Xiaoying Yu

Cervical cancer screening and prevalence among older US Medicare beneficiaries with and without HIV

Abstract Females with HIV (FWH) are recommended to receive cervical cancer screening annually, with the interval extended to every 3 years after three sequential normal results. Lifelong screening is highly recommended due to their increased risk of human papillomavirus infection and cervical cancer. We assessed the trends in cervical cancer screening rates and cervical cancer/precancer prevalence among older FWH and females without HIV (FWOH) using 2007–2019 US Medicare data. We found that age‐adjusted cervical cancer screening rates decreased similarly in both FWH and FWOH (average annual percentage change: −4.4 [95% CI: −5.2, −3.6] vs. −5.7 [95% CI: −6.8, −4.7], p  = 0.11). However, the age‐adjusted cervical cancer/precancer prevalence showed increasing rates among FWH (5.4, [2.9, 7.9]) while stable in FWOH (−0.6 [−1.4, 0.1]). These findings underscore the need for strict adherence to clinical practice guidelines for cervical cancer screening in older FWH.

Cervical Cancer Screening Utilization among Kidney Transplant Recipients, 2001 to 2018

Abstract Background: Kidney transplant recipients (KTR) have elevated risks of cervical precancers and cancers and guidelines recommend more frequent cervical cancer screening exams. However, little is known about current trends in cervical cancer screening in this unique population. We described patterns in the uptake of cervical cancer screening exams among female KTRs and identified factors associated with screening utilization. Methods: This retrospective cohort study included female KTRs between 20 and 65 years old, with Texas Medicare fee-for-service coverage, who received a transplant between January 1, 2001, and December 31, 2017. We determined the cumulative incidence of receiving cervical cancer screening post-transplant using ICD-9, ICD-10, and CPT codes and assessed factors associated with screening utilization, using the Fine and Gray model to account for competing events. Subdistribution hazard models were used to assess factors associated with screening uptake. Results: Among 2,653 KTRs meeting the inclusion and exclusion criteria, the 1-, 2-, and 3-year cumulative incidences of initiating a cervical cancer screening exam post-transplant were 31.7% [95% confidence interval (CI), 30.0%–33.6%], 48.0% (95% CI, 46.2%–49.9%), and 58.5% (95% CI, 56.7%–60.3%), respectively. KTRs who were 55 to 64 years old (vs. <45 years old) and those with a higher Charlson Comorbidity Score post-transplant were less likely to receive cervical cancer screening post-transplant. Conclusions: Cervical cancer screening uptake is low in the years immediately following a kidney transplant. Impact: Our findings highlight a need for interventions to improve cervical cancer screening utilization among kidney transplant recipients. See related In the Spotlight, p. 1554