ORIGINAL RESEARCH
Lisa F. Soltani, MD MPH; Ilana Addis, MD, MPH, MBA; Paul Lin, MS; Neil Kamdar, MA; Marie Claire O'Dwyer, MB, Bch, BAO, MPH; Alisa P. Young, MD; Diane M. Harper, MD, MPH, MS
Corresponding Author: Diane M. Harper, MD, MPH, MS; Departments of Family Medicine, Obstetrics & Gynecology and Women's and Gender Studies, University of Michigan
Email: harperdi@med.umich.edu
DOI: 10.3122/jabfm.2025.250040R1
Keywords: Cancer Screening, Cervical Cancer, Family Medicine, Gynecology, Internal Medicine, Medical Education, Obstetrics, Population Health, Practice Management, Preventive Care, Primary Health Care, Public Health, Women's Health, Workforce
Dates: Submitted: 01-29-2025; Revised: 04-07-2025; Accepted: 05-12-2025
Status: In production.
BACKGROUND: Cervical cancer screening (CCS) is shifting from in-office to self-screening. The primary aim of this study is to define a baseline distribution of in-office CCS providers by specialty and the race/ethnicity and age of those screened.
METHODS: We extracted electronic health record data (Truveta- multiple health systems in 34 states) of individuals eligible for CCS aged 21-65, documented between January 1, 2017-December 31, 2022. Those with a hysterectomy before 2017, had any gynecological cancer at any time, or had evidence of CCS after the hysterectomy, except if there was a history of cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3) disease were excluded. We reported the total number of CCS and colposcopies per eligible patient and the specialty of the performing clinician (medical taxonomy).
RESULTS: Among the 2,439,331 individuals included in the study, the average age was 42.9 (SD 11.7). There were 3,412,148 CCSs linked with one of three provider specialties: obstetrics & gynecology (OG), family medicine (FM), and general internal medicine (GIM). OG provided less than half of all CCS, dropping to 31.6% of those 50-65. While only 70.5% (1,718,914) of the population received at least one CCS during the study, the mean CCS per patient was 2.6 (SD 2.7). The rate of colposcopy after a CCS was 3.9%.
CONCLUSIONS AND RELEVANCE: Family and Internal Medicine clinicians provide the majority of CCS in the US (61.9 %), particularly for people aged 50-65 (68.4%), when cervical cancer risk is the highest.