In the Journals

Only half of physicians follow cervical cancer prevention guidelines

Less than one-third of obstetrician-gynecologists vaccinate eligible patients against HPV and only half follow the cervical cancer prevention guidelines that were published in 2009, according to recent survey findings published in the American Journal of Preventive Medicine.

“In the current survey and others, providers stated that the largest barrier to HPV vaccination was patients and parents declining to receive the vaccine,” Rebecca B. Perkins, MD, MSc, of the Boston University School of Medicine, said in a press release. “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.”

The survey-based study included 366 obstetrician-gynecologists from the American Congress of Obstetricians and Gynecologists. Surveys evaluated sociodemographic characteristics, clinical practices and perceived barriers to HPV vaccination and cervical cancer screening.

Researchers found that 92% of participants offered the HPV vaccine but only 27% estimated that most eligible patients (≥60%) started the vaccine series. Participants reported that parent and patient refusals were common barriers to HPV vaccination.

Fifty-seven percent of participants reported starting Pap testing in patients who were aged 21 years and 45% reported discontinuing screening in those aged 70 years at low risk. Sixty-one percent reported discontinuation of Pap testing after a hysterectomy. Participants also reported that they continued to recommend annual Pap testing (74% for patients aged 21 to 29 years and 53% for patients aged at least 30 years).

“Our survey, which was conducted prior to the new 2012 guidelines, reveals limited implementation of HPV vaccination and cervical cancer screening guidelines 6 and 3 years, respectively, after these guidelines were published,” Perkins said. “It may portend very slow uptake of these guidelines unless efforts are made to hasten implementation. In the light of persistently low HPV vaccination rates, and new guidelines recommending Pap and HPV co-testing at 5-year intervals, programs to educate physicians and patients on the evidence behind universal HPV vaccination, and extended-interval cervical cancer screening with Pap and HPV co-testing could help improve the quality of cervical cancer prevention.”

In an accompanying commentary, Russell Harris, MD, MPH, and Stacey Sheridan, MD, MPH, both with the University of North Carolina Cecil G. Sheps Center for Health Services Research, said the US Preventive Services Task Force and other professional and advocacy groups continue to recommend less screening for breast, colorectal, prostate and cervical cancer. “The new message boils down to this: Screening is not the unqualified good that we have advertised it to be,” they wrote. “It has clear potential harms as well as benefits, and these must be carefully weighed before a rational decision about screening can be made. Sometimes screening does more good than harm, but at other times it does more harm than good.”

For more information:

Harris R. Am J Prev Med. 2013;doi:10.1016/j.amepre.2013.05.002.

Perkins RB. Am J Prev Med. 2013;doi:10.1016/j.amepre.2013.03.019.

Disclosure: The study was funded in part by DHHS, Health Resources and Services Administration, Maternal and Health Research Program and by an American Cancer Society Mentored Research Scholar Grant.

Less than one-third of obstetrician-gynecologists vaccinate eligible patients against HPV and only half follow the cervical cancer prevention guidelines that were published in 2009, according to recent survey findings published in the American Journal of Preventive Medicine.

“In the current survey and others, providers stated that the largest barrier to HPV vaccination was patients and parents declining to receive the vaccine,” Rebecca B. Perkins, MD, MSc, of the Boston University School of Medicine, said in a press release. “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.”

The survey-based study included 366 obstetrician-gynecologists from the American Congress of Obstetricians and Gynecologists. Surveys evaluated sociodemographic characteristics, clinical practices and perceived barriers to HPV vaccination and cervical cancer screening.

Researchers found that 92% of participants offered the HPV vaccine but only 27% estimated that most eligible patients (≥60%) started the vaccine series. Participants reported that parent and patient refusals were common barriers to HPV vaccination.

Fifty-seven percent of participants reported starting Pap testing in patients who were aged 21 years and 45% reported discontinuing screening in those aged 70 years at low risk. Sixty-one percent reported discontinuation of Pap testing after a hysterectomy. Participants also reported that they continued to recommend annual Pap testing (74% for patients aged 21 to 29 years and 53% for patients aged at least 30 years).

“Our survey, which was conducted prior to the new 2012 guidelines, reveals limited implementation of HPV vaccination and cervical cancer screening guidelines 6 and 3 years, respectively, after these guidelines were published,” Perkins said. “It may portend very slow uptake of these guidelines unless efforts are made to hasten implementation. In the light of persistently low HPV vaccination rates, and new guidelines recommending Pap and HPV co-testing at 5-year intervals, programs to educate physicians and patients on the evidence behind universal HPV vaccination, and extended-interval cervical cancer screening with Pap and HPV co-testing could help improve the quality of cervical cancer prevention.”

In an accompanying commentary, Russell Harris, MD, MPH, and Stacey Sheridan, MD, MPH, both with the University of North Carolina Cecil G. Sheps Center for Health Services Research, said the US Preventive Services Task Force and other professional and advocacy groups continue to recommend less screening for breast, colorectal, prostate and cervical cancer. “The new message boils down to this: Screening is not the unqualified good that we have advertised it to be,” they wrote. “It has clear potential harms as well as benefits, and these must be carefully weighed before a rational decision about screening can be made. Sometimes screening does more good than harm, but at other times it does more harm than good.”

For more information:

Harris R. Am J Prev Med. 2013;doi:10.1016/j.amepre.2013.05.002.

Perkins RB. Am J Prev Med. 2013;doi:10.1016/j.amepre.2013.03.019.

Disclosure: The study was funded in part by DHHS, Health Resources and Services Administration, Maternal and Health Research Program and by an American Cancer Society Mentored Research Scholar Grant.