Cervical cancer screening intervals, 2006 to 2009: moving beyond annual testing

Abstract

Background:: Cervical cancer screening guidelines have endorsed less than-annual testing of women aged 30 and older with normal test results for many years. For example, they recommend that women with no evidence of infection with oncogenic human papillomavirus (HPV) and a concurrent normal Pap test (known as co-testing) be re-tested no sooner than 3 years later. Little is known about clinicians’ adherence to this recommendation over time.

Methods:: Cross-sectional, nationally representative data from the 2006, 2007, 2008 and 2009 Cervical Cancer Screening Supplement (CCSS) to the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to assess primary care providers’ recommendations for the next Pap test for women aged 30–60 years using 5 clinical vignettes. We compared responses to the vignettes with guidelines to estimate guideline adherence. We also compared potential differences in adherence over the 4-year period. Data analysis included 566 providers in 2006, 387 in 2007, 578 in 2008 and 547 in 2009.

Results:: Guideline adherence was low in all vignettes. After a normal HPV test and a normal cytology result, adherence was 12.4% in 2006 but improved to 26.6 % in 2009 (p<0.05); The vast majority of respondents suggested Pap tests sooner than recommended by guidelines. Over the 4-year period, adherence was highest in vignettes in which more vigilant screening was recommended.

Conclusions:: Most providers continued to recommend testing sooner than recommended in women with normal tests, although small improvements were noted over the 4-year period. Qualitative research might be useful in understanding these behaviors such that strategies that improve guideline adherence can be identified and implemented.