#USA #San Francisco #Women's Health #Cervical Cancer #Screening Guidelines

Unnecessary Cervical Cancer Screening in Women Over 65

Introduction

Recent findings from Motive Medical Intelligence have highlighted a concerning trend: despite clear clinical guidelines advising against routine cervical cancer screening for women over the age of 65, unnecessary testing persists. This article delves into the implications of these findings, shedding light on the reasons behind this continued practice and its potential consequences.

The Findings

According to a nationwide analysis of data from over 100 million patients, there is extensive variation in cervical cancer screening rates among various U.S. states. Some states report screening rates as low as 5%—with North Dakota and Minnesota leading the way—while others, particularly in the Northeast, have rates exceeding 25%. This discrepancy raises questions about the adherence to evidence-based medical practice in different regions and the factors contributing to such variations.

Clinical organizations, including the U.S. Preventive Services Task Force and the American Cancer Society, recommend discontinuing routine cervical cancer screenings for older women who have adequately screened before and have no prior abnormal results. In simpler terms, if a woman is over 65 and has had three consecutive negative Pap results, or two negative HPV tests, or a combination of both in the past decade, routine screening is deemed unnecessary.

Why is Screening Unnecessary?

Cervical cancer screening has indeed played a vital role in reducing the incidence of cervical cancer in the United States. However, after a certain age, particularly after 65, the benefits of continued screening diminish significantly. Studies consistently show that adequately screened women face extremely low risks of developing high-grade cervical lesions or cancers. False positives can lead to unnecessary invasive procedures, which can, in turn, result in complications and patient distress. Rich Klasco, MD, Motive's Chief Medical Officer, emphasizes the psychological burden caused by false positives and unnecessary treatments, stating that unnecessary screening can do more harm than good.

State-Level Variability

The analysis of screening rates suggests that geographic discrepancies are largely influenced by local practice patterns, clinician behavior, and health system incentives, rather than patient risk factors. While states with lower screening rates tend to align closely with clinical guidelines, those with higher rates of unnecessary screening could benefit from targeted educational campaigns for healthcare providers and potential policy adjustments designed to reduce low-value care.

Julie Scherer, PhD, Motive’s Chief Solutions Officer, expresses concern that these variations are far from trivial. They manifest as avoidable procedures and wasteful use of resources in a healthcare system that is already grappling with efficiency issues. Each unnecessary screening represents a burden on both the healthcare infrastructure and the patients involved.

Moving Forward

To address these disparities, it may be crucial for healthcare stakeholders to implement quality improvement initiatives that focus on reducing the overuse of cervical cancer screenings among older women. Educating physicians about adherence to screening guidelines and the potential harms of unnecessary procedures could be an important first step.