Impact of management guidelines for abnormal cervical cytology on colposcopy procedure rates among young women

In 2012, updated ASCCP management guidelines for abnormal cervical cytology recommended observation rather than immediate referral to colposcopy for low-grade abnormalities in women ages 21–24. We evaluated the impact of these guidelines on changes in colposcopy procedure rates among young women. We analyzed administrative and claims data from the largest statewide family planning program between July 2011 and June 2015. Using a difference-in-differences approach, we estimated changes in colposcopy procedure rates among women ages 21–24 years before and after the 2012 ASCCP management guidelines, relative to a comparison group of women ages 25–44. Our analysis included 333,977 women from 216 primary care provider sites. After publication of the 2012 ASCCP management guidelines, colposcopy rates significantly declined from 6.70% (95% CI 6.21–7.19) to 3.94% (95% CI 3.60–4.29) among women ages 21–24 and from 4.35% (95% CI 4.03–4.67) to 3.53% (3.25–3.80) among women over 24 years. These declines correspond to a 1.93 percentage point reduction (95% CI 1.62–2.25; p