Association between delayed confirmatory testing and cervical cancer detection among women with abnormal screening results.

Abstract

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.