Current performance measures for cervical cancer screening promote overscreening

Following current performance measures that require adherence to strict time intervals for cervical cancer screening may promote overscreening. Changing cervical cancer screening performance measures to distinguish between overscreening and appropriate screening and include time ranges rather than strict intervals could help to reduce the frequency of unnecessary procedures. The findings of a brief research report are published in Annals of Internal Medicine.

Current performance measures for cervical cancer screening are based on guidelines from organizations such as the American College of Obstetricians and Gynecologists and require strict adherence to screening intervals. Satisfactory cervical cancer screening involves at least one Pap test every 3 years for average-risk women between the ages of 21 and 64 or at least one Pap and HPV test every 5 years for average-risk women between the ages of 30 and 64. These performance measures have two main flaws: 1) they do not distinguish between overscreening and appropriate screening; and 2) they do not allow ranges of intervals in appropriate screening definitions.

To address these flaws, researchers at the University of Pittsburgh used Pennsylvania Medicaid administrative data for women aged 18 to 64 between 2007 and 2013 to determine how frequently screening practices were adherent to traditional performance measures and to alternative measures that distinguished between overscreening and appropriate screening and incorporated ranges of +/- 3 months and +/- 6 months to appropriate screening definitions. Distinguishing between appropriate screening and overscreening (i.e., creating a separate overscreening category) decreased appropriate screening by up to 70 percent. However, incorporating the ranges increased appropriate screening by up to 11 percent.

The authors conclude that changing cervical cancer screening performance measures to align better with clinical guidelines will help to reduce the frequency of unnecessary procedures and more accurately measure the quality of women's health care