should be maintained for women aged 21–30 years. ACS and ACOG explicitly recommend against yearly screening (5–7). To assess trends in Pap testing before the new guidelines were introduced, CDC analyzed 2000–2010 data from the Behavioral Risk Factor Surveillance System (BRFSS) for women aged 18–30 years. CDC found that, among women aged 18–21 years, the percentage reporting never having been screened increased from 26.3% in 2000 to 47.5% in 2010, and the proportion reporting having had a Pap test in the past 12 months decreased from 65.0% to 41.5%. Among those aged 22–30 years, the proportion reporting having had a Pap test within the preceding 12 months decreased from 78.1% to 67.0%. These findings showed that Pap testing practices for young women have been moving toward the latest guidelines. However, the data also showed a concerning trend: among women aged 22–30 years, who should be screened every 3 years, the proportion who reported never having had a Pap test increased from 6.6% to 9.0%. More effort is needed to promote acceptance of the latest evidence-based recommendations so that all women receive the maximal benefits of cervical cancer screening.

BRFSS is a state-based, random-digit–dialed telephone survey of the noninstitutionalized, U.S. civilian adult population aged ≥18 years. During 2000–2010, women respondents were asked, “Have you ever had a Pap test?” Those answering “yes” were asked about the timing of their last test. Pap test status was categorized into four mutually exclusive groups (never, within 12 months, within 13–24 months, and within 25–36 months). Women who reported having had their last Pap test >36 months ago (<5%) were not categorized. Survey response rates ranged from 46.0% to 55.7% over the 10-year study period.

Data were collected during 2000–2010 from 125,297 women aged 18–30 years who lived in the 50 states and the District of Columbia. Pap test status was analyzed by age group, race/ethnicity, U.S. Census region,* and health-care coverage status. Unadjusted logistic regression models were used to test for statistical differences in Pap testing behaviors over the 10-year period, with year treated as a categorical variable. Percentages and 95% confidence intervals were calculated; differences in percentages were considered statistically significant at p≥0.05. All analyses were performed using statistical software to account for the complex sampling design.

Among women aged 18–21 years, an increase from 26.3% in 2000 to 47.5% in 2010 was observed in the percentage reporting never having been tested (Table 1), and a decrease from 65.0% in 2000 to 41.5% in 2010 was observed in the percentage reporting a Pap test within the preceding 12 months (Figure). Among women in this age group, an increase in reporting never having been tested was observed in all racial/ethnic categories (Table 1).

Among women aged 22–30 years, a decrease from 78.1% in 2000 to 67.0% in 2010 was observed in the percentage reporting a Pap test within the preceding 12 months (Table 2). From 2000 to 2010, increases were observed in the percentages of women aged 22–30 years who reported having had a Pap test within the preceding 13–24 (9.8% to 15.3%) and 25–36 months (2.6% to 4.5%) (Figure). Among women in this age group, increases in reported Pap tests within the preceding 13–36 months were observed in all racial/ethnic categories (Table 2).

Whereas more women who did not need screening reported not being screened, an increase also was observed in the number of women who did need screening but reported not being screened. Among women aged 18–21 years, the percentage who reported never having had a Pap test increased from 26.3 to 47.5%, whereas, among women aged 22–30 years, the percentage who reported never having had a Pap test increased from 6.6% in 2000 to 9.0% in 2010.

Full report can be found here: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6151a2.htm?s_cid=mm6151a2_w

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