Cervical Cancer Screening Utilization among Kidney Transplant Recipients, 2001 to 2018

BACKGROUND: Kidney transplant recipients (KTR) have elevated risks of cervical precancers and cancers and guidelines recommend more frequent cervical cancer screening exams. However, little is known about current trends in cervical cancer screening in this unique population. We described patterns in the uptake of cervical cancer screening exams among female KTRs and identified factors associated with screening utilization.

METHODS: This retrospective cohort study included female KTRs between 20 and 65 years old, with Texas Medicare fee-for-service coverage, who received a transplant between January 1, 2001, and December 31, 2017. We determined the cumulative incidence of receiving cervical cancer screening post-transplant using ICD-9, ICD-10, and CPT codes and assessed factors associated with screening utilization, using the Fine and Gray model to account for competing events. Subdistribution hazard models were used to assess factors associated with screening uptake.

RESULTS: Among 2,653 KTRs meeting the inclusion and exclusion criteria, the 1-, 2-, and 3-year cumulative incidences of initiating a cervical cancer screening exam post-transplant were 31.7% [95% confidence interval (CI), 30.0%-33.6%], 48.0% (95% CI, 46.2%-49.9%), and 58.5% (95% CI, 56.7%-60.3%), respectively. KTRs who were 55 to 64 years old (vs. <45 years old) and those with a higher Charlson Comorbidity Score post-transplant were less likely to receive cervical cancer screening post-transplant.

CONCLUSIONS: Cervical cancer screening uptake is low in the years immediately following a kidney transplant.

IMPACT: Our findings highlight a need for interventions to improve cervical cancer screening utilization among kidney transplant recipients. See related In the Spotlight, p. 1554.