Journal: NPJ digital medicine
Study type and setting
- – Longitudinal cohort of 33,362 women aged 35–64 in Wuxiang County, a low‑resource area in China.
- – Objective: quantify how often cervical cancer screening aligns with guidelines and identify factors associated with over‑ and under‑screening.
Methods
- – Screening episodes were categorized as:
- – Guideline-adherent
- – Over-screened
- – Under-screened
- – Unscreened
- – Classification depended on prior screening modality (primary HPV, cytology, or co-testing) and results.
- – Cause-specific frailty models evaluated determinants of inappropriate screening.
Key findings
- – Only 19.9% of screening events adhered to guidelines.
- – 29.5% represented over-screening.
- – 50.6% represented under-screening or no screening at all.
- – After implementation of a county-wide electronic medical record (EMR) platform in 2022, over-screening dropped sharply from 36.7% to 15.7%.
- – Prior co-testing increased hazards of both over- and under-screening compared with primary HPV testing.
- – Prior cytology was strongly associated with under-screening.
- – Women with low-grade abnormalities (≤CIN1) were at particularly high risk of under-screening versus those with prior negative results.
- – Residence patterns mattered:
- – Community (more urbanized) residents were more likely to be over-screened.
- – Village (more rural) residents were more likely to be under-screened.
Implications for practice and policy
- – HPV-based primary screening appears more conducive to guideline-adherent intervals than cytology or co-testing.
- – EMR integration can significantly curb unnecessary repeat testing.
- – Persistent under-screening—especially among women with prior low-grade abnormalities and rural residents—will likely require active reminder and follow-up systems, tailored outreach, and resource-sensitive implementation strategies.