Cervical Cancer Screening: Encouraging Patient Participation

Cervical cancer, despite being highly preventable and treatable, kills over 4,000 women annually. Regular cervical cancer screenings, such as Pap smears and human papillomavirus (HPV) tests, are crucial for early detection and prevention. Over half of the new cervical cancer cases in the United States are attributable to insufficient screenings. Barriers to screening include cost, access, and fear. 

Understanding Cervical Cancer Screenings

The main cause of cervical cancer is long lasting infection with certain types of HPV. Three main ways to screen for cervical cancer include:

1. HPV test – checks cells for infection with high-risk HPV types; can be done using the same sample from a Pap test
2. Pap test – collects cervical cells to check for changes that may become cancerous if not treated appropriately
3. HPV/Pap co-test – uses HPV and pap tests together to check for high-risk HPV and cervical cell changes

The USPSTF recommends the following screening guidelines:

Encouraging Preventive Screenings

In 2021, 75% of women were up to date with cervical cancer screenings. Several factors contribute to low screening rates such as lack of awareness, fear, financial concerns, and discomfort or embarrassment. To close this gap, healthcare professionals must understand and support the need for education surrounding screenings. 

Cervical Cancer Screening is a quality measure in various quality programs established by the Centers for Medicare & Medicaid Services (CMS). This screening is an essential preventive health service that improves early detection and treatment of cervical cancer. 

Strategies to Increase Patient Participation

• Educational Campaigns – disseminate information on cervical cancer, HPV, the importance of consistent adherence to routine screenings, and HPV vaccination as a prevention strategy.
• Personalized Communication – reach out to patients due for screenings via phone, email, and/or text, emphasizing the importance of their health and offering support and information.
• Addressing Barriers – provide information on financial assistance programs, address concerns about discomfort, and create a welcoming environment for discussion. Women who have a low income or do not have health insurance may be able to get free or low-cost screening tests through CDC’s National Breast and Cervical Cancer Early Detection Program. 
• Patient Empowerment – empower patients by educating them on the screening process, its significance, and the control they have over their health outcomes through preventive measures.

Addressing this Gap in Care – Tips for Communication & Medical Record Documentation

1. Communicate the importance of prevention, consistent routine screening, and early detection.
2. Documentation in the medical record of “HPV Test” completed within the last 5 years can be counted as evidence of HrHPV if test result is included.
3. If a patient had cervical cancer screening with another provider, document the test, date, and result.
4. Hysterectomy with no residual cervix, cervical agenesis, or acquired absence of the cervix are exclusions for this quality measure. Documentation of “hysterectomy” alone will not meet exclusion criteria. Specific documentation as appropriate and indicated would include one of the following: 
   • Documentation of the words “total,” “complete,” or “radical” abdominal or vaginal hysterectomy  
   • Documentation of hysterectomy AND documentation that a member no longer needs Pap testing/cervical cancer screening 
5. Biopsies do not meet criteria for primary cervical cancer screening.
6. Lab results for cervical cancer screening or procedural codes for hysterectomy are acceptable documentation and can reduce the need for some chart reviews for quality reporting.  
7. Pre-visit planning chart reviews prior to upcoming appointments and the use of EHR alerts can help staff and providers identify patients due for cervical cancer screening.