Primary care provider practices and beliefs related to cervical cancer screening with the HPV test in Federally Qualified Health Centers

Abstract

Objective: Cervical cancer screening using the human papillomavirus (HPV) test and Pap test together (co-testing) is an option for average-risk women ≥ 30 years of age. With normal co-test results, screening intervals can be extended. The study objective is to assess primary care provider practices, beliefs, facilitators and barriers to using the co-test and extending screening intervals among low-income women.

Method: Data were collected from 98 providers in 15 Federally Qualified Health Center (FQHC) clinics in Illinois between August 2009 and March 2010 using a cross-sectional survey.

Results: 39% of providers reported using the co-test, and 25% would recommend a three-year screening interval for women with normal co-test results. Providers perceived greater encouragement for co-testing than for extending screening intervals with a normal co-test result. Barriers to extending screening intervals included concerns about patients not returning annually for other screening tests (77%), patient concerns about missing cancer (62%), and liability (52%).

Conclusion: Among FQHC providers in Illinois, few administered the co-test for screening and recommended appropriate intervals, possibly due to concerns over loss to follow-up and liability. Education regarding harms of too-frequent screening and false positives may be necessary to balance barriers to extending screening intervals.

Keywords: Cervical cancer screening; HPV testing; Screening guidelines.

Fig. 1

Primary care provider recommended screening intervals based on the co-test result for a woman 35 years of age (n = 97), 2009–2010. (Study was conducted in 15 Federally Qualified Health Center clinics in Illinois, USA, 2009–2010). HPV = human papillomavirus.

Fig. 2

Primary care provider beliefs about extending the screening interval to 3 years for a woman ≥30 years of age with a normal co-test result, 2009–2010. (Study was conducted in 15 Federally Qualified Health Center clinics in Illinois, USA, 2009–2010). Total n for each measure: beneficial-harmful n = 94; easy-difficult n = 95; good-bad n = 95. Survey questions: Deciding to extend the cervical cancer screening interval to 3 or more years because a woman ≥30 years of age had received a normal Pap result and negative HPV test would be… 1) good versus bad; 2) easy versus difficult; and 3) beneficial versus harmful.

Fig. 3

Factors considered important to primary care providers when deciding to extend the screening interval for a women ≥30 years of age¹ (n = 97), 2009–2010. (Study was conducted in 15 Federally Qualified Health Center clinics in Illinois, USA, 2009–2010). ¹No distinction made as to whether the Pap test or the HPV and Pap test (co-test) would be used to screen.

Fig. 4

Primary care provider perceived risks and benefits to extending the screening interval for a 30 year old woman with a normal co-test result, 2009–2010. (Study was conducted in 15 Federally Qualified Health Center clinics in Illinois, USA, 2009–2010). The total n for all measures = 97, except for “help reduce healthcare costs”, and “increase patient concerns about missing cervical cancer” where n = 96.