Provider beliefs in effectiveness and recommendations for primary HPV testing in 3 health-care systems

Abstract

In 2018, the US Preventive Services Task Force endorsed primary human papillomavirus testing (pHPV) for cervical cancer screening. We aimed to describe providers' beliefs about pHPV testing effectiveness and which screening approach they regularly recommend. We invited providers who performed 10 or more cervical cancer screens in 2019 in 3 healthcare systems that had not adopted pHPV testing: Kaiser Permanente Washington, Mass General Brigham, and Parkland Health; 53.7% (501/933) completed the survey between October and December 2020. Response distributions varied across modalities (P < .001), with cytology alone or cotesting being more often viewed as somewhat or very effective for 30- to 65-year-olds compared with pHPV (cytology alone 94.1%, cotesting 96.1%, pHPV 66.0%). In 21- to 29-year-olds, the pattern was similar (cytology alone 92.2%, 64.7% cotesting, 50.8% pHPV). Most providers were either incorrect or unsure of the guideline-recommended screening interval for pHPV. Educational efforts are needed about the relative effectiveness and recommended use of pHPV to promote guideline-concordant care.

Figure 1.

Distribution of provider beliefs on the effectiveness of the use of primary human papillomavirus (pHPV) testing, cytology alone, and cotesting on reducing lifetime risk of cervical cancer mortality by age and site. Providers who did not respond to this survey item for each age category were excluded (cytology alone, for patients 21-29 years old, n = 1 and for patients 30-65 years old, n = 0; cotesting, for patients 21-29 years old, n = 4 and for patients 30-65 years old, n = 4; and primary HPV testing, for patients 21-29 years old, n = 4 and for patients 30-65 years old, n = 4). The χ²P values at the lower right corner of each section compare provider responses across screening modalities (α = .05). KPWA = Kaiser Permanente Washington; MGB = Mass General Brigham; PH/UTSW = Parkland Health/University of Texas Southwestern Medical Center.

Figure 2.

Distribution of providers’ regular recommendation for cervical cancer screening by modality (primary human papillomavirus [pHPV] screening vs cytology-based screening), age, and site. (A) Approach regularly recommended by provider for cervical cancer screening using pHPV testing if it were to become available at their practice among those who indicated that this modality was not currently available (n = 375), with providers who did not respond to this survey item for each age category excluded (patients 21-29 years old, n = 4; 30-65 years old, n = 3). (B) Approach regularly recommended by provider for cervical cancer screening using cytology alone or cotesting, with providers who did not respond to this survey item for each age category excluded (patients 21-29 years old, n = 6; 30-65 years old, n = 6). The χ²P values at the lower right corner of each section compare provider responses across sites (α = .05). KPWA = Kaiser Permanente Washington; MGB = Mass General Brigham; PH/UTSW = Parkland Health/University of Texas Southwestern Medical Center.