A state-wide population-based evaluation of cervical cancers arising during opportunistic screening in the United States.

Despite widespread cervical screening, an estimated 13,800 women will be diagnosed with cervical cancer in the United States in 2020. To inform improvements, the screening histories of women diagnosed with cervical cancer in New Mexico were assessed. Data were collected on all cervical screening, diagnostic tests and treatment procedures for all women diagnosed with cervical cancer aged 25-64 yrs. in New Mexico from 2006 to 2016. Women were categorized by their screening attendance in the 5-40 months (screening interval) and 1-4 months (peri-diagnostic interval) prior to cancer diagnosis. Of the 504 women diagnosed between May 2009-December 2016, 64% were not screened or had only inadequate screening tests in the 5-40 months prior to diagnosis, and 90 of 182 screened women (49%) had only negative screens in this period. Only 32% (N = 162) of cervical cancers were screen-detected. Women with adenocarcinomas were more likely to have had a recent negative screen (41/57 = 722%) than women with squamous cancers (50/112 = 45%). Both older women (aged 45-64 years) and women with more advanced cancers were less likely to have been screened, and if screened, were more likely to have a false-negative outcome. Only 9% of cancers were diagnosed in women who did not attend biopsy or treatment after positive tests requiring clinical management. Screening currently prevents 35% of cancers, whereas full screening coverage could prevent 61% of cervical cancers. Improved screening coverage has the largest potential for reducing cervical cancer incidence, though there is also a role for improved recall procedures and screening sensitivity.

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Published by Elsevier Inc.

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Declaration of Competing Interest JC and CMW have received funds from grants, cooperative agreements or subcontracts related to cervical screening and triage through their institutions. JC reports grants to his institution and personal fees from Qiagen, Becton Dickinson (BD), Genera Biosystems (GB), and grants to his institution from Hologic, Gene First, and Trovagene, all outside the submitted work. CMW reports receiving reagents and equipment from Roche Molecular Systems, Roche Ventana Medical Systems and GB through her institution and personal fees from BD all outside of the submitted work. PDS reports collaborating in studies receiving reagents and equipment from Hologic and Roche Molecular Systems outside of the submitted work. RL, CM, CLW, MR, YJM, DWG, ICS have no interests to report. The findings and conclusions of this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.