Study Shows Annual Cervical Cancer Screening Still Recommended By Most Primary Care Providers Despite Suggested Guidelines

Researchers from the Centers of Disease Control and Prevention (CDC) have determined that most primary care providers still recommend annual cervical cancer screening, and less than 15% would extend the screening interval when using the Papanicolaou test and human papillomavirus (HPV) test together, as some guidelines suggest. The results of the investigation are published online today in the American Journal of Obstetrics Gynecology (AJOG).

Issued by the American Cancer Society in 2002 and the American College of Obstetricians and Gynecologists in 2003, the current cervical cancer screening guidelines recommend a combination of a Papanicolaou test and an HPV test, (known as an HPV co-test) for women aged 30 years and over. If the results of these tests are normal, upon screening, women can wait three years for their next test. However, annual cervical cancer screening continues to be a frequent recommendation, irrespective of whether a woman has a history of normal pap tests or normal HPV co-test. Roughly one-half of providers investigated ordered the HPV co-test for their patients.

Lead researcher Katherine B. Roland, MPH, a behavioral scientist in CDCs Division of Cancer Prevention and Control explained,

“Use of the HPV co-test and adherence to the extended screening interval with normal test results reduce patient harms that can be caused by over-testing, including pain, inconvenience, morbidity, and unnecessary follow-up procedures and treatments Appropriate use of cervical cancer screening technologies is essential, now more than ever, if HPV co-testing is to be considered a preventive service for women covered by insurance providers.”

Evaluating nationally representative information gathered in 2006 through the CDCs National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, investigators examined HPV testing and co-testing practices and recorded the recommendations for screening intervals given by private office-based providers at hospital outpatient departments (OPDs). Responses from 376 private office-based physicians and 216 physicians from hospital and outpatient facilities were included in the investigation.

Health providers who ordered the HPV co-test were asked their recommendation for the next Papanicolaou test according to 3 clinical vignettes. The vignettes describe a woman between 30 and 60 years of age with a current normal Papanicolaou test with:

  1. no current HPV test results and history of 2 consecutive normal Papanicolaou test results
  2. a current negative HPV test result and a history of 2 consecutive normal Papanicolaou test results, and..
  3. a current negative HPV test result and no history of Papanicolaou tests.

The guidelines support extending the screening interval up to 3 years in each of the vignettes described.

76.4% of office-based providers and 85.2% of hospital OPDs would recommend a next screening in one year, for vignette 1. For vignette 2, 66.6% of office-based providers and 72.7% of hospital OPDs would recommend a next Papanicolaou test in 12 months. However, only 14% of office-based providers would recommend, as guidelines suggest, a next test in 3 years or more. 73.4% of office-based providers and 73.5% of hospital OPDs would recommend a next Papanicolaou test in 12 months, for vignette 3.

Establishing a record of normal Papanicolaou test results with the patient appears to be a key factor to providers making guideline-supported screening interval recommendations.
Roland continued,

“Our findings suggest a need for continued surveillance on cervical cancer screening guideline adherence. Evaluating provider screening behaviors, whether they reflect national guidelines and policies, and how those behaviors and policies translate to a woman’s clinical preventive care are vital, especially in an area where science and policy are rapidly evolving.”

Written by Grace Rattue

Copyright: Medical News Today

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