Many Ob/Gyns Continue Outdated Cervical Cancer Screening Practices

Despite new screening guidelines, most obstetrician-gynecologists continue to perform annual pap tests, according to a recent survey of members of the American Congress of Obstetricians and Gynecologists (ACOG).¹
   
In 2009, ACOG recommended that ob-gyns begin Pap testing in 21-year-old women, decrease the screening interval to every 2 years for women aged 21 to 29 and to every 3 years for women aged 30 or older if the results of previous Pap tests were normal or if previous concurrent HPV co-testing was negative, and discontinue screening at age 70 years or after a hysterectomy for benign conditions. In this study, researchers sought to determine whether ob-gyns have implemented these recommendations in their practice via a 15-item questionnaire. Of 1000 surveys sent out, 366 were completed and returned.

Most respondents (92%) reported offering HPV vaccination to patients. However, only about 27% of eligible patients receive it. The most commonly reported barrier to HPV vaccination was patient or parent refusal. Nearly all (96%) respondents said they would recommend HPV vaccination to a 13-year-old patient, but only 73% said they would recommend the vaccine to an 11-year-old patient.
   
For cervical cancer screening, approximately 50% of respondents begin offering screening at 21 years, discontinue screening at 70 years or after a hysterectomy, and appropriately use Pap and HPV co-testing. However, 74% still recommend annual Pap tests for patients aged 21 to 29 years, and 53% recommended annual Pap tests for patients aged 30 years and older. Their justification was that patients may not be comfortable with the extended testing interval and subsequently ignore annual examinations if a Pap test was not included.
   
About 45% of respondents offered Pap and HPV co-testing to patients 30 years and older, 21% offered co-testing only if the patient requested it, 11% screened all women with both tests, and 23% did not offer HPV testing. Only 16 physicians (4%) reported adhering to all ACOG recommendations for cervical cancer screening. Of interest, ob-gyns in solo practice were less likely than physicians in a group practice to adopt both vaccination and cervical cancer screening guidelines.
   
The most current recommendations for the prevention of cervical cancer include HPV vaccination in women aged 11 to 26 years, Pap tests every 3 years for women aged 21 to 29 years, and co-testing with Pap and HPV tests every 5 years for women aged 30 to 65 years regardless of HPV vaccination status.²

Pertinent Points:
- Less than one third of obstetrician-gynecologists vaccinate eligible patients against the human papillomavirus (HPV).
- Only half of ob-gyns adhere to cervical cancer prevention guidelines published in 2009.

References:

1. Perkins RB, Anderson BL, Sheinfeld S, Schulkin JA. Challenges in cervical cancer prevention: a survey of U.S. obstetrician-gynecologists. Am J Prev Med. 2013;45:175-181.2. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012;137:516-542.