Most Docs Don't Follow Screening Guidelines for Cervical Cancer

Primary care physicians are likely to recommend cervical cancer screening more often than suggested by professional guidelines, according to a new study by researchers from CDC and the National Cancer Institute. And if the physician adds HPV screening, which makes testing even more sensitive, he or she is even less likely to adhere to the nearly unanimous consensus of testing every three years.

The authors analyzed responses to clinical vignettes from 1,212 primary care physicians, 950 of whom perform Pap tests and recommend HPV testing for screening or management. The growing use of HPV testing has increased the complexity of screening guidelines, but also has prompted the American College of Obstetrics and Gynecology and the American Cancer Society to extend the screening intervals to three years without the necessity of a prior normal Pap result, the authors note.

In the study, the hypothetical vignettes described a 35-year-old woman with various histories of Pap or HPV screening. All test results that were described were negative. When addressed, it was noted that the woman had no recent new sexual partners. The doctors were then asked how they would conduct future screening in each scenario.

For a 35-year-old woman with three normal Pap test results, the next test should be in three years, said 31.8 percent of Pap test providers who recommend HPV testing. However, for a 35-year-old woman with one normal Pap and one negative HPV test, the authors report that only 19.0 would recommend the next test be conducted in three years. Even more (60.1 percent) said they would give both Pap and HPV testing annually.

"A lower proportion of [US primary care physicians] recommend extending screening intervals to 3 years with an HPV co-test than those screening with Pap alone," the study authors conclude. "Implementation of effective interventions and strategies that improve physician adherence to recommendations will be important for efficient screening practices."

The study, "Cervical Cancer Screening with Both Human Papillomavirus and Papanicolaou Testing vs Papanicolaou Testing Alone," was published in Archives of Internal Medicine (2010;170(11):985-986).

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