Objective: The fight against cervical cancer requires effective screening together with optimal and on-time treatment along the care continuum. We aimed to examine the impact of cervical cancer screening and treatment guidelines on screening, and follow-up adherence to guidelines. Methods: Data from electronic health records and healthcare provision claims for 50 702 women was used. The annual rates of PAP tests, HPV tests and colposcopies during two guideline periods (2nd version 2012-2014 vs 3rd version 2016-2019) were compared. To assess the adherence to guidelines, the subjects were classified as adherent, over- or undertested based on the timing of the appropriate follow-up test. Results: The number of PAP tests decreased and HPV tests increased during the 3rd guideline period (p < 0.01). During the 3rd guideline period, among 21-29-year-old women, the adherence to guidelines ranged from 38.7% (44.4...50.1) for ASC-US to 73.4% (62.6...84.3) for HSIL, and among 30-59-year-old from 49.0% (45.9...52.2) for ASC-US to 65.7% (58.8...72.7) for ASC-H. The highest rate of undertested women was for ASC-US (21-29y: 25.7%; 30-59y: 21.9%). The rates of over-tested women remained below 12% for all cervical pathologies observed. There were 55.2% (95% CI 49.7...60.8) of 21-24-year-old and 57.1% (95% CI 53.6...60.6) of 25-29-year-old women who received an HPV test not adherent to the guidelines. Conclusions: Our findings highlighted some shortcomings in the adherence to guidelines, especially among women under 30. The insights gained from this study helps to improve the quality of care and thus, reduce cervical cancer incidence and mortality.

The authors have declared no competing interest.

The research was carried out with the financial support of the Estonian Research Council grant (PRG1844), the European Social Fund via the IT Academy programme, the European Regional Development Fund through EXCITE Centre of Excellence (TK148) and OPTIMA project (grant agreement No. 101034347) through IMI2 Joint Undertaking supported by European Union's Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA).

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The study was approved by the Research Ethics Committee of the University of Tartu (300/T-23) and the Estonian Committee on Bioethics and Human Research (1.1-12/653) and the requirement for informed consent was waived.

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