title: Impact of the 2002 American society for Colposcopy and Cervical Pathology guidelines on cervical cancer diagnosis in a geographically diverse population of commercially insured women, 1999-2004.
abstract: OBJECTIVE
  To report the impact of the release of the 2002 American Society for Colposcopy and Cervical Pathology guidelines on the management of abnormal cytological findings on time to diagnosis of cervical cancer in an insured population.
  
  
  METHODS
  This retrospective study identified women with cervical cancer (invasive and carcinoma in situ) through commercially insured administrative claims data. The cervical cancer case definition required a claim for cervical cancer and a claim with a diagnostic procedure (colposcopy, conization, biopsy, or hysterectomy). Time to diagnosis was defined as days between the initial Pap screening and the diagnostic procedure.
  
  
  RESULTS
  Between 1999 and 2004, there were 3,325 women aged 18 to 64 years who met the case definition for cervical cancer. Median time to diagnosis decreased from 42 days (interquartile range = 23-93 d) to 36.5 days (interquartile range = 20.5-80 d) for women with invasive cancer after the guideline change. The number of follow-up Pap screenings before biopsy also decreased (p = .0067). Among women with carcinoma in situ whose initial Pap screening was completed by a family practice clinician, time to diagnosis was projected to be more than 9 days longer compared with those whose screening was performed by a gynecologist.
  
  
  CONCLUSIONS
  The 2002 American Society for Colposcopy and Cervical Pathology guidelines for the management of abnormal cytological findings seem to have had a positive impact on the time to diagnosis and Pap screening use before biopsy for women diagnosed with cervical cancer.
authors.affiliation: Center for Health Care Policy and Evaluation, Minneapolis, MN, USA.
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Martin
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Berkman
authors.forename: Tzy-Mey
authors.initials: TM
authors.lastname: Kuo
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Yuen
authors.forename: Vicki B
authors.initials: VB
authors.lastname: Benard
mesh_terms: D000293:Adolescent; D000328:Adult; D002277:Carcinoma / Q000175:diagnosis*; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult