Differences among primary care physicians' adherence to 2009 ACOG guidelines for cervical cancer screening

Abstract

Background: In 2009, the American Congress of Obstetrics and Gynecology (ACOG) guidelines for cervical cancer screening changed significantly, to recommend less frequent screening than prior guidelines. The extent to which physicians in different specialties implemented these guidelines in the years following publication is unknown.

Methods: Cross-sectional survey completed by 316 physicians in internal medicine, family medicine, and gynecology. Survey items assessed respondents' cervical cancer screening practices in women of different ages and medical histories. We used descriptive statistics to generate response distribution for survey items, and logistic regression models to compare responses among specialties.

Results: Our response rate was 55% (316/575). Thirty-four percent of respondents' screening practices were inconsistent with ACOG guidelines for women under age 21, and 49% were inconsistent with guidelines for women over age 30. Internists (50%) were less likely than family medicine (89%, p<0.001) and gynecology (80%, p=0.02) physicians to delay pap testing until age 21. Internists (41%) were less likely than both family medicine (60%, p=0.009) and gynecology (68%, p=0.03) physicians to follow guidelines for women over age 30 (p=0.003). Overall 22% percent of physicians followed guidelines for women ages 21-29 years, with no significant differences between specialties. Differences remained significant in multivariable models.

Conclusions: Despite consensus among national organizations as to optimal regimens for cervical cancer screening, a significant proportion of providers, especially in internal medicine, do not adhere to ACOG's 2009 guidelines. The lack of comprehensive guideline implementation suggests that adherence to new 2012 guidelines, which advocate for less frequent screening, will likely be suboptimal and discrepant by specialty.