Primary Care Physicians' Adherence to Expert Recommendations for Cervical Cancer Screening and Prevention in the Context of Human Papillomavirus Vaccination.
Teri L Malo, Rebecca B Perkins, Ji-Hyun Lee, Susan T Vadaparampil
Author Information
Teri L Malo: From the *Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; †Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA; ‡Department of Internal Medicine, School of Medicine, University of New Mexico Cancer Center, Albuquerque, NM; § Health Outcomes and Behavior Program, ¶Center for Infection Research in Cancer, Moffitt Cancer Center; and ∥Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, FL.
BACKGROUND: Expert recommendations do not recommend using Papanicolaou (Pap) or Human Papillomavirus (HPV) test results to determine whether unvaccinated women should receive HPV vaccine, nor do they recommend using vaccine receipt to inform Cervical Cancer screening practices. This study characterizes physicians' HPV vaccine recommendations and practices in the context of HPV and Pap testing. METHODS: We surveyed family physicians and obstetrician-gynecologists randomly selected from the American Medical Association Masterfile in 2011 (n = 574). Physicians used a 5-point scale (never to always) to report the frequency of (1) using HPV testing results to decide whether to recommend HPV vaccine, and (2) recommending HPV vaccination to women (≤26 years) who had an abnormal Pap test. Physicians also reported (3) intention to change Pap screening frequency for vaccinated women. RESULTS: Across both specialties, 80% correctly reported rarely or never using HPV testing results to guide vaccine recommendations; 66% often or always recommended vaccination to patients with an abnormal Pap result; and 77% did not plan to change Pap screening frequency for vaccinated women. About 41% reported recommendation-consistent practices with all 3 measures. In multivariable analysis, obstetrician-gynecologist specialty and private practice type were associated with higher average overall adherence to recommendations. CONCLUSIONS: Contrary to expert recommendations, a considerable minority of physicians reported recommending HPV vaccination based on HPV and Pap test results. If these clinical practices persist, many young adult women will not realize the benefits of HPV vaccination. Additional efforts are needed to ensure all young women are screened and vaccinated appropriately.
References
JAMA. 1999 Oct 20;282(15):1458-65
[PMID: 10535437]
