Summary
In 2012, updated American Society for Colposcopy and Cervical Pathology (ASCCP) management guidelines for abnormal cervical cytology recommended observation rather than immediate referral to colposcopy for low-grade abnormalities in women ages 21–24. Researchers evaluated the impact of these guidelines on changes in colposcopy procedure rates among young women. They analyzed administrative and claims data from the largest statewide family planning program between July 2011 and June 2015. Using a difference-in-differences approach, researchers estimated changes in colposcopy procedure rates among women ages 21–24 years before and after the 2012 ASCCP management guidelines, relative to a comparison group of women ages 25–44.
Findings: The analysis included 333,977 women from 216 primary care provider sites. After publication of the 2012 ASCCP management guidelines, colposcopy rates significantly declined from 6.70% to 3.94% among women ages 21–24 and from 4.35% to 3.53% among women over 24 years. These declines correspond to a 1.93 percentage point reduction in colposcopy rate among women 21–24 vs. over 24 years, or a two-fold relative reduction.
Among women ages 21–24, colposcopy receipt was associated with speaking primarily English vs. non-English, having a cervical cytology test within the past year vs. not, and receiving care from a public vs. private provider.
Colposcopy procedure rates among young women significantly declined following publication of the 2012 management guidelines, which has implications for reducing potential harms of overtreatment.
