Analysis of Diagnosis Rate and Factors Influencing the Implementation of Confirmatory Tests in Women with Epithelial Abnormalities of Squamous Cells in Pap Tests: 5 years follow-up using the National Health Insurance Service database.

Abstract

Abstract Objective: this study aims to investigate the diagnosis rates of cervical cancer and carcinoma in situ between women who did not undergo confirmatory tests within 6 months and those who did, considering influencing factors. Methods: We identified all Korean women who participate in nationwide cervical cancer screening program from January 2011 and December 2017 using the National Health Insurance Service (NHIS) database. Results: Among the 21,452,058 eligible patients from 28,619,210 Pap smear tests (2011-2017), 450,349 (1.57%) had squamous cell abnormalities in Pap smear results. Among women notified of squamous cell abnormalities, 124,135 (27.6%) underwent a confirmatory test within 6 months. Among these, there were 4,529 women (3.65%) diagnosed with cervical cancer (C53) and 11,465 women (9.24%) diagnosed with carcinoma in situ (D06). Women who did not undergo confirmatory tests within 6 months were 326,214 (72.4%). Among them, within 5 years, 5,198 women (1.59%) were diagnosed with cervical cancer (C53), and 9,517 women (9.24%) were diagnosed with carcinoma in situ (D06). For cervical cancer (RR 4.11, 95% CI: 3.72-4.54), the diagnosis rate was significantly higher in women over 70. Both cervical cancer (RR 0.73, 95% CI: 0.66-0.79) and carcinoma in situ (RR 0.85, 95% CI: 0.81-0.90) showed significantly lower diagnosis rates in highest economic status. Conclusions: Encouraging confirmatory tests for abnormal Pap smears is crucial, particularly among the elderly and those with lower economic status.