title: Compliance with cervical cancer screening and human papillomavirus testing guidelines among insured young women.
abstract: OBJECTIVE
  In December 2009, the American Congress of Obstetricians and Gynecologists (ACOG) recommended that women under 21 years old should not receive cervical cancer screening (Papanicolaou tests) or human papillomavirus (HPV) tests. This study examined whether clinicians stopped administering Papanicolaou and HPV tests among women younger than 21 years of age after new ACOG guidelines were issued.
  
  
  METHODS
  This study was a retrospective secondary data analysis of administrative claims data that included insurance enrollees from across the United States that examined the frequency of Papanicolaou tests and HPV tests among 178,898 nonimmunocompromised females 12-20 years old who had a paid claim for a well-woman visit in 2008, 2009, or 2010. Young women with well-woman examinations in each observed year were examined longitudinally to determine whether past diagnoses of cervical cell abnormalities accounted for Papanicolaou testing in 2010.
  
  
  RESULTS
  The proportion of women younger than 21 years old that received a Papanicolaou test as part of her well-woman exam dropped from 77% in 2008 and 2009 to 57% by December of 2010, whereas HPV testing remained stable across time. A diagnosis of cervical cell abnormalities in 2009 was associated with Papanicolaou testing in 2010. However, a previous Papanicolaou test was more strongly associated with a Papanicolaou test in 2010.
  
  
  CONCLUSIONS
  These data show that some physicians are adjusting their practices among young women according to ACOG guidelines, but Papanicolaou and HPV testing among insured women younger than 21 years of age still remains unnecessarily high.
authors.affiliation: Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Hirth
authors.forename: Alai
authors.initials: A
authors.lastname: Tan
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Wilkinson
authors.forename: Abbey B
authors.initials: AB
authors.lastname: Berenson
mesh_terms: D000293:Adolescent; D000328:Adult; D004279:DNA, Viral / Q000032:analysis; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D012189:Retrospective Studies; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: Papanicolaou test; guidelines compliance; human papillomavirus; human papillomavirus test