Adherence to 2019 ASCCP Cervical Cancer Screening Guidelines at a Community Health Network

We evaluated the adherence of cervical cancer screening (CCS) to ASCCP guidelines in the United States within a single hybrid community-academic institution.

In this retrospective cohort study, pap smears from October 2022 through December 2023 were abstracted from the electronic medical record. Adherence with CCS was determined by collecting tests ordered, the interval between tests, and subsequent result management. The findings were classified as adherent (appropriate order, interval, and management) or nonadherent. Descriptive statistics were employed.

Three hundred and forty-eight pap smears were included; 225 (65%) were normal and 123 (35%) were abnormal. Two hundred thirty-two (67%) were nonadherent with ASCCP guidelines, while 116 (33%) were adherent. Of the nonadherent pap smears, 71 (31%) were ordered incorrectly, most commonly due to lack of HPV cotesting (87%); 190 (55%) were performed at an incorrect interval, most commonly due to an inappropriately short interval (89%); and 63 (18%) were managed inappropriately, most commonly due to lack of indicated colposcopy (57%) or unnecessary colposcopy (33%). Based on specific cytology results, overall adherence, appropriateness of interval, and order type did not vary between results ( p =.18, p =.71, p =.23, respectively); however, the subsequent management was significantly different based on the cytology ( p <.001). There were significant differences among provider type ( p =.01) and practice ( p <.001), but no difference by age, BMI, or medical comorbidity.

In this cohort, the majority of pap smears were nonadherent, largely due to underutilization of HPV cotesting, overscreening, and lack of indicated colposcopy. With clear guidelines available, there is significant room for improvement.