Risk of cervical precancer and cancer among uninsured and underserved women from 2009 to 2017 - 25/03/21
, Li C. Cheung, PhD b, 1, Ashwini Soman, MBBS, MPH a, Jacqueline Mix, PhD, MPH a, Kristy Kenney, MPH a, Xiaojian Chen, MS b, Rebecca B. Perkins, MD, MPH c, Mark Schiffman, MD, MPH b, Nicolas Wentzensen, MD, PhD b, Jacqueline Miller, MD aAbstract |
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.
Le texte complet de cet article est disponible en PDF.Key words : cervical cancer screening, HPV and cytology cotesting, low-income women, risk-based management guidelines
Plan
| This analysis was funded in part by the Intramural Research Program of the US National Institutes of Health (NIH)/National Cancer Institute. |
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| The authors report no conflict of interest. |
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| The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. |
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| Cite this article as: Saraiya M, Cheung LC, Soman A, et al. Risk of cervical precancer and cancer among uninsured and underserved women 2009 to 2017. Am J Obstet Gynecol 2021;224:366.e1-32. |
Vol 224 - N° 4
P. 366.e1-366.e32 - avril 2021 Retour au numéro
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