Failure to follow up abnormal test results associated with cervical cancer in primary and ambulatory care - a systematic review

Sep 24, 2026

Uploaded by Kyle

Cervical cancer remains a major global burden despite being preventable and treatable. In primary and ambulatory care, inadequate follow-up of abnormal test results can worsen outcomes, including higher mortality and reduced quality of life. This systematic review examines the magnitude and determinants of inadequate follow-up for cervical abnormalities. Searches covered MEDLINE, Embase, Cochrane Library and CINAHL for 2000–2022. Results synthesize evidence from studies reporting patient populations without prior cancer diagnoses.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages28

Reading Time1 h 11 min

AccessFree to download

Abstract

Background

Aims

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Keywords

Introduction

Cervical cancer globally

Martinez‑Gutierrez et al. BMC Cancer (2023) 23:653 [https://doi.org/10.1](https://doi.org/10.1) 186/s12885‑023‑11082‑z BMC Cancer RESEARCH Open Access Failure to follow up abnormal test results associated with cervical cancer in primary and ambulatory care: a systematic review Javiera Martinez‑Gutierrez 1,2* , Sophie Chima1, Lucy Boyd1,3 , Asma Sherwani1 , Allison Drosdowsky1 , Napin Karnchanachari 1 , Vivien Luong1 , Jeanette C. Reece4 and Jon Emery1 Abstract Background Cervical cancer is a preventable and treatable form of cancer yet continues to be the fourth most common cancer among women globally. Primary care is the first point of contact most patients have with health services and is where most cancer prevention and early detection occur. Inadequate follow‑up of abnormal test results for cervical abnormalities in primary care can lead to suboptimal patient outcomes including higher mortality and decreased quality of life. Aims To explore the magnitude of and factors associated with, inadequate follow‑up of test results for cervical abnor‑ malities in primary and ambulatory care. Methods MEDLINE, Embase, Cochrane Library and CINAHL were searched for peer‑reviewed literature from 2000– 2022, excluding case‑studies, grey literature, and systematic reviews. Studies were included if they reported on patients aged ≥ 18 years with no previous cancer diagnosis, in a primary care/ambulatory setting. Risk of bias was assessed using the Joanna Briggs Institute Critical appraisal checklists, appropriate to the study design. A seg‑ regated methodology was used to perform a narrative synthesis, maintaining the distinction between quantitative and qualitative research. Results We included 27 publications reporting on 26 studies in our review; all were conducted in high‑income countries. They included 265,041 participants from a variety of ambulatory settings such as family medicine, primary care, women’s services, and colposcopy clinics. Rates of inadequate follow‑up ranged from 4 to 75% . Studies reported 41 different factors associated with inadequate follow‑up. Personal factors associated with inadequate follow‑up included younger age, lower education, and socioeconomic status. Psychological factors were reported by only 3/26 studies and 2/3 found no significant association. System protective factors included the presence of a regular primary care provider and direct notification of abnormal test results. Discussion This review describes inadequate follow‑up of abnormal cervical abnormalities in primary care. Preva‑ lence varied and the evidence about causal factors is unclear. Most interventions evaluated were effective in decreas‑ ing inadequate follow‑up. Examples of effective interventions were appointment reminders via telephone, direct notification of laboratory results, and HPV self‑sampling. Even though rates of cervical cancer have decreased over the years, there is a lack of information on factors affecting follow‑up in primary care and ambulatory settings, *Correspondence: Javiera Martinez‑Gutierrez [javiera. martinez@unimelb.edu.au](javiera. martinez@unimelb.edu.au) Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly f

FAQs

Why is follow-up of abnormal cervical test results important in primary care?

Inadequate follow-up can lead to suboptimal patient outcomes, including higher mortality and decreased quality of life, by delaying appropriate diagnosis or treatment.

What time span and types of studies were included in the review?

The review searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed literature from 2000 to 2022, excluding case studies, grey literature, and systematic reviews.

What factors were associated with inadequate follow-up?

Reported factors included personal factors such as younger age, lower education, and socioeconomic status, as well as system protective factors like having a regular primary care provider and direct notification of abnormal results.

Sep 24, 2026

Uploaded by Kyle