Equitable access for management of pre-invasive cervical disease.

Abstract

e17528 Background: The goal of this study was to evaluate the utilization and effectiveness of Nurse Practitioners (NPs) in under-resourced areas as a method to enhance access to cervical cancer screening and treatment. Methods: This retrospective study evaluated patients with cervical preinvasive disease on colposcopy referred to a single academic institution for loop electrosurgical excision procedure (LEEP) procedure from January 2022 to December 2024. Patients either received their care at the tertiary care center with a physician or at a state health department with an NP. Self-reported race and primary language data were collected, alongside pathology and lab results from medical records. The primary outcome assessed was the time from abnormal colposcopy to LEEP differences by race and age based on whether they received care at the tertiary care center or a state health department. Data was analyzed using GraphPad. Results: A total of 167 patients underwent LEEP after colposcopy in this study. Of these, 60% (N=100) had their procedure at a single center academic institution, while 40% (N=67) received colposcopy externally by NPs in state health departments. The median age was 33 years (29-40). Most patients were 38% (N=61) Hispanic, 33% (N=52) African American, or 29% (N=46) White Among the cohort, 81 patients (48%) had colposcopic biopsies indicating CIN II, and 69 patients (41%) with CIN III. The remaining 17 patients (11%) had squamous intraepithelial lesions or benign colposcopic results with positive endocervical curettage. The median time from colposcopy to LEEP across all participants was 63 days (22-93). There was no difference in the time to treatment based on age (p=0.42) or race (p=0.48). The duration from colposcopy to LEEP also did not differ significantly based on colposcopy location (p=0.72). This pattern held true across races between locations (p=0.73) and across ages between locations (p=0.16) (Table 1). Conclusions: In conclusion, the time from colposcopy to LEEP remains consistent across healthcare providers, including NPs at local health departments and at a single center academic institution with physicians. With increased utilization of innovative detection methods like the deployment of NPs in state health departments, equal outcomes were noted. The findings further emphasize a critical role that NPs can play in providing necessary care to underserved and rural communities and increasing access to cancer screening care. Time from colposcopy to day of LEEP procedure stratified by demographics. Overall Median Days NPMedian Days Physician Median Days Age  <30 64 p= 0.42 58 63 p=0.16  30-39 63 72 63  >40 70 72 61 Race  White 63 p=0.48 72 63 p=0.73  African American 65 72 63  Hispanic 63 71 63 Colposcopy Location  External 68.5 p=0.72  SCAI 61