Factors Associated With Timely Receipt of Colposcopy After Abnormal Cervical Cancer Screening

The aim of the study was to examine factors associated with timely colposcopy following abnormal cervical cancer screening among patients receiving care at an urban safety-net obstetrics and gynecology clinic.

In this cohort study, the authors reviewed the care cycle of index abnormal cervical cancer screening requiring colposcopy follow-up from 3 separate years: 2016, 2018, and 2021. Primary outcomes included colposcopy attendance and timely colposcopy evaluation based on established guidelines. Multivariable log binomial regression models were used to evaluate patient characteristics and outcomes.

Across the 3 years, the authors identified 820 abnormal cervical cancer screening results from 752 patients for which a colposcopy was indicated. Of these patients, 42.2% identified as non-Hispanic Black, 79.7% were English-speaking, and 80.0% were publicly insured. Pap tests requiring colposcopy resulted in completion 85.2% of the time, with 59.8% completed within guideline-concordant intervals. Human papillomavirus-vaccinated patients were less likely to attend colposcopy (relative risk [RR] = 0.84, 95% confidence interval [CI] = 0.76-0.93). Current smokers had lower colposcopy attendance compared to never-smokers (RR = 0.89, 95% CI = 0.81-0.98). Timely colposcopy took place 59.6% of the time in 2016, 56.9% of the time in 2018, and 63.3% of the time in 2021. Patients aged 40-49 and 50-64 were more likely to complete colposcopy within guideline recommended intervals than those younger than age 30 (RR = 1.23, 95% CI = 1.03-1.47; RR = 1.38, 95% CI = 1.15-1.66).

Despite modest overall improvement in the rate of guideline-concordant colposcopy attendance, significant gaps in timely follow-up persist. Targeted interventions are needed to improve follow-up care, particularly for younger patients and smokers.