Trends in cervical cancer screening modality in the active component U.S. military, 2013-2023

Cervical cancer screening recommendations have evolved in the past 20 years. Several recent studies have reported on practice pattern changes in the U.S. in response to these guideline changes, but practice patterns have not yet been evaluated in the Military Health System (MHS). Data for active component service women were queried from the Defense Medical Surveillance System for relevant inpatient and outpatient encounter codes within the MHS between January 1, 2013 and December 31, 2023 to identify instances of cervical cancer screening and classify each by modality: cytology alone, HPV alone, and co-testing. Trends in the use of each were evaluated within age categories: younger than age 21 years, ages 21-29 years, ages 30-64 years. A total of 378,952 screening events were captured from 2013 through 2023. MHS practice patterns demonstrated a response to national guideline changes, including increased co-testing and evidence of increasing primary HPV screening among women aged 30-64 years. Cervical cancer screening in women younger than age 21 years markedly decreased following recommendations against screening in this age group. The overall trends in the MHS are similar to those reported in the U.S. general population. Trends in use of each screening modality-cytology, primary HPV, and co-testing-for active component service women are shifting in response to changing national guidelines. There is emerging evidence of increasing primary HPV screening in women ages 30-64 years, especially after 2021.