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Providers still recommending yearly screening for cervical cancer, regardless of test results
Roland KB. Am J Obstet Gynecol. 2011;205.
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Despite guidelines recommending a 3-year interval, most providers continued to recommend yearly screening for cervical cancer among women with normal Pap smears and a negative HPV co-test, according to data from a study commissioned by the CDC.
In 2006, the CDC commissioned the Cervical Cancer Screening Supplement (CCSS) to obtain national data on self-reported cervical cancer screening practices by private office-based providers and hospital outpatient departments. CCSS is a supplement to the CDC’s National Ambulatory Medical Care Survey, which collects information on visits made to private office-based physicians from a representative, randomly selected sample, and the National Hospital Ambulatory Medical Care Survey, which collects information on visits made to emergency and outpatient departments of noninstitutional and general short-stay hospitals.
The American Cancer Society and American College of Obstetricians and Gynecologists recommend extending the cervical cancer screening interval to 2 to 3 years for women aged 30 years and older who have a history of normal Pap smears.
Data collected via the CCSS revealed that 78% of office-based providers ordered the HPV test, 51% ordered the HPV co-test, and 64.1% ordered it for women aged 30 years or older, which is the only approved use of the test, according to the researchers. Among the outpatient departments surveyed, 84% reported ordering the HPV test, 51.4% ordered the HPV co-test and 62.4% ordered it for women aged 30 years or older.
In all cases assessed, most providers in both settings would perform the next Pap smear in 1 year. Just 14% of office-based providers said that they would recommend a 3-year screening interval for a woman aged 30 to 60 years old with both a normal Pap smear and negative HPV result, as well as two consecutive normal Pap smears.
In the case of a woman aged 30 to 60 years old with a current normal Pap smear, no current HPV test result and two consecutive normal Pap smears, 76.4% of office-based providers and 85.2% of outpatient department providers said they would recommend the next screening in 1 year. In the case of a woman at the same age with a current normal Pap smear and negative HPV test result and two consecutive normal Pap smears, 66.6% of office-based providers and 72.7% of hospital outpatient department providers would recommend the next Pap smear in 1 year.
“Use of the HPV co-test and adherence to the extended screening interval guideline with concurrent normal test results circumvents patient harms that can be caused by overtesting, which include pains, inconvenience, and morbidity that is associated with testing, follow-up procedures and treatments,” the researchers wrote. “Frequent and inappropriate use of cervical cancer screening technologies also burdens the patient and practice with unnecessary financial costs.”
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This is an important paper, as it helps provide insight into differences between public policy decisions and actual clinical practice. An important next step in this research will be to gain a clearer understanding of why the primary care physician community appears to not fully support the suggested guidelines for cervical cancer screening.
This paper provides evidence that practicing physicians may have a different view regarding reasonable screening strategies, based on the available evidence, compared with those responsible for establishing public health policy. It is relevant for both the practicing physician community and public policymakers to be aware of these study results and for the groups to work together to understand the reasons for these differing opinions.
These findings do suggest the need for educational efforts designed to explain both the scientific and clinical rationale for national guideline recommendations regarding cervical cancer screening.
– Maurie Markman, MD
HemOnc Today Editorial Board member
Disclosure: Dr. Markman reports no relevant disclosures.
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