by Boston Medical Center

Comparison of diagnostic accuracy of single image and time series. The proportion of cervical images visually classified as normal (green), indeterminate (yellow) or high-grade (red) for single images (1) and time series (17 images) in each histologic category (< CIN2, CIN2, CIN3). Visual classifications of normal (green) would be considered correct for histology < CIN2, and classifications of high-grade (red) would be correct for histologies of CIN2 and CIN3+. The proportion of images classified as normal (green) was higher for the time series than the single image for all histologic categories. This led to an increase in correct classifications for histology Gynecologic Oncology (2022). DOI: 10.1016/j.ygyno.2022.08.001

According to new research from Boston Medical Center, younger women aged 21–39 are more likely to be over-screened for cervical cancer, while older women aged 50–64 are more likely to be under or unscreened. Of those who qualified for routine screening, less than 20% received guideline-adherent screening, while more than 25% were unscreened during the six years of this study. This study, published in Gynecologic Oncology, shows that high rates of both under- and over-screening indicate a need for additional strategies to improve guideline-adherent care.

All those with a cervix need to have cervical cancer screening, including all women and those assigned female at birth who have not undergone hysterectomy with removal of the cervix for benign indications. Cervical cancer is a risk for women in their 40s, 50s, and 60s, so it is critical for women to have regular screenings, even if they are menopausal or no longer sexually active.

Screening recommendations depend on patient age and risk levels and were developed to maximize disease detection and cancer prevention, while minimizing overtreatment. Unfortunately, screening in the United States is opportunistic, meaning that screening relies primarily on patients accessing care—no coordinated system exists to inform patients when they are due.

In addition, lack of insurance, structural inequities, and lack of both patient and clinician awareness of updated guidelines may also contribute to under- and over-screening. Failure to receive age- and risk-appropriate screening may contribute to persistent race/ethnicity-, income-, and insurance-related disparities in rates of cervical cancer and outcomes.

The updated cervical cancer screening guidelines are individualized, meaning low-risk individuals screen less, while high-risk individuals screen more. This benefits everyone because people at low risk do not undergo invasive tests and procedures, while people at high risk receive the testing they need to prevent cancer.

"Screening is one of the most vital steps in cancer detection and prevention," said Rebecca Perkins, MD, MSc, professor of Obstetrics & Gynecology at the Boston University Chobanian & Avedisian School of Medicine and senior author of this study. "By improving adherence to screening guidelines and taking individual risk into account, we can hope to avoid under- or over-screening women and optimize the effectiveness of this tool."

This study found that about 1 in 5 women are at high-risk for cervical cancer and need to be screened more often, and among women of average risk, only about 1 in 5 are screened for cervical cancer according to guidelines. This study highlights the need to improve cervical cancer screening delivery. By using a risk-based approach, unnecessary tests and procedures can be avoided in low-risk individuals, while ensuring that those at high risk receive the care they need to prevent cancer.

More information: Rebecca Perkins et al, Comparison of accuracy and reproducibility of colposcopic impression based on a single image versus a two-minute time series of colposcopic images, Gynecologic Oncology (2022). DOI: 10.1016/j.ygyno.2022.08.001

Journal information: Gynecologic Oncology 

Provided by Boston Medical Center