Timing of colposcopy after cervical cytologic abnormalities

OBJECTIVE:: To examine the length of time from Pap test (index Pap) screening to follow-up colposcopy for women with abnormal Pap test results of low-grade squamous intraepithelial lesions (LSIL); atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (ASC-H); or high-grade squamous intraepithelial lesions (HSIL). METHODS:: We identified 4,824 women aged 18 to 64 years with the index Pap test results of LSIL, HSIL, or ASC-H from health insurance claims in a large U.S. health care organization and who had a routine Pap test in 2004. We used a survival regression model to estimate factors related to the length of time (days) from the index Pap test to a follow-up colposcopy. RESULTS:: The expected length of time from an abnormal Pap test to a colposcopy differed by age and Pap test result. For women with an ASC-H result, those who were older were more likely to delay colposcopy compared with the younger women. For women with LSIL and HSIL results, the timing of colposcopy did not differ by age; however, the time was shorter compared with ASC-H. We found that physician specialties, health care settings, and area-level racial and ethnic density were related to timing of receiving follow-up procedures after an abnormal index Pap test result. CONCLUSION:: Women with LSIL and HSIL received a colposcopy in 3-4 months, but women with ASC-H were more likely to receive the procedure at a later time. LEVEL OF EVIDENCE:: I