Predictors of routine HPV-based cervical cancer screening adoption in federally qualified health centers within a multi-state practice research network 2012-2022: retrospective observational study.

Michelle B Shin, Connor R Volpi, Warren Szewczyk, Peggy A Hannon, Paula Lozano, Jennifer Tsui, Allison M Cole

Abstract readObservational Study

In one paragraph

Observational study in BMC primary care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Michelle B ShinDepartment of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA. mbyshin@uw.edu.

Connor R VolpiDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Warren SzewczykDepartment of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA.

Peggy A HannonDepartment of Health Systems and Population Health, University of Washington, Seattle, WA, USA.

Paula LozanoKaiser Permanente Washington Health Research Institute, Seattle, WA, USA.

Jennifer TsuiDepartment of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Allison M ColeDepartment of Family Medicine, University of Washington, Seattle, WA, USA.

Funding

University of Washington School of Nursing Research Intramural Funding Program

6 · The paper itself

Abstract

backgroundCervical cancer screening guidelines in the United States have evolved with the introduction of human papillomavirus (HPV)-based modalities, including co-testing in 2012 and primary HPV testing in 2018, in addition to Pap-only screening. However, adoption of these modalities in federally qualified health centers (FQHCs) has been underexplored. We examined longitudinal patterns of HPV-based cervical cancer screening adoption (e.g., proportion screened with co- and primary HPV testing) across three FQHC systems in Washington and Idaho and explored factors associated with receipt of HPV-based modalities.

methodsUsing electronic health record data, we identified the first routine cervical cancer screening among 11,316 individuals from 2012-2022 across 25 clinics within three FQHCs. Screening modality at the screening was classified as Pap-only, co-testing, or primary HPV testing. We quantified the proportion of each screening modality by year and FQHC from 2012-2022 and used multivariable logistic regression to estimate associations of factors (age, race, ethnicity, rurality, insurance status, primary care visits, and FQHC) with HPV-based screening for 2012-2018 and 2018-2022 guideline periods.

resultsThe proportion of up-to-date screening in 2022 was 34.0%, 22.7%, and 37.6% for FQHCs A, B, and C, respectively. Among individuals receiving their first routine screening from 2012-2022, 59.1% underwent Pap-only, 38.8% co-testing, and 2.0% primary HPV testing, respectively. Pap-only was nearly universal in 2012 but declined to 57.0% by 2022, while co-testing increased to 41.0%. Primary HPV testing remained < 7.0% across all years and FQHCs. During the 2012-2018 guideline period, odds of co-testing (vs. Pap-only) were higher among Hispanic (aOR = 1.56; 95% CI, 1.35-1.80) and Black (aOR = 1.64; 95% CI, 1.18-2.28) individuals and screened at FQHC C (aOR = 4.21; 95% CI, 3.41-5.22). Odds were lower among rural (aOR = 0.20; 95% CI, 0.17-0.24) and uninsured patients (aOR = 0.51; 95% CI, 0.44-0.58). From 2018-2022, odds of co-testing were higher among individuals aged 40-59 and Black, lower at FQHC B (aOR = 0.48; 95% CI, 0.37-0.63), and higher at FQHC C (aOR = 1.34; 95% CI, 1.06-1.68).

conclusionsAdoption of HPV-based screening modalities increased over time and varied by patients' rurality, race, and ethnicity. Lower adoption in some organizations may reflect limited capacity/resources for adopting newer screening modalities, which could impact equitable access to screening.

Indexed as

Early Detection of CancerHuman Papillomavirus VirusesPapillomavirus InfectionsUterine Cervical NeoplasmsAdultFemaleHumansIdahoMass ScreeningMiddle AgedPapanicolaou TestRetrospective StudiesSafety-net ProvidersUnited StatesWashingtonCervical cancer screeningFederally qualified health centersHealth disparitiesHuman papillomavirus (HPV) testingScreening modalities

Identifiers

PMID42481945

DOI10.1186/s12875-026-03452-w

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.