Changes in Cervical Cancer Screening and Follow-Up in Women Under Age 21 Following New Screening Guidelines [11M]

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In 2009 and 2012 major US cervical cancer screening guidelines recommended no screening for women under age 21 years. We examined changes in annual screening and treatment procedures for cervical dysplasia.


We identified Davidson County women age 18–20 years enrolled in Tennessee Medicaid (TennCare), 2006–2014 with at least one Pap smear, HPV test, colposcopy, or dysplasia treatment each year via CPT coding. We also counted total numbers of these outcomes annually and estimated yearly costs based on average procedural costs from OptumInsight's proprietary research database of US health insurance coverage.


From 2006 to 2014, about 4,000 Davidson County women age 18–20 years were enrolled in TennCare annually: 30.7% White, 54.8% Black, 4.5% Hispanic. The percent receiving Pap smears declined from 52.4% in 2006 to 14.2% in 2014 (rate ratio [RR] 0.27, 95% confidence interval [CI] 0.25–0.30), HPV testing declined 12.8% to 5.4% (RR 0.42, CI 0.36–0.50), colposcopy 8.8% to 0.9% (RR 0.10, CI 0.07–0.14), and dysplasia treatment 1.2% to 0.0%. Rates of all outcomes declined similarly in non-Hispanic Whites and Blacks, and Hispanics. The estimated cost of all screening tests/procedures totaled $1,001,893 in 2006 and $169,412 in 2014.


Since the introduction of new screening guidelines, Pap smears, HPV testing, colposcopy and treatment procedures for cervical dysplasia have decreased in young women. We estimate savings of close to $800,000 annually for Davidson County women 18–20 years old enrolled in TennCare. These estimate do not account for changes in visit rates or complications from these procedures.

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