Many Docs Don't Follow HPV/Pap Test Guidelines: Study07/09/13
TUESDAY, July 9 (HealthDay News) -- Too few doctors follow U.S.
guidelines for human papillomavirus (HPV) vaccination and cervical
cancer screening, according to a new study.
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
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
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
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.
The U.S. National Cancer Institute has more about
cervical cancer prevention.
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