Procedural and temporal compliance to cervical cancer screening guidelines in a CDC funded program in Alaska

Background: In October of 2007, the American Society for Colposcopy and Cervical Pathology (ASCCP) issued new Consensus Guidelines (2006CG) for management of women with abnormal cervical cancer screening and diagnostic test results. Important updates were included regarding Human Papillomavirus (HPV) testing and management of adolescents. Objective/purpose: The Breast and Cervical Health Check Program (BCHC), run by the Alaska Department of Health and Social Services and funded primarily by the CDC, provides cervical cancer screening to low-income uninsured or underinsured Alaskan women. A baseline evaluation of the procedural and temporal compliance of 2005-2006 BCHC practices as compared to 2006CG is reported. Methods: A novel computer-based process was developed. Each of the sixteen ASCCP algorithms was encoded and the entire set of patient records in the study window (n=1,416) was evaluated against the encoding. Areas of noncompliance were further investigated using mechanized techniques. Results: Eleven percent of all patients were procedurally compliant, 41% were noncompliant, and 48% were lost to follow-up. Of the non-lost patients, 69% were temporally compliant, 21% were late and 10% were early. Of adolescents with low-grade abnormal Pap test results, 40% received a non-recommended colposcopy and 33% received a non-recommended HPV test. Twenty-three percent of adult women with certain low-grade abnormal results received repeat cytology instead of the recommended colposcopy. Conclusions: This baseline evaluation, conducted on practices pre-dating 2006CG issuance, can be used to inform a communication program with practitioners to improve treatment and outcomes. The mechanized process can be easily ported to other applications.