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Association between delayed confirmatory testing and cervical cancer detection among women with abnormal screening
Haiwon Yoo1, Hyeongsu Kim2, Jong Ha Hwang3
1Department of Preventive Medicine, Konkuk University College of Medicine, Chungju, Korea.
Objective:
To investigate the association between delayed confirmatory testing and cervical cancer detection among women with abnormal Pap smear results in the Korean national cervical cancer screening program.
Methods:
This retrospective cohort study used customized data from the National Health Insurance Service of Korea. Women aged ≥30 years who underwent cervical cancer screening in 2019/2020 were included. After excluding those with prior gynecologic conditions or inadequate screening history, participants were classified according to confirmatory testing within 2 years after abnormal screening results. Outcomes included claims-based detection of cervical cancer (C53) and carcinoma in situ (D06). Adjusted hazard ratios (HRs) were estimated using multivariable Cox proportional hazards models.
Results:
Among 10,331,369 participants, 64,762 were eligible (20,073 in Group 1 and 44,689 in Group 2). The 2-year detection rate of cervical cancer was 4.6% in Group 2 and 0.6% in Group 1. When including carcinoma in situ, rates were 19.5% and 5.6%, respectively. Delayed confirmatory testing was associated with higher detection rates, which may reflect delayed identification of pre-existing cases rather than a true increase in incidence (adjusted HR for C53+D06=1.45). Disparities by age, income, and region were observed.
Conclusion:
Delayed confirmatory testing was associated with higher cervical cancer detection; however, this likely reflects delayed identification of pre-existing cases rather than a causal increase in cancer occurrence. Improving follow-up systems may help reduce disparities in cancer detection.
