ED-based cervical cancer screening finds elevated abnormal Pap rates and high-risk HPV in trial participants

BACKGROUND: More than 4300 lives are lost to cervical cancer in the US annually. The survival rate is nearly 100% when precancerous lesions are identified and acted upon appropriately. A randomized controlled trial of two Emergency Department-based (ED) cervical cancer screening interventions demonstrated that patients in each condition received screening at rates far above an untreated historical control group. While screening represents a necessary first step in preventing cervical cancer morbidity and mortality, a lack of data on subsequent clinical care limits appreciation of ED-based screening efforts. OBJECTIVE: The current study describes test results and subsequent care observed among patients who received documented cervical cancer screening following an ED-based intervention. METHODS: Information on HPV infections, Pap test results, and cervical cancer diagnoses documented in the electronic health record were collected from women ages 21-65 who were (a) enrolled into the above-mentioned trial and (b) received cervical cancer screening over the 365-days post enrollment. RESULTS: 181 women received screening. Of those who had a Pap test, 12% had abnormal findings. Compared to a national rate of 3.8%, significantly elevated risk was observed (Z = 5.55, p < 0.001). High-risk HPV infection was observed in 15% among those tested, elevated from an estimated nationwide prevalence of 11% (Z = 1.63, p = 0.052). Notably, nearly half of patients who went on to have colposcopy and cervical biopsy did not have a routine women's health provider. CONCLUSION: ED-based cervical cancer screening interventions have meaningful positive impact on subsequent testing and care.