Skip to main content


Reducing unnecessary cervical cancer screening: achieving more by doing less

Date and Location




Sunday 22 September 2013 - 10:30 - 12:00


Presenting author and contact person

Presenting author

Marguerite Koster

Contact person

Marguerite Koster
Abstract text
Background: Too-frequent screening for cervical cancer can increase costs, lead to unnecessary invasive procedures associated with overtreatment, and shift resources away from the one in five women who do not receive recommended routine screening. Objectives: A large, U.S.-based integrated healthcare system with centralized evidence services and eight independent regions developed and implemented an evidence-based guideline for cervical cancer screening. Novel implementation strategies and performance monitoring in one region led to significant improvements and are described below. Methods: Graded systematic reviews were conducted by a centralized analytic unit, and recommendations developed by a guideline team with representation from each region. In one large region with more than 3.5 million patients, interventions aimed at the practitioner, patient and systems levels were implemented for routine Pap and HPV cotesting. Practitioner interventions included electronic distribution of guidelines, point-of-care electronic prompts, and workflow support. Patient-level interventions included point-of-care education, and inreach/outreach activities. System-level interventions focused on centralized patient outreach letters and reminder calls, computerized decision support, and unscreened cancer lists for panel management. Monthly performance monitoring on a measure of “overpapulation” was reported at medical center, department and provider levels. Results: In a five-year period, over 100,000 fewer unnecessary Pap tests were performed, while screening rates increased by 7%. Conclusions: Centralized systematic evidence review and guideline development, coupled with coordinated implementation and performance monitoring, can reduce unnecessary screening and invasive procedures, focus resources on appropriate routine screening in underscreened populations, improve patient access and reduce costs.