{"id":31415,"date":"2024-02-20T09:28:34","date_gmt":"2024-02-20T14:28:34","guid":{"rendered":"https:\/\/avalere.com\/?p=31415"},"modified":"2024-02-26T12:57:46","modified_gmt":"2024-02-26T17:57:46","slug":"cervical-cancer-screening-rates-differ-across-demographics","status":"publish","type":"post","link":"https:\/\/advisory.avalerehealth.com\/insights\/cervical-cancer-screening-rates-differ-across-demographics","title":{"rendered":"Cervical Cancer Screening Rates Differ Across Demographics"},"content":{"rendered":"

Background<\/h2>\n

The American Cancer Society (ACS) and the US Preventive Services Task Force (USPSTF) both have issued <\/span>recommendations<\/span><\/a> for cervical cancer screening frequency across age groups. As of 2020, the ACS recommends that women begin screening at age 25 (up from 21 in previous recommendations) and that those ages 25\u201330 be screened every three years. This differs from USPSTF\u2019s 2018 recommendation that screenings start at age 21 and occur every three years until age 30. Both organizations recommend only Papanicolaou (Pap) tests for women ages 21\u201330. For women ages 31\u201365, both organizations recommend a Pap test every three years, a human papillomavirus (HPV) test every five years, or HPV\/Pap co-testing every five years. In 2021, the American College of Obstetricians and Gynecologists, American Society for Colposcopy and Cervical Pathology, and Society of Gynecologic Oncology <\/span>endorsed<\/span><\/a> USPSTF\u2019s cervical cancer screening recommendations.\u00a0<\/span>\u00a0<\/span><\/p>\n

The Affordable Care Act (ACA) mandates that most commercial health insurers provide coverage of women’s preventive healthcare\u2014such as mammograms and screenings for cervical cancer\u2014with no cost sharing. Screening can detect precancerous changes and cervical cancer before symptoms are present. Early detection of cervical cancer may facilitate earlier interventions to reduce risk of the advancement to more difficult-to-treat stages of cervical cancer, potentially saving lives through effective treatment strategies. HPV infection is associated with nine in ten cervical cancers; therefore, screenings inform the risk of developing cervical cancer in the future.\u00a0<\/span>\u00a0<\/span><\/p>\n

The incidence and mortality rate of cervical cancer remains relatively higher among certain populations. According to the <\/span>Centers for Disease C<\/span><\/a>ontrol and Prevention<\/span>, every year in the United States, about 11,500 new cases of cervical cancer are diagnosed and approximately 4,000 women die of this cancer. Rates in African American, American Indian\/Alaska Native, and Hispanic women are disproportionately higher than those of White women.\u00a0<\/span>\u00a0<\/span><\/p>\n

Claims Analysis<\/h2>\n

Methodology\u00a0<\/em><\/p>\n

Avalere performed a retrospective analysis of women of screening age in a convenience sample of Managed Medicaid and commercial insurance claims to identify the utilization of cervical cytology Pap smears in order to determine how many women received screenings consistent with USPSTF and ACS recommendations.\u00a0<\/span>\u00a0<\/span><\/p>\n

We analyzed 2018\u20132022 claims data to determine the proportion of women between the ages of 21 and 65 who received at least one Pap smear during that time. We used a five-year range for the claims data to account for any care delays or barriers due to the COVID-19 pandemic. To capture women eligible for screening in the five-year timeframe, we capped the upper age to enter the analysis at 61, since women who are older in 2018 would not be eligible for screening\u00a0 for the full five-year period. The analysis also looked specifically at women continuously enrolled in the insurance type for the entire timeframe.<\/span>\u00a0<\/span><\/p>\n

Findings\u00a0<\/em><\/p>\n

The analysis showed that about 38% of the approximately 12 million women in this sample received at least one cervical cancer screening. Less than half of women with commercial insurance (41%) and even fewer with Managed Medicaid (33%) insurance received at least one cervical cancer screening during the five-year period (see Figure 1).\u00a0<\/span>\u00a0<\/span><\/p>\n

Figure 1. Rates of Cervical Cancer Screening in Women 21\u201365 Years of Age, by Insurance Type (2018\u20132022)\u00a0<\/i><\/h2>\n

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Avalere also analyzed cervical cancer screening rates by age group, since USPSTF and ACS recommendations differ for women less than 30 years of age.\u00a0\u00a0<\/span>\u00a0<\/span><\/p>\n

In the commercial payer population (N= 7,604,391), women in the 26\u201340 age group had marginally higher screening rates (45%) when compared to the 21\u201325 age group (39%). We observed a steady decline in percent of women who received at least one cervical cancer screening from ages 41\u201361 (see Figure 2).\u00a0<\/span>\u00a0<\/span><\/p>\n

Figure 2. Rates of Cervical Cancer Screening for Commercially Insured Women 21\u201365 Years of Age, by Age Group (2018\u20132022)<\/h2>\n

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In the Managed Medicaid population (N= 4,482,500), women between the ages of 21 and 30 had marginally higher screening rates (38%) than women between the ages of 31 and 65 (30%). We observed a steady decline in screening rates across age groups, from 38% for women aged 21\u201325 to 22% for women aged 56\u201361 (see Figure 3).<\/span>\u00a0<\/span><\/p>\n

Figure 3. Rates of Cervical Cancer Screening for Women Covered by Managed Medicaid, 21\u201365 Years of Age, by Age Group (2018\u20132022)<\/h2>\n

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Barriers to Access<\/h2>\n

In navigating the landscape of cervical cancer screenings, an array of challenges emerges.<\/span>\u00a0<\/span><\/p>\n