Accessibility of Criteria to Exit Cervical Cancer Screening at Age 65 Years in the Electronic Health Record

To describe the proportion of patients with documentation of meeting cervical cancer screening exit criteria in the medical record and to estimate the incidence of cancer and high-grade precancerous lesions after age 65 years detected by the end of the study period, by screening exit eligibility.

We conducted a retrospective analysis of patients who turned 66 years old between 2010 and 2019 at two large health care systems located in Dallas, Texas, and Boston, Massachusetts, from the METRICS (MultilEvel opTimization of the ceRvIcal Cancer Screening process in diverse Settings & populations) Research Center, part of the PROSPR II (Population-based Research to Optimize the Screening Process) consortium. The primary outcomes were 1) the percentage of patients who were eligible for screening exit at age 66 years after adequate documented negative screening history (at least three consecutive negative cytology test results or two consecutive negative human papillomavirus [HPV] test or co-test results [cytology+HPV testing] within the prior 10 years) and 2) the worst pathology or cytology outcome documented in the cohort after age 65 years.

Among 42,393 people who turned 66 years old while in the METRICS cohort, approximately 75.7% (n=32,094) were not eligible to exit screening at age 66 years, primarily because too few screening tests were documented (n=29,354, 91.5% of those ineligible). Furthermore, only 4,037 patients at both sites had 10 years of prior observation within the health care system, meaning data from current and prior health care delivery sites would be needed to assess exit eligibility for more than 90% of the cohort. Patients remained in the cohort after their 66th birthday on average for 3.8 years (interquartile range 2.0-6.5 years), and most (79.3%) had no subsequent evaluation after their 66^th birthday. Among those ineligible to exit due to insufficient screening history, 83.7% were not subsequently screened. Of the 16.3% who were screened, 90 (1.9%) were diagnosed with cancer or high-grade precancerous lesions, including 34 (0.7%) who were diagnosed with cervical cancer. By contrast, among patients eligible to exit with sufficient screening history, 34.3% had at least one subsequent cytology or pathology result or both, and high-grade precancerous lesions or cervical cancer were diagnosed in only 0.6% (n=16).

Data documented in the medical record are often insufficient to meet guidelines for exiting cervical cancer screening.