title: Use of claims data to estimate annual cervical cancer screening percentages in Portland metropolitan area, Oregon.
abstract: BACKGROUND
  Human papillomavirus (HPV) vaccine should reduce cervical dysplasia before cervical cancer. However, dysplasia diagnosis is screening-dependent. Accurate screening estimates are needed.
  
  
  OBJECTIVE
  To estimate the percentage of women in a geographic population that has had cervical cancer screening.
  
  
  METHODS
  We analyzed claims data for (Papanicolau) Pap tests from 2008-2012 to estimate the percentage of insured women aged 18-39 years screened. We estimated screening in uninsured women by dividing the percentage of insured Behavioral Risk Factor Surveillance Survey respondents reporting previous-year testing by the percentage of uninsured respondents reporting previous-year testing, and multiplying this ratio by claims-based estimates of insured women with previous-year screening. We calculated a simple weighted average of the two estimates to estimate overall screening percentage. We estimated credible intervals using Monte-Carlo simulations.
  
  
  RESULTS
  During 2008-2012, an annual average of 29.6% of women aged 18-39 years were screened. Screening increased from 2008 to 2009 in all age groups. During 2009-2012, the screening percentages decreased for all groups, but declined most in women aged 18-20 years, from 21.5% to 5.4%. Within age groups, compared to 2009, credible intervals did not overlap during 2011 (except age group 21-29 years) and 2012, and credible intervals in the 18-20 year group did not overlap with older groups in any year.
  
  
  CONCLUSIONS
  This introduces a novel method to estimate population-level cervical cancer screening. Overall, percentage of women screened in Portland, Oregon fell following changes in screening recommendations released in 2009 and later modified in 2012.
authors.affiliation: Acute and Communicable Disease Prevention Program, Oregon Public Health Division, Portland, Oregon, United States. Electronic address: nasreen.abdullah@state.or.us.
authors.forename: Nasreen
authors.initials: N
authors.lastname: Abdullah
authors.affiliation: Acute and Communicable Disease Prevention Program, Oregon Public Health Division, Portland, Oregon, United States.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Laing
authors.affiliation: Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, United States.
authors.forename: Susan
authors.initials: S
authors.lastname: Hariri
authors.affiliation: Acute and Communicable Disease Prevention Program, Oregon Public Health Division, Portland, Oregon, United States.
authors.forename: Collette M
authors.initials: CM
authors.lastname: Young
authors.affiliation: Acute and Communicable Disease Prevention Program, Oregon Public Health Division, Portland, Oregon, United States.
authors.forename: Sean
authors.initials: S
authors.lastname: Schafer
mesh_terms: D000293:Adolescent; D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D009922:Oregon; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer screening; Cervical dysplasia; Cervical intraepithelial neoplasia (CIN); HPV vaccines; Human papillomavirus (HPV)