[ { "phenotype_id": "PH389", "phenotype_version_id": 778, "name": "Screen Cervical", "definition": "Aims/hypothesis: \n\nStudies from healthcare databases suggest that patients with type 2 diabetes (T2D) under-utilize cancer screening opportunities, but recording bias may be a problem. We evaluated the relative effect of T2D on screening utilization trends among long-established UK national programmes in breast and cervical cancers; and tested the impact of introducing a primary care financial incentive scheme (QOF) in 2004, known to improve data recording for diabetes-related care.\n\n\nMaterials and methods: \n\nUsing the Clinical Practice Research Datalink, we identified women with prevalent T2DM (N = 174,256), separately by year for 1999 to 2011, and eligible for screening events for breast (aged 50-70 years) and cervical (aged 35-49 and 50-64 years) cancers. We described secular trends and compared these with the non-diabetes population, and accounted for co-morbidities using matched conditional logistic regression models. We performed interrupted time-series (ITS) analyses to assess the impact of the QOF introduction.\n\n\nResults: \n\nCompared with the non-diabetes population, relative uptake rates for breast and cervical screening were generally similar in patients with T2D pre-2004, becoming greater for years post-2004. These patterns were unaffected by adjustment for GP practice, and were not accounted for by T2D associated co-morbidities. ITS analysis showed increased activities in all three screening groups for 2007, but these broadly returned to pre-2004 trends by 2011, paralleling similar patterns in recording for other care provision indicators.\n\n\nConclusions/interpretation: \n\nIn this population, we found no evidence that women with T2D under-utilize breast and cervical cancer screening opportunities. A financial incentive scheme was associated with intermediate-term improvements in screening utilization, but this is likely to reflect improved recording of care events.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Magthew Carr, Even Kontopantelis, Tim Doran, Christian Campbell, Lorraine Lipscombe, Emma Crosbie, Anthony Howell, Iain E Buchan, Andrew G Renehan, Breast and Cervical Cancer Screening Utilization, and recording bias, in women with type 2 diabetes (UK). 2015." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:17:00.970128Z", "author": "Matthew Carr, Evan Kontopantelis, Tim Doran, Christine Campbell, Lorraine Lipscombe, Emma Crosbie, Anothony Howell, Iain E Buchan, Andrew G Renehan", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:17:00.970155Z", "sex": [ { "name": "Female", "value": "2" } ], "type": [ { "name": "Biomarker", "value": "1" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 }, { "name": "OXMIS codes", "value": 15 } ], "event_date_range": "1999 - 2011", "concept_information": [ { "concept_id": 1720, "concept_version_id": 4578, "concept_name": "Screen Cervical - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH389", "phenotype_version_id": 778, "phenotype_name": "Screen Cervical", "code_attribute_header": [ "Entity type", "Coding System (OXMIS Read)", "Category" ], "codes": [ { "code": "4149.00", "description": "Cervical cytology sample sent to laboratory", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4JRL.00", "description": "Cervical cytology screening test", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2..00", "description": "Cervical smear result", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K21.00", "description": "Cervical smear:inadequate spec", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2..11", "description": "Dyskaryosis on cervical smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2..12", "description": "Dysplasia (dysk.)on cerv.smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K22.00", "description": "Cervical smear: negative", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K22.11", "description": "Smear NAD: no endocervic cells", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K23.00", "description": "Cerv.smear: mild dyskaryosis", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K24.00", "description": "Cerv.smear: severe dyskaryosis", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K25.00", "description": "Cerv.smear:severe dysk.?inv.ca", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K26.00", "description": "Cervical smear: ? gland neopl.", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K27.00", "description": "Cervical smear:atrophic change", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K27.11", "description": "Atrophic change on cerv.smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K28.00", "description": "Cerv.smear: mod.dyskaryosis", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K29.00", "description": "Cerv.smear: borderline changes", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2A.00", "description": "Cervical smear endocervical cells present", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2B.00", "description": "Cervical smear endocervical cells absent", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2C.00", "description": "Smear NAD - no endocervical cells", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2D.00", "description": "Cervical smear transformation zone cells present", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2E.00", "description": "Cervical smear transformation zone cells absent", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2F.00", "description": "", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2Z.00", "description": "Cervical smear result NOS", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K2Z.11", "description": "Nuclear abnormality on smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K3..00", "description": "Cervical smear - inflam.change", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K31.00", "description": "Cervical smear-no inflammation", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K32.00", "description": "Cervical smear-severe inflamm.", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K33.00", "description": "Cervical smear - trichomonas", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K34.00", "description": "Cervical smear - candida", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K35.00", "description": "Cerv.smear - viral infl.unsp.", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K35.11", "description": "Viral changes on cerv. smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K36.00", "description": "Cervical smear - wart virus", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K36.12", "description": "HPV changes: cervical smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K3A.00", "description": "Cervical smear: koilocytosis", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K3B.00", "description": "Cervical smear - mild inflammation", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K3C.00", "description": "Cervical smear - moderate inflammation", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K3Z.00", "description": "Cervical smear - inflam. NOS", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K4..00", "description": "Cervical smear - action needed", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K48.00", "description": "Cx. smear: colposcopy needed", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K49.00", "description": "Cx. smear:cervical biopsy need", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K4Z.00", "description": "Cervical smear action NOS", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4K55.00", "description": "Cervical cytology test", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4KA..00", "description": "Vaginal vault smear result", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4KA1.00", "description": "Vaginal vault smear negative", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "4KA4.00", "description": "Vaginal vault smear abnormal", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685..00", "description": "Cervical neoplasia screening", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685..11", "description": "Cervical cytology screen", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685..12", "description": "Cervical smear screen", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "6859.00", "description": "Ca cervix - screen done", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "6859.11", "description": "Cervical cytology examination", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685A.00", "description": "Ca cervix screen-no result yet", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685B.00", "description": "Ca cervix screen normal", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685C.00", "description": "Ca cervix screen abnormal", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685D.00", "description": "Ca cervix screen + fee claim", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685E.00", "description": "Cervical smear status unknown", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685R.00", "description": "Liquid based cervical cytology screening", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "685Z.00", "description": "Ca cervix screen NOS", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "7E2A000", "description": "Exam female genital tract under anaesth & Papanicolau smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "7E2A200", "description": "Papanicolau smear NEC", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "7E2A211", "description": "Cervical smear NEC", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "7E2A300", "description": "Vaginal vault smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "981..00", "description": "FP74 - cervical cytology claim", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "981..11", "description": "Cervical smear - fee claim", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "9O81.00", "description": "Cervical smear - 1st call", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "9O8A.00", "description": "Abnormal smear - 1st recall", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "9O8R.00", "description": "Smear normal - pt. notified", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "9O8T.00", "description": "Cervical smear slide lost in transit", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "9O8U.00", "description": "Cervical smear slide broken in transit", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "9O8V.00", "description": "Place cervical smear taken", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "R150.00", "description": "[D]Nonspecific abnormal Papanicolaou cervical smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "R150000", "description": "[D]Dyskaryotic cervical smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "R150100", "description": "[D] Koilocytosis - cervical smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "R150.11", "description": "[D]Cervical smear - nonspecific abnormality", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "R150.12", "description": "[D]Papanicolaou smear - nonspecific abnormality", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "R150z00", "description": "[D]Nonspecific abnormal Papanicolaou cervical smear NOS", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "R151.00", "description": "[D]Nonspecific abnormal Papanicolaou smear of other origin", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "ZV76200", "description": "[V]Screening for malignant neoplasm of cervix", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "ZV76211", "description": "[V]Routine Papanicolaou smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } }, { "code": "ZV76212", "description": "[V]Routine cervical smear", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "Read", "Category": "test" } } ] }, { "concept_id": 1721, "concept_version_id": 4580, "concept_name": "Screen Cervical - Primary Care", "coding_system": { "id": 15, "name": "OXMIS codes", "description": "OXMIS codes" }, "phenotype_id": "PH389", "phenotype_version_id": 778, "phenotype_name": "Screen Cervical", "code_attribute_header": [ "Entity type", "Coding System (OXMIS Read)", "Category" ], "codes": [ { "code": "9O89.00", "description": "SMEAR ABNORMAL - PATIENT TOLD", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "9O89.11", "description": "SMEAR ABNORMAL - PT. NOTIFIED", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L3230T", "description": "CERVICAL SMEAR TAKEN", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L9160", "description": "PAP SMEAR EXAMINATION", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L9160NG", "description": "PAP SMEAR NEGATIVE", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L9161AC", "description": "CERVICAL SMEAR ABNORMAL", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L9162", "description": "CERVICAL SMEAR", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L9162BA", "description": "SMEAR INFLAMED", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L9162N", "description": "NEGATIVE - CERVICAL SMEAR", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L9162PJ", "description": "CARCINOMA IN SITU - CERVICAL SMEAR", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L9162PP", "description": "CERVICAL SMEAR CIN I", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } }, { "code": "L9162PQ", "description": "CERVICAL SMEAR CIN II", "attributes": { "Entity type": "res22: screen_cervical", "Coding System (OXMIS Read)": "OXMIS", "Category": "test" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/7xc1-ye92", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 778, "version_name": "Screen Cervical", "version_date": "2021-10-06T16:17:00.992493Z", "is_published": true, "is_latest": true } ] } ]