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Screening histories were ascertained from 0.5 to 4\u2009years prior to cervical cancer diagnosis. We identified potential care gaps in the screening history for each woman and classified them into one of three mutually exclusive types: lack of a screening test, screening test failure, and diagnostic\/treatment care gap. Distributions of care gaps were tabulated by stage, histology, and study site. Multivariable nominal logistic regression was used to examine the associations between demographic and cancer characteristics and type of care gap.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 499 women evaluated, 46% lacked a screening test in the time window examined, 31% experienced a screening test failure, and 22% experienced a diagnostic\/treatment care gap. More than half of the women with advanced cancer and squamous cell carcinoma lacked a screening test compared to 31% and 24% of women with localized cancer and adenocarcinoma, respectively. Women aged 21\u201329 at diagnosis were more likely to experience screening test failure and diagnostic\/treatment care gap, while those aged 50\u201365 were more likely to lack a screening test, compared to women aged 30\u201339.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings demonstrate a continuing need to develop interventions targeting unscreened and under\u2010screened women and improve detection and diagnosis of adenocarcinoma in women undergoing cervical cancer screening and diagnostic follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.5226","type":"journal-article","created":{"date-parts":[[2022,9,15]],"date-time":"2022-09-15T07:27:56Z","timestamp":1663226876000},"page":"3705-3717","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Gaps in the screening process for women diagnosed with cervical cancer in four diverse <scp>US<\/scp> health care settings"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6072-4954","authenticated-orcid":false,"given":"Chun R.","family":"Chao","sequence":"first","affiliation":[{"name":"Department of Research and Evaluation Kaiser Permanente Southern California  Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1630-9021","authenticated-orcid":false,"given":"Jessica","family":"Chubak","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8401-1396","authenticated-orcid":false,"given":"Elisabeth F.","family":"Beaber","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Research Center, Public Health Sciences Division  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aruna","family":"Kamineni","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Silverberg","sequence":"additional","affiliation":[{"name":"Division of Research Kaiser Permanente Northern California  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin A.","family":"Tiro","sequence":"additional","affiliation":[{"name":"Department of Population and Data Sciences University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Harold C. 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