Trends Over Time in Pap and Pap-HPV Cotesting for Cervical Cancer Screening

J Womens Health (Larchmt). 2019 Feb;28(2):244-249. doi: 10.1089/jwh.2018.7380. Epub 2019 Jan 7.


Background: In 2012, updated cervical cancer screening recommendations were released with consensus on Papanicolaou (Pap) testing every 3 years for women age 21-65 years or Pap-human papillomavirus (HPV) cotesting at 5-year intervals for women age 30-65 years. Primary study aims: Assess current use of Pap-HPV cotesting and describe local population trends over time in Pap and Pap-HPV cotesting. Secondary aim: Assess sociodemographic factors correlating with screening.

Methods: We assessed Rochester Epidemiology Project data for Pap and Pap-HPV cotesting among women age 16 years and older living in Olmsted County, Minnesota, yearly from 2005 (study population n = 47,203) through 2016 (study population n = 49,510). We calculated 3-year (Pap) and 5-year (Pap-HPV) moving prevalence rates of screening as proportion of eligible population. Multivariable logistic regression was used to assess factors potentially associated with screening.

Results: In 2016, 64.6% of 27,418 eligible 30- to 65-year-old women were up to date with cervical cancer screening; 60.8% had received Pap-HPV cotest screening. Significant declines in Pap completion rates over time were observed in all age groups, including an unexpected decline in 21- to 29-year-old women. Coincident with decreasing Pap screening rates, Pap-HPV cotesting significantly increased among women age 30-65 years, from 10.0% in 2007 to 60.8% in 2016.

Conclusions: This suggests increasing adoption of 2012 screening recommendations in the 30- to 65-year-old population. However, decline in Pap screening among 21- to 29-year-old women is concerning. Disparities by race, ethnicity, smoking status, and comorbidity level were observed. Results suggest need for multilevel patient and clinician interventions to increase cervical cancer screening adherence.

Keywords: adolescent health; gynecologic cancer; health disparities; sexually transmitted infections.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Early Detection of Cancer / methods
  • Female
  • Humans
  • Mass Screening / statistics & numerical data
  • Mass Screening / trends*
  • Middle Aged
  • Minnesota
  • Papanicolaou Test / statistics & numerical data
  • Papanicolaou Test / trends*
  • Papillomaviridae / classification
  • Papillomavirus Infections / diagnosis*
  • Socioeconomic Factors
  • Uterine Cervical Neoplasms / diagnosis*
  • Young Adult