Impact of age-based discontinuation guidelines on cervical cancer screening in the United States: findings from 2022 Behavioral Risk Factor Surveillance System
1
Epidemiology and Biostatistics, Indiana University Bloomington, Yes, United States
2
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, United States
3
Epidemiology and Disease Control Division, Department of Health Services, Kathmandu, Nepal
4
Department of Population Health Sciences, University of Wisconsin Madison, Madison, United States
5
Brac James P Grant School of Public Health, Brac University, Dhaka, Bangladesh
6
World Federation of Public Health Association, Geneva, Switzerland
7
Health and Wellness Design, Indiana University Bloomington, Bloomington, United States
Popul. Med. 2026;8(Supplement Supplement 1):A3050
ABSTRACT
BACKGROUND:
In 2019, the United States Preventive Services Task Force (USPSTF) updated its cervical cancer screening guidelines, recommending the discontinuation of routine cervical cancer screening for women after age 65. This age-based discontinuation recommendation, however, remains controversial, as over 20% of cervical cancers are diagnosed in women aged 65 and older. This study estimated the effect of the USPSTF cervical screening guideline on Human Papillomavirus (HPV) and Papanicolaou (Pap) testing at age 66.
METHODS:
We conducted a quasi-experimental study using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). Our primary outcome was self-reported use of Pap and HPV tests in the past year. We restricted our analysis to 60,469 women aged 56 to 76 years without hysterectomy and plotted the weighted proportions of women screened by age group to examine trends on both sides of the 66-year cutoff. We applied a regression discontinuity design centered at age 66 and estimated changes in the predicted probability of HPV and Pap screening at the threshold.
RESULTS:
About 13.7% and 31.7% of women aged 56 to 76 reported having HPV and Pap test, respectively, within the past year. Regression discontinuity plots showed declines in both HPV (-3.7 percentage points, 95% CI: -5.0 to -2.4) and Pap testing (-9.8 percentage points, 95% CI: -10.7 to -7.4) at the 66-year threshold. When stratified by race, declines in HPV and Pap testing were statistically significant among Non-Hispanic White women but not among Non-Hispanic Black and other racial groups. HPV testing declined significantly among insured women compared with uninsured women.
CONCLUSIONS:
The USPSTF recommendation to discontinue cervical cancer screening after age 65 decreased cervical cancer screening uptake among women in the US, with a slower disengagement in Non-Hispanic Black women. Our findings underscore the need for adequate and equitable pre-screening before discontinuation of routine testing.
In 2019, the United States Preventive Services Task Force (USPSTF) updated its cervical cancer screening guidelines, recommending the discontinuation of routine cervical cancer screening for women after age 65. This age-based discontinuation recommendation, however, remains controversial, as over 20% of cervical cancers are diagnosed in women aged 65 and older. This study estimated the effect of the USPSTF cervical screening guideline on Human Papillomavirus (HPV) and Papanicolaou (Pap) testing at age 66.
METHODS:
We conducted a quasi-experimental study using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). Our primary outcome was self-reported use of Pap and HPV tests in the past year. We restricted our analysis to 60,469 women aged 56 to 76 years without hysterectomy and plotted the weighted proportions of women screened by age group to examine trends on both sides of the 66-year cutoff. We applied a regression discontinuity design centered at age 66 and estimated changes in the predicted probability of HPV and Pap screening at the threshold.
RESULTS:
About 13.7% and 31.7% of women aged 56 to 76 reported having HPV and Pap test, respectively, within the past year. Regression discontinuity plots showed declines in both HPV (-3.7 percentage points, 95% CI: -5.0 to -2.4) and Pap testing (-9.8 percentage points, 95% CI: -10.7 to -7.4) at the 66-year threshold. When stratified by race, declines in HPV and Pap testing were statistically significant among Non-Hispanic White women but not among Non-Hispanic Black and other racial groups. HPV testing declined significantly among insured women compared with uninsured women.
CONCLUSIONS:
The USPSTF recommendation to discontinue cervical cancer screening after age 65 decreased cervical cancer screening uptake among women in the US, with a slower disengagement in Non-Hispanic Black women. Our findings underscore the need for adequate and equitable pre-screening before discontinuation of routine testing.
| eISSN: | 2654-1459 |
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