Diagnosis to Excision: Estimates for Guideline-Concordant Treatment of High-Grade Cervical Intraepithelial Neoplasia.

Abstract

Objective: To estimate the proportion of participants with high-grade cervical intraepithelial neoplasia (CIN 2/3) who completed indicated therapeutic procedures.

Methods: This was a retrospective observational cohort study of the National Institutes of Health's All of Us database enriched for racial and ethnic minorities historically underrepresented in biomedical research. We included female participants aged 25 and older with a diagnosis of CIN 2/3 only, excluding invasive malignancy. We conducted both univariate and multivariate logistic regression to identify background characteristics associated with guideline-concordant ablative and excisional procedures.

Results: Of 1,764 participants with CIN 2/3, only 27.7% of participants underwent a therapeutic procedure in the 12 months following a diagnosis of CIN 2/3. We found that Hispanic participants had a 1.48 increased odds ratio (OR) (95% CI = 1.18-1.85) of undergoing therapeutic procedures (compared to non-Hispanic). Participants residing in the Midwest had a 2.04 OR (95% CI = 1.6-2.6) of undergoing a therapeutic procedure compared to the Northeast. After adjusting for race, ethnicity, region, and smoking status, Hispanic ethnicity remained associated with therapeutic excision (OR = 2.37, 1.13-4.78). Geography was significant with 2.37 (95% CI = 1.17-3.29) increased odds of therapy completions for Midwest residents but 0.52 (95% CI = 0.27-0.96) decreased odds for Western residents.

Conclusion: In this large US national database enriched for racial and ethnic minorities, we found that 3 of 4 participants with cervical precancer did not undergo a therapeutic procedure in the 12 months following their first diagnosis. Increased efforts to promote access to and completion of treatment of CIN 2/3 are needed to prevent cancer.