Cervical cancer screening quality improvement in urban underserved primary care setting

Since the establishment of widespread screening and human papilloma virus (HPV) vaccination, cervical cancer has become one of the most preventable cancers, drastically dropping in its mortality in the U.S. by at least 50% since the 1970s. Primary care physicians offer such screenings and vaccinations in order to increase accessibility and as a tenant of preventive care management. As a primary care clinic in the only public hospital and tertiary care center in Miami-Dade County, we care for patients of incredibly diverse cultures and origins. The location of our health care system makes us the entry point for patients newly-arrived in the country from the entirety of the Caribbean basin, Central and South America and, coupled with its public nature, grants us the opportunity and honor to serve the unfunded, under-represented, underserved, and healthcare illiterate. Indeed, the vast majority of our patients are Spanish and Haitian Creole-speaking patients with overlapping complex illnesses and a history of scant-to-nonexistent medical care.

In this quality improvement project, we aim to evaluate the efficacy of cervical cancer screenings to age appropriate patients at the primary care clinic of Jefferson Reaves Sr. Clinic through data collection to determine if eligible patients are offered screening in a time appropriate manner and if abnormal results are followed up with evidence based guidelines for repeat pap smear testing vs. further testing (colposcopy, cone biopsy, etc.) Over the course of 3 months from January to March 2026, we independently reviewed patient charts who are eligible for cervical cancer screenings based on age and gender to determine retroactively if screening was performed and if follow up was needed for abnormal results. Based on our findings, we hope to identify barriers that prevent appropriate screenings in the Jefferson Reaves Clinic (JRC).

During our investigation, we found that over a 3 month period, there were 365 patients who were eligible for cervical cancer screening. 66% (242 patients) were up to date with their screening. 25% (92 patients) required a pap smear and/or HPV cotesting. Most interestingly, 6% (22 patients) required further work up with colposcopy testing. For 50% (11 patients) who appropriately were followed up with colposcopy, there was an average wait time of 3.5 months with referral to our GYN colleagues. The other 50% were not able to obtain the appropriate follow up secondary to socioeconomic, scheduling barriers and/or inappropriate retesting via pap smear according to the ASCCP guidelines.

Therefore, based on our findings, we hope to advocate for further resources at our primary care clinic with hospital administration to demonstrate the need for residency training with Family Medicine faculty in colposcopy testing in order to expedite work up and treatment of patients who are at risk of developing cervical cancer, particularly in vulnerable patient populations who face legal, socioeconomic barriers in seeking and obtaining evidence based and high-quality medical attention.