Many Doctors Overuse Pap Testing: Survey

Guidelines for Pap screening were substantially revised earlier this decade in response to research showing that low-risk women age 30 and older did not need annual testing. However, a new study suggests that many U.S. primary care doctors recommend Pap screening more often than guidelines suggest.

Researchers surveyed a nationally representative sample of physicians during 2006-07, asking what their Pap testing recommendations would be for four patient vignettes. Of 1,212 participants responding, just 22.3 percent made recommendations fully consistent with major professional organizations' guidelines, including the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG). The proportion making guideline-consistent recommendations was 27.5 percent among internists, 21.1 percent among family and general practitioners, and 16.4 percent among obstetricians and gynecologists.

Half of respondents would not recommend Pap testing for a hypothetical 18-year-old woman with no sexual experience, which is in line with guidelines. The other half recommended testing at least every three years. ACS, ACOG, and the U.S. Preventive Services Task Force generally counsel that women begin Pap testing at age 21 or within three years of sexual debut, whichever is earlier; then screen yearly to age 30; and thereafter screen every two to three years if results for three consecutive tests are normal.

More than 40 percent said they would advise Pap testing for a 66-year old woman with lung cancer, and some recommended annual testing, despite the fact that the guidelines say Pap testing would not be indicated for this patient.

Low-risk women ages 65-70 can stop Pap screening, the recommendations say. In addition, according to ACS guidance, women who have had a total hysterectomy for a noncancerous condition or who have a serious disease limiting life expectancy can stop Pap screening.

The researchers said doctors' reasons for disregarding the guidelines could include disagreement with them, confusion about the recent changes, concerns over potential malpractice suits or financial incentives for testing more often.

The full report, "Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007," was published in Annals of Internal Medicine (2009;151(9):602-611).

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