Study Reveals Resistance to Change in Cervical Cancer Screenings

The majority of women are willing to undergo less frequent cervical cancer screening, consistent with screening guidelines, if it was recommended by their health care provider, according to a study published in the February special issue of Preventive Medicine, dedicated to analyzing the shift from cytology to human papillomavirus (HPV) testing for cervical cancer screening. However, a sizeable minority expresses resistance to longer screening intervals and/or new detection methods, including HPV testing, instead of the traditional Papanicolaou (Pap) test.

In 2012, multiple professional organizations, including the American Cancer Society, the U.S. Preventive Services Task Force, and the American College of Obstetricians and Gynecologists, published updated guidelines for cervical cancer screening that discourage annual testing and screening of low-risk populations (e.g., women below age 21 or above age 65). Cytology is now recommended every three years for women aged 21 to 29 years and cytology every 3 years or HPV co-testing every five years is recommended for women aged 30 to 65 years. (For recent changes to clinical guidelines that impact laboratory testing, see “Guidelines at a Glance” in the March 2017 issue of Diagnostic Testing & Emerging Technologies.) However, the authors of the Preventive Medicine study say that patients’ comfort with the guidelines could affect successful adoption.

The researchers conducted an online survey using a national sample of 376 U.S. women aged 21 to 65 years. The survey assessed sociodemographic characteristics, cervical cancer knowledge, health history (including sexual history), and views on the 2012 cervical cancer screening guidelines following a brief educational summary of the screening recommendations.

More than half of those surveyed (57 percent) report having their last Pap test within the past year and almost 30 percent reported having an abnormal Pap test. Nearly three-quarters of respondents (73 percent) were not aware of the change in cervical cancer screening guidelines. Yet, over two thirds (n = 239) were willing to have a Pap test at longer intervals (every three to five years), if it was recommended by their health care provider. One in five, though, said they would not agree to less frequent screening, even if recommended by their provider. Uncertainty about the longer screening interval appears to stem from concern about developing cancer between screenings, the authors say. Additionally, 45 percent of respondents either opposed or were unsure if they would be comfortable replacing Pap testing with primary HPV testing.

“It is possible that healthcare providers are contributing to patients’ hesitancy around less frequent screening,” write the authors led by Mary Gerend, Ph.D., from Northwestern University in Chicago. “Recent data indicate that many providers continue to conduct Pap tests annually and only about half initiate and discontinue screening at guideline-appropriate ages.”

The authors say their findings can help inform methods to educate patients, and possibly providers, on the screening guidelines and may ultimately cut overscreening and improve guideline adherence.