Poor Adherence to Post-Cervical Dysplasia Care Guidelines

TOPLINE:

Only 45.5% of patients completed guideline-concordant surveillance within 30 months after treatment for high-grade cervical dysplasia, with one third of those receiving abnormal co-test results. Among all patients, 0.5% were diagnosed with cervical cancer posttreatment.

METHODOLOGY:

• Researchers conducted a retrospective analysis of 3146 patients aged 30-65 years treated for high-grade cervical dysplasia at two Population-based Research to Optimize the Screening Process Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations sites in the United States from 2010 to 2019.
• Data collection involved two healthcare systems: Massachusetts General Brigham, an integrated healthcare delivery system in Boston, and Parkland Health, a publicly funded safety net system in Dallas County, Texas.
• Patient demographics reflected broader population characteristics, with most participants aged 30-39 years and having few known comorbidities.
• Primary outcome measure focused on receipt of two negative co-tests after treatment within 30 months, allowing 6-month scheduling flexibility.

TAKEAWAY:

• Only 45.5% of patients completed two surveillance co-tests within 30 months posttreatment, with rates varying between sites (Massachusetts General Brigham, 55.3%; Parkland Health, 40.6%).
• Among patients completing two co-tests, approximately one third (31.3%) received at least one abnormal result.
• Surveillance timing for those completing two co-tests aligned with guidelines, with a median time to the first co-test of 6.4-10.1 months and 8.5-12.0 months between the first and second tests.
• A total of 16 patients (0.5%) were diagnosed with cervical cancer posttreatment, with a median time to diagnosis of 14.9 months (interquartile range, 3.8-45.9 months).

IN PRACTICE:

“Patients with high-grade cervical dysplasia are at elevated risk of subsequent abnormalities and should continue to be closely monitored. Additional systematic monitoring is needed to ensure guideline-compliant surveillance after dysplasia treatment,” wrote the authors of the study.

SOURCE:

The study was led by Victoria Wang, MD, Division of Gynecologic Oncology, Brigham and Women’s Hospital, Harvard Medical School in Boston. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

As a retrospective cohort study, researchers could not determine definitive reasons for suboptimal surveillance completion. The study was unable to capture follow-up testing conducted outside of the participating healthcare systems. No data were collected on the margin status of excisional procedures, which would have required earlier and more frequent co-testing. The short follow-up period limited the ability to determine lifetime cervical cancer rates. Patient mobility between healthcare systems due to insurance changes may have affected continuity of care tracking.

DISCLOSURES:

The study was supported by the National Cancer Institute grant UM1CA221940 awarded to Jennifer S. Haas, PhD, Jasmin A. Tiro, PhD, MPH, and Aruna Kamineni. Haas received additional funding from the American Cancer Society grant CRP-22-080-01-CTPS. Sarah Feldman, MD, MPH, disclosed receiving payment from UpToDate and a grant from the Foundation for Women’s Cancer. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.