title: A population-based evaluation of cervical screening in the United States: 2008-2011.
abstract: BACKGROUND
  Cervical screening consumes substantial resources, but little is known about utilization in the United States or compliance with guideline recommendations.
  
  
  METHODS
  To describe population screening coverage, utilization, and outcomes and examine time trends from 2008 to 2011, cervical cytology reports from women residing in New Mexico (981,063 tests from 511,381 women) were evaluated.
  
  
  RESULTS
  From 2008 to 2011 cervical screening utilization decreased at all ages, but especially in younger women, with a two-third reduction at ages 15 to 20 years. Ninety-four percent of women ages 25 to 29 years were screened within 48 months but coverage decreased at older ages to 69% at 45 to 49 years and 55% at 60 to 64 years. Intervals between screening tests were significantly longer in 2011 compared with 2008 [HR = 1.23; 95% confidence intervals (CI), 1.22-1.24], although the commonest rescreening interval was 13 months. In 2011, 91.9% of screening tests for women ages 21 to 65 years were negative, 6.6% showed minor abnormalities, and 1.0% high-grade abnormalities. High-grade abnormality rates were relatively constant over time, but minor abnormalities and atypical cells cannot rule out high-grade (ASC-H) were increasing.
  
  
  CONCLUSIONS
  This population-based evaluation of cervical screening shows high coverage under the age of 40 years, but lower levels in older women. Screening under age 21 years is becoming less common and screening intervals are lengthening, reflecting updates in national screening guidelines.
  
  
  CONCLUSIONS
  Assessment of cervical screening intervals and population outcomes is essential for accurately estimating the impact and effectiveness of changing recommendations and vaccination against human papilloma virus infections.
authors.affiliation: Authors' Affiliations: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Division of Epidemiology, Department of Internal Medicine; Department of Pathology, University of New Mexico Health Sciences Center, House of Prevention Epidemiology (HOPE), Albuquerque, New Mexico; Global Cancer Initiative, Chestertown, Maryland; and Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.forename: Orrin
authors.initials: O
authors.lastname: Myers
authors.forename: William C
authors.initials: WC
authors.lastname: Hunt
authors.forename: Michael
authors.initials: M
authors.lastname: Robertson
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Joste
authors.forename: Philip E
authors.initials: PE
authors.lastname: Castle
authors.forename: Vicki B
authors.initials: VB
authors.lastname: Benard
authors.forename: Cosette M
authors.initials: CM
authors.lastname: Wheeler
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology*; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology*