Are Immunocompromised Patients Without HIV Being Screened According to ASCCP Guidelines?
Location
Center for Advanced Learning & Simulation (CALS)
Publication Date
May 2026
Start Date
8-5-2026 10:00 AM
End Date
8-5-2026 10:15 AM
Description
Background: Cervical cancer remains the fourth most common cancer among women worldwide. Immunocompromised patients without HIV have increased risk of cervical dysplasia and cervical cancer. ASCCP guidelines recommend more intensive screening in immunocompromised women, recommending three consecutive annual Pap tests before transitioning to screening every 3 years. However, adherence to these guidelines in the South Louisiana Health System remains unclear. The aim of this study was to evaluate if patients who are immunocompromised without HIV are screened according to ASCCP cervical cancer screening guidelines.
Methods: We conducted a retrospective cross-sectional study of immunocompromised female patients aged 21–65 years receiving gynecologic care within the South Louisiana Health System between January 1, 2019, and December 31, 2021. Patients were included if they had at least one preventive gynecologic visit within the LCMC system during the study period. Immunocompromised status was defined by diagnoses including systemic lupus erythematosus, inflammatory bowel disease, rheumatoid arthritis, solid organ transplantation, or hematopoietic stem cell transplantation. Patients with HIV infection, prior hysterectomy, or current cervical dysplasia were excluded. Data were obtained through electronic medical record review and included demographic, clinical, and cervical cancer screening history. The primary outcome was adherence to ASCCP cervical cancer screening guidelines for immunocompromised patients without HIV. Descriptive statistics were used to summarize patient characteristics. Associations between patient factors and screening adherence were assessed using Fisher’s exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables, with statistical significance defined as p<0.05.
Results: A total of 177 immunocompromised patients without HIV met inclusion criteria. Overall, 76.3% (n=135) of patients received guideline-adherent follow-up according to ASCCP recommendations, while 23.7% (n=42) did not. Adherence to appropriate follow-up varied by select clinical factors. Patients with a history of cervical dysplasia were more likely to receive appropriate follow-up compared to those without prior dysplasia (p = 0.049). There was a trend toward differences in adherence by race (p = 0.069) and area deprivation index (local area deprivation index decile, p = 0.099), suggesting potential disparities, although these did not reach statistical significance. No significant differences in follow-up adherence were observed based on ethnicity (p = 0.114), marital status (p = 0.186), smoking status (p = 0.624), location (p = 0.664), immunosuppressive condition (p = 0.207), BMI (p = 0.561), or national area deprivation index percentile (p = 0.115).
Conclusions: In this cohort of immunocompromised patients without HIV, adherence to ASCCP-recommended cervical cancer screening follow-up was suboptimal, with nearly one-quarter of patients not receiving appropriate care. Patients with a prior history of cervical dysplasia were more likely to receive guideline-adherent follow-up, suggesting that recognized high-risk status may improve adherence. Trends toward disparities by race and neighborhood deprivation highlight potential inequities in care delivery that warrant further investigation. These findings underscore the need for improved systems-based interventions to ensure consistent adherence to cervical cancer screening guidelines in this high-risk population.
Recommended Citation
Etienne, Saskya MD; Jernigan, Amelia MD; Plaisance, Taylor BS; Chang, Angella BA; and Tran, Ngan BS, "Are Immunocompromised Patients Without HIV Being Screened According to ASCCP Guidelines?" (2026). Dept. of Obstetrics & Gynecology Resident Research Day. 5.
https://digitalscholar.lsuhsc.edu/obgyn_rd/2026/presentations/5
Are Immunocompromised Patients Without HIV Being Screened According to ASCCP Guidelines?
Center for Advanced Learning & Simulation (CALS)
Background: Cervical cancer remains the fourth most common cancer among women worldwide. Immunocompromised patients without HIV have increased risk of cervical dysplasia and cervical cancer. ASCCP guidelines recommend more intensive screening in immunocompromised women, recommending three consecutive annual Pap tests before transitioning to screening every 3 years. However, adherence to these guidelines in the South Louisiana Health System remains unclear. The aim of this study was to evaluate if patients who are immunocompromised without HIV are screened according to ASCCP cervical cancer screening guidelines.
Methods: We conducted a retrospective cross-sectional study of immunocompromised female patients aged 21–65 years receiving gynecologic care within the South Louisiana Health System between January 1, 2019, and December 31, 2021. Patients were included if they had at least one preventive gynecologic visit within the LCMC system during the study period. Immunocompromised status was defined by diagnoses including systemic lupus erythematosus, inflammatory bowel disease, rheumatoid arthritis, solid organ transplantation, or hematopoietic stem cell transplantation. Patients with HIV infection, prior hysterectomy, or current cervical dysplasia were excluded. Data were obtained through electronic medical record review and included demographic, clinical, and cervical cancer screening history. The primary outcome was adherence to ASCCP cervical cancer screening guidelines for immunocompromised patients without HIV. Descriptive statistics were used to summarize patient characteristics. Associations between patient factors and screening adherence were assessed using Fisher’s exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables, with statistical significance defined as p<0.05.
Results: A total of 177 immunocompromised patients without HIV met inclusion criteria. Overall, 76.3% (n=135) of patients received guideline-adherent follow-up according to ASCCP recommendations, while 23.7% (n=42) did not. Adherence to appropriate follow-up varied by select clinical factors. Patients with a history of cervical dysplasia were more likely to receive appropriate follow-up compared to those without prior dysplasia (p = 0.049). There was a trend toward differences in adherence by race (p = 0.069) and area deprivation index (local area deprivation index decile, p = 0.099), suggesting potential disparities, although these did not reach statistical significance. No significant differences in follow-up adherence were observed based on ethnicity (p = 0.114), marital status (p = 0.186), smoking status (p = 0.624), location (p = 0.664), immunosuppressive condition (p = 0.207), BMI (p = 0.561), or national area deprivation index percentile (p = 0.115).
Conclusions: In this cohort of immunocompromised patients without HIV, adherence to ASCCP-recommended cervical cancer screening follow-up was suboptimal, with nearly one-quarter of patients not receiving appropriate care. Patients with a prior history of cervical dysplasia were more likely to receive guideline-adherent follow-up, suggesting that recognized high-risk status may improve adherence. Trends toward disparities by race and neighborhood deprivation highlight potential inequities in care delivery that warrant further investigation. These findings underscore the need for improved systems-based interventions to ensure consistent adherence to cervical cancer screening guidelines in this high-risk population.
Comments
Advisor: Amelia Jernigan MD