Annual Cervical Cancer Screening Persists, Despite Recommended Guidelines

According to New CDC Study in the American Journal of Obstetrics & Gynecology

Philadelphia, PA, August 18, 2011 - Investigators from the Centers for Disease Control and Prevention (CDC) have determined that the majority of primary care providers continue to recommend annual cervical cancer screening, and less than 15% would extend the screening interval when using the Papanicolaou test and human papillomavirus (HPV) test together, as some guidelines suggest. The results of the study are published online today in the American Journal of Obstetrics & Gynecology (AJOG).

Current cervical cancer screening guidelines, issued by the American Cancer Society in 2002 and the American College of Obstetricians and Gynecologists in 2003, recommend a combination of a Papanicolaou test and an HPV test, known as an HPV co-test, for women 30 years of age and older. Upon screening, if the results of these two tests are normal, women can wait 3 years for their next cervical cancer screening test. However, annual cervical cancer screening continues to be a common recommendation, regardless if a woman has a history of normal Pap tests or normal HPV co-test. Approximately one-half of providers studied ordered the HPV co-test for their patients.

“Use of the HPV co-test and adherence to the extended screening interval with normal test results reduce patient harms that can be caused by over-testing, including pain, inconvenience, morbidity, and unnecessary follow-up procedures and treatments,” commented lead investigator Katherine B. Roland, MPH, a behavioral scientist in CDC’s Division of Cancer Prevention and Control. “Appropriate use of cervical cancer screening technologies is essential, now more than ever, if HPV co-testing is to be considered a preventive service for women covered by insurance providers.”

Analyzing nationally representative data collected in 2006 through the CDC’s National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, researchers assessed HPV testing and co-testing practices and documented the recommendations for screening intervals given by private office-based providers and hospital outpatient departments (OPDs). The study included responses from 376 private office-based physicians and 216 physicians from hospitals and outpatient facilities.

Providers who ordered the HPV co-test were asked their recommendation for the next Papanicolaou test according to 3 clinical vignettes. The vignettes describe a woman between the ages of 30 and 60 years of age with a current normal Papanicolaou test with: 1) no current HPV test results and history of 2 consecutive normal Papanicolaou test results 2) a current negative HPV test result and a history of 2 consecutive normal Papanicolaou test results, and 3) a current negative HPV test result and no history of Papanicolaou tests. The guidelines support extending the screening interval up to 3 years in each of the vignettes described.

For vignette 1, 76.4% of office-based providers and 85.2% of hospital OPDs would recommend a next screening in 12 months. For vignette 2, 66.6% of office-based providers and 72.7% of hospital OPDs would recommend a next Papanicolaou test in 12 months. Only 14.0% of office-based providers would recommend a next Papanicolaou test in 3 years or more, as guidelines recommend. For vignette 3, 73.4% of office-based providers and 73.5% of hospital OPDs would recommend a next Papanicolaou test in 12 months.

Establishing a history of normal Papanicolaou test results with the patient appears to be a critical component to providers making guideline-supported screening interval recommendations.

Roland added, “Our findings suggest a need for continued surveillance on cervical cancer screening guideline adherence. Evaluating provider screening behaviors, whether they reflect national guidelines and policies, and how those behaviors and policies translate to women’s clinical preventive care are vital, especially in an area where science and policy are rapidly evolving.”

The article is “Human papillomavirus and Papanicolaou tests screening interval recommendations in the United States" by Katherine B. Roland, MPH; Ashwini Soman, MBBS, MPH; Vicki B. Benard, PhD; Mona Saraiya, MD, MPH (doi: 10.1016/j.ajog.2011.06.001). It will appear in the American Journal of Obstetrics & Gynecology, Volume 205, Issue 5 (November 2011) published by Elsevier.
 

# # #


Notes for Editors
Full text of the article is available to credentialed journalists upon request. Contact Francesca Costanzo at +1 215 239 3249orajogmedia@elsevier.com to obtain a copy. Journalists wishing to schedule interviews with the author should contact Anita Blankenship at +1 404 639 3286 or aob4@cdc.gov.

About the American Journal of Obstetrics & Gynecology
The American Journal of Obstetrics & Gynecology ( www.AJOG.org), known as “The Gray Journal,” presents coverage of the entire spectrum of the field, from the newest diagnostic procedures to leading-edge research. The Journal provides comprehensive coverage of the specialty, including maternal-fetal medicine, reproductive endocrinology/infertility, and gynecologic oncology. It also publishes the annual meeting papers of several of its 7 sponsoring societies, including the Society for Maternal-Fetal Medicine and the Society of Gynecologic Surgeons.

The American Journal of Obstetrics & Gynecology's 2010 Impact Factor is 3.313. It is ranked 8th out of 75 and continues to be ranked #1 in citations in the Obstetrics & Gynecology category, according to the latest Journal Citation Reports® 2011, published by Thomson Reuters. The Journal’s standard of excellence and continued success can be attributed to the strong leadership of Editors-in-Chief Thomas J. Garite, MD, and Moon H. Kim, MD, and their outstanding nationally and internationally recognized editorial board and reviewers. The journal has also been recognized as one of the 100 most influential journals in Biology & Medicine over the last 100 years, as determined by the BioMedical & Life Sciences Division of the Special Libraries Association (2009).

About Elsevier

Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Elsevier Research Intelligence, and ClinicalKey — and publishes nearly 2,200 journals, including The Lancet and Cell, and over 25,000 book titles, including a number of iconic reference works.

The company is part of Reed Elsevier Group PLC, a world leading provider of professional information solutions in the Science, Medical, Legal and Risk and Business sectors, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).

Media Contact
Francesca Costanzo
Marketing Manager
Elsevier
+1 215 239 3249
ajogmedia@elsevier.com