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

Abstract

Objective: 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.

Materials and methods: In this cohort study, we 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.

Results: Across the 3 years, we 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).

Conclusions: 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.