Retrospective study of guideline concordance in cervical cancer screening surveillance by age, race, and ethnicity.

5525 Background: Nearly one in five new cervical cancer cases occur in individuals aged ≥ 65, with higher incidence among Black women compared to White women. Despite these disparities, evidence guiding screening and surveillance in older women is limited. This study evaluates guideline concordance for follow-up after abnormal cervical cancer screening and examines variation by age, race, and ethnicity. Methods: This retrospective cohort study assessed 1,861,906 cervical cancer screening results (2009-2024) from the TrinetX database. Included patients were female, ≥ 21 years old, and had an HPV test or pap smear. Guideline concordance (i.e., colposcopy within one year of high-risk cervical cancer screenings result) was assessed by running logistic regression models by age group, race, and ethnicity. Logistic regression assessed odds of concordant follow-up by age, race, and ethnicity, using women aged 30–39 and non-Hispanic White women as reference groups, respectively. Results: Guideline-concordant follow-up varied by age: 56.87% aged 21-29, 58.84% aged 30-39, 56.36% aged 40-49, 53.93% aged 50-65, and 45.80% aged 65+. Compared with women aged 30-39, both younger and older women were significantly less likely to receive guideline concordant follow-up. Women 65+ had 44% lower odds of concordant follow-up (OR= 0.56, 95% CI 0.53 to 0.60, p<.001). Guideline-concordant care also varied by race and ethnicity: 51.11% of non-Hispanic Black, 56.65% of non-Hispanic Asian, 60.36% of non-Hispanic White, 58.43% of non-Hispanic Other, and 51.71% of Hispanic patients. Compared to non-Hispanic White women, all other groups had significantly lower odds of follow-up, with non-Hispanic Black women having 30% lower odds (OR = 0.70, 95% CI 0.68 to 0.72, p<.001) and Hispanic women having 28% lower odds (OR= 0.72, 95% CI 0.71 to 0.74, p<.001) of concordant follow-up. Conclusions: Overall, the rate of guideline concordant follow-up after high-risk cervical cancer screening results was low (57.83%) and declined with age, with lowest rates among women ≥ 65 (45.80%). All other age groups had significantly lower odds of concordance than those 30-39, with those 65+ having the lowest odds of concordance. Significant disparities were also observed by race and ethnicity, particularly among non-Hispanic Black and Hispanic women. Further research is needed to assess the decreased surveillance rates after high-risk cervical cancer screening results at the population level and specific attention should be focused on groups who have been under-surveilled.