Many Docs Don't Follow HPV/Pap Test Guidelines: Study
Too few vaccines recommended, and too many cervical cancer tests done, survey finds
Tuesday, July 9, 2013
A survey of 366 obstetricians-gynecologists in the United States found that less than one-third of them vaccinate eligible patients against HPV and only half follow cervical cancer prevention guidelines.
Vaccination against HPV -- which can cause cervical cancer -- is recommended for females aged 11 to 26 years.
In 2009, the American Congress of Obstetricians and Gynecologists (ACOG) issued guidelines that recommended beginning annual cervical cancer screening Pap tests at age 21, and decreasing screening to once every two years for women aged 21 to 29 years, and to once every three years for women aged 30 and older who have either prior normal Pap test results or negative results on tests for HPV.
Pap screening should be halted at age 70 years or after a woman undergoes a hysterectomy for non-cancer-related reasons, according to the guidelines.
The survey revealed that 92 percent of respondents offered HPV vaccination to patients, but only 27 percent said that most eligible patients received vaccination. The most commonly cited barriers to HPV vaccination were parent and patient refusals.
About half of the doctors followed guidelines to begin cervical cancer screening at age 21, discontinue screening at age 70 or after hysterectomy, and to use Pap and HPV co-testing appropriately, according to the study published in the August issue of the American Journal of Preventive Medicine.
However, most of the doctors continued to recommend annual Pap test screening (74 percent for ages 21 to 29, and 53 percent for ages 30 and above), the findings showed. Although the doctors in the survey were comfortable with the recommended extended screening intervals, they felt that patients were uncomfortable with these intervals and were concerned that women would not schedule annual checkups if a Pap test was not part of the exam.
Doctors in solo practices were less likely to follow both vaccination and screening guidelines than those in group practices, the study authors found.
About 45 percent of the doctors offered Pap and HPV co-testing to women aged 30 years and older, 21 percent offered this only if requested by the patient, 11 percent screened all women with both tests, and 23 percent did not offer HPV testing, the investigators noted.
Only 16 (4 percent) of the doctors said they followed all the 2009 guidelines for cervical cancer screening.
Doctor-patient communication may be a major factor in low HPV vaccination rates, the researchers suggested.
"In the current survey and others, providers stated that the largest barrier to HPV vaccination was patients and parents declining to receive the vaccine. However, studies indicate that most patients support HPV vaccination, and that a strong physician recommendation is the most important determinant of vaccine uptake in young women," lead investigator Dr. Rebecca Perkins, of the Boston University School of Medicine, said in a journal news release.
The survey was conducted before new guidelines were issued in 2012 by the U.S. Preventive Services Task Force, American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology. The guidelines, endorsed by ACOG, recommend Pap tests once every three years for women aged 21 to 29 years and co-testing with Pap and HPV tests at five-year intervals for women aged 30 to 65 years, regardless of whether they have received HPV vaccination.